Efficacy of ethanol ablation as a treatment of benign head and neck cystic lesions

Lee, Esther; Park, Isabel; Elzomor, Amir; Li, Lilun; Lloyd, Ashley M.; Benito, Daniel A.; Goodman, Joseph; Thakkar, Punam; Joshi, Arjun S.

doi:10.1016/j.amjoto.2021.103082

Cited by 5 publications

(8 citation statements)

References 25 publications

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“…EA is an office-based, minimally invasive technique that has been used to treat various benign cystic lesions, such as cystic thyroid nodules and branchial cleft cysts. Its feasibility has been well-documented in numerous previous studies [12,[17][18][19]. In the present study on TGDCs, the EA procedures were successfully completed in a median time of 9 minutes, without the need for anesthesia or hospitalization.…”

supporting

confidence: 59%

“…With respect to the specific EA technique, two major issues related to this study require clarification: (1) the volume of ethanol injection and (2) the retention or aspiration of the injected ethanol at the conclusion of EA. A literature review of seven studies on EA for TGDC published since 2010 revealed that five studies referenced 50% or more of the aspirate volume as the minimum limit for ethanol injection (up to 15 mL of ethanol) [7][8][9][10]16,19,22]. However, in the current study, a relatively small volume of ethanol was used (≤2.5 mL).…”

mentioning

confidence: 78%

“…This suggests that EA with low-dose ethanol is effective regardless of the initial cyst volume and aspirate properties [23]. Second, the present study employed the retention method; this contrasts with several studies that used the aspiration method, which involves the aspiration of injected ethanol at the end of the EA procedure after a retention time of 5-10 minutes [7][8][9][10]16,19,22]. In fact, although no consensus exists on whether ethanol should be fully aspirated after instillation, these authors presumed that retention of the injected ethanol may be associated with better treatment outcomes, as the duration of the chemical reaction is longer than with the aspiration method [13,14].…”

mentioning

confidence: 87%

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Ultrasound-guided ethanol ablation versus the Sistrunk operation as a primary treatment for thyroglossal duct cysts

Ahn,

Kwak,

Lee

et al. 2024

Ultrasonography

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Purpose: This study compared ethanol ablation (EA) with the Sistrunk operation (SO) with regard to feasibility, treatment efficacy, and cost-effectiveness. The goal was to evaluate whether EA could replace SO as a primary treatment modality for thyroglossal duct cysts (TGDCs).Methods: This retrospective case-control study included patients with TGDCs who were treated with either EA or SO between 2016 and 2022. The primary outcome variables evaluated were treatment efficacy (as measured by the volume reduction rate [VRR] and treatment success rate), complications, and cost-effectiveness.Results: A total of 72 patients were enrolled, with 33 in the EA group and 39 in the SO group. The procedure or operation times for the EA and SO groups were 9 and 82 minutes, respectively (P<0.001). At the final follow-up appointment, the VRR was 94.1% for the EA group and 100.0% for the SO group (P<0.001). Treatment success was achieved for 32 patients (97.0%) in the EA group and for all 39 patients (100.0%) in the SO group (P=0.458). The overall complication rates were 0.0% and 17.9% in the EA and SO groups, respectively (P=0.013). The total costs, including all treatment procedures and follow-up ultrasound examinations, were $485 and $1,081.7 for the EA and SO groups, respectively (P<0.001).Conclusion: EA demonstrates superiority over SO in terms of feasibility, safety, and costeffectiveness, while maintaining comparable treatment efficacy. Despite the need for multiple treatment sessions in approximately one-quarter of patients, EA can serve as a primary treatment modality for selected patients with TGDCs, supplanting SO.

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supporting

confidence: 59%

mentioning

confidence: 78%

mentioning

confidence: 87%

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Ultrasound-guided ethanol ablation versus the Sistrunk operation as a primary treatment for thyroglossal duct cysts

Ahn,

Kwak,

Lee

et al. 2024

Ultrasonography

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“…One other series of 8 patients was published in 2021. Mean index cyst volume was 10.6 mL, and mean VRR at 3 months follow-up was 74.4%, although these figures include other benign head and neck cystic lesions besides TGDC (n = 25) [ 9 ]. To our knowledge, no other reports exist of EA for TGDC exist on patients in the United States.…”

Section: Discussionmentioning

confidence: 99%

Ethanol Ablation of a Thyroglossal Duct Cyst and Review of the Literature

2023

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Ultrasound-guided ethanol ablation (EA) is a less invasive alternative to surgical resection for the management of thyroglossal duct cysts (TGDCs). However, to date, EA is rarely used in the United States to treat TGDCs. We present a case of TGDC successfully treated with EA in the United States. A 66-year-old man presented with a mobile anterior neck mass. Neck ultrasonography revealed a complex cystic mass in the midline directly anterior to the trachea, measuring 52 × 41 × 50 mm. Fine needle aspiration revealed no malignant cells, and pathology was consistent with TGDC. The patient had no contraindications to surgical resection. The patient's pretreatment symptom score was 7 and cosmetic score was 3. One month after EA, volume reduction ratio was 40%, symptom score was 1, and cosmetic score was 3. Four months after EA, the TGDC was resolved without need for an additional procedure. The volume reduction ratio was 96.8%, and symptom score and cosmetic score were both 1. In summary, EA is a viable alternative to surgical resection, even in patients who are surgical candidates. EA is attractive due to its simplicity, cost effectiveness, and tolerable side effect profile. Further studies are needed to evaluate long-term safety and efficacy, particularly in United States patients.

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“…The treatment efficacy after EA is usually assessed using two parameters, that is, VRR and TSR. The VRR is an objective value of the volume decrease in TGDC calculated by the following formula: (initial volume − final volume)/initial volume × 100%; the TSR is a semi-objective value defined by physicians based on the VRR, and 50% or 70% of the VRR was commonly used as cutoff values for TSR in previous studies [7,[13][14][15][16]18,19].…”

Section: Treatment Efficacymentioning

confidence: 99%

Ultrasound-Guided Ethanol Ablation for Thyroglossal Duct Cyst: A Review of Technical Issues and Potential as a New Standard Treatment

Ahn

2023

JCM

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The thyroglossal duct cyst (TGDC) is the most common congenital neck mass, accounting for 70–75% of all congenital neck masses. Although the Sistrunk operation has been used as a standard of treatment, it is accompanied by a considerable surgical burden, including the need for general anesthesia, a visible surgical scar on the neck surface, and postoperative complications. Ultrasound-guided ethanol ablation (US-EA) is a minimally invasive and office-based technique that is widely used as a non-surgical treatment for several benign cystic lesions, particularly benign thyroid cysts. Recently, US-EA has also been gaining popularity as a good alternative for TGDC treatment, which is associated with high feasibility, a high safety profile, and favorable treatment outcomes. To our best knowledge, seven studies on the use of EA as a primary treatment option for TGDC have been published since 2011. Although these studies have reported promising results, there is a lack of consensus on several issues regarding the application of EA for TGDC, particularly its detailed techniques and role as a primary treatment. This article aims to provide a comprehensive review of EA for TGDC, addressing technical issues and its possible role as a new standard of treatment for TGDC.

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Efficacy of ethanol ablation as a treatment of benign head and neck cystic lesions

Cited by 5 publications

References 25 publications

Ultrasound-guided ethanol ablation versus the Sistrunk operation as a primary treatment for thyroglossal duct cysts

Ultrasound-guided ethanol ablation versus the Sistrunk operation as a primary treatment for thyroglossal duct cysts

Ethanol Ablation of a Thyroglossal Duct Cyst and Review of the Literature

Ultrasound-Guided Ethanol Ablation for Thyroglossal Duct Cyst: A Review of Technical Issues and Potential as a New Standard Treatment

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