Cystic versus predominantly cystic thyroid nodules: efficacy of ethanol ablation and analysis of related factors

Kim, Young Joong; Baek, Jung Hwan; Ha, Eun Ju; Lim, Hyun; Lee, Jeong Hyun; Sung, Jin Young; Kim, Tae Yong; Kim, Won; Shong, Young Kee

doi:10.1007/s00330-012-2406-5

Cited by 108 publications

(125 citation statements)

References 31 publications

(72 reference statements)

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“…Most patients report mild, temporary pain at the site of injection, radiating into the neck, chin and ears, due to leakage of a little ethanol into the subcutaneous tissues. In different studies, the pain was reported in 2.5% to 30% or, in large cysts, even 70% of patients 14,18,21 . Occasionally, temporary vocal fold paralysis and dysphonia or, rarely, transient thyrotoxicosis may occur 22 .…”

Section: Discussionmentioning

confidence: 96%

“…Moreover, when using the less frequent ethanol aspiration approach, the ethanol is left in the cavity for 2 to 10 min 8,14,17 . The amounts of ethanol administered during PEI procedures ranged from 36% to 100% of the initial cyst volume in various studies, such as those by Bennedbaek 5,8,14,15,[18][19][20] ). Although most authors do not recommend to administer a single dose of more than 10 mL of ethanol, Kim DW et al injected amounts equal to 100% of the volume of cysts smaller than 20 mL, that is, up to 20 mL of absolute ethanol and, in one case of an extremely large 135-mL cyst, even as much as 30 mL of ethanol 14 .…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound-guided percutaneous ethanol injection of small and medium-sized thyroid cysts with relatively small amounts of ethanol

2015

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Background. Ultrasound-guided percutaneous ethanol injection (US-guided PEI) is used in patients with recurring symptomatic thyroid cysts in whom simple drainage was not successful. It is an alternative non-surgical approach in patients refusing or at risk during surgery. Methods and Results. US-guided PEI was performed in 33 patients, with a success rate of 100% and significantly decreased cyst volume after 1, 3 and 6 months after the last PEI compared with the initial volume. The mean number of PEI procedures was 1.5±0.7 with a mean 96% ethanol volume of 2.4±1.2 mL. In the entire group, the initial cyst volume was significantly reduced to the final volume at 6 months after PEI (10.82±5.03 mL vs. 0.78±0.84 mL; P<0.001). Also in all patients, mean volume reduction rates were significantly increased (P<0.001) at check-ups at 1 month (83.1±8.1%), 3 months (89.9±6.3%) and 6 months (92.6±6.4%). In case of medium-sized cysts, more PEI procedures were needed than in small cysts (1.1±0.4 vs. 2.0±0.5). The total amount of 96% ethanol was equal to 22.7±7.9% of the initial cyst volume. Conclusion. Our experiences confirm that small and medium-sized cysts may be successfully treated with relatively small amounts of ethanol. In case of medium-sized cysts, more PEI procedures were needed. Final reduction of complex cysts was achieved later. Apart from temporary localized pain, no serious complications were observed in most cases.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided percutaneous ethanol injection of small and medium-sized thyroid cysts with relatively small amounts of ethanol

2015

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“…After skin sterilization and anesthesia with 2% lidocaine at the puncture site, a 16-or 18-ga needle was inserted into the cystic portion of the thyroid nodules through the isthmic area (this is the so-called transisthmic approach) to prevent leakage of fluid or ethanol. 6,18,25 After the needle tip was placed into the cystic portion, as much of the internal fluid as possible was aspirated. If active bleeding was detected during the aspiration of the internal fluid, the aspiration was stopped and 99% ethanol was injected slowly into the cystic space to control the bleeding (On-line Video).…”

Section: Methodsmentioning

confidence: 99%

“…After 2 minutes of ethanol retention, as much of the injected ethanol as possible was removed. 18 After real-time US confirmed that the bleeding had stopped, RF ablation was initiated. On the basis of previous experience, the RF ablation was performed by using a transisthmic approach and the moving-shot technique.…”

Section: Methodsmentioning

confidence: 99%

“…14,15 EA has been used as a first-line treatment for cystic thyroid nodules 6,16 ; however EA as a first-line treatment is debatable for predominantly cystic thyroid nodules 15,17,18 because the recurrence rate is Ͼ50% in these nodules with solid components of Ͼ20%. When treating predominantly cystic nodules by thermal ablation, it is recommended that the internal fluid content be aspirated before RF or laser ablation 6,19 because it is easier to treat decompressed small nodules than larger ones.…”

mentioning

confidence: 99%

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Combination Therapy Consisting of Ethanol and Radiofrequency Ablation for Predominantly Cystic Thyroid Nodules

Yoon

Baek

Lee

et al. 2013

AJNR Am J Neuroradiol

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SUMMARY:Predominantly cystic thyroid nodules are often aspirated before radiofrequency ablation to enhance its efficacy; however internal bleeding during the aspiration is a problem. We evaluated the feasibility and safety of ethanol ablation to control internal bleeding that occurred during preparatory aspiration. Between September 2010 and August 2011, 11 of 40 predominantly cystic nodules bled internally during fluid aspiration before radiofrequency ablation. To control the bleeding, 99% ethanol was injected. The efficacy of ethanol in controlling bleeding, final nodule volume and complications were assessed. Control of the bleeding by ethanol ablation and subsequent radiofrequency ablation was feasible in all patients. Ninety-one percent (10/11) could be treated in 1 session. The mean nodule volume dropped from 17.1 to 4.3 mL (P Ͻ .018). There were no major complications. Ethanol ablation and radiofrequency ablation combination therapy is a feasible and safe technique for treating predominantly cystic thyroid nodules that exhibit internal bleeding during preparatory aspiration. ABBREVIATIONS:EA ϭ ethanol ablation; RF ϭ radio-frequency; US ϭ ultrasound

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Image‐guided chemical and thermal ablations for thyroid disease: Review of efficacy and complications

et al. 2018

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Image-guided ablation of thyroid disease is increasingly being commonly reported. Techniques including ethanol injection and thermal ablation using radio-frequency, laser, and microwave devices have been described. Minimally invasive approaches to the management of benign cystic, solid, and functional thyroid nodules as well as both primary and recurrent thyroid malignancy have been reported. The purpose of this article is to review the current evidence relating to image-guided ablation of thyroid disease with a focus on clinical outcomes and complication rates for patients treated with this minimally invasive approach.

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Cystic versus predominantly cystic thyroid nodules: efficacy of ethanol ablation and analysis of related factors

Abstract: • Ethanol ablation under ultrasound guidance is increasingly used for cystic thyroid nodules. • EA seems effective for cystic and predominantly cystic nodules, especially cystic nodules. • The effectiveness of EA was reduced in large or vascular predominantly cystic nodules.

Cited by 108 publications

References 31 publications

Ultrasound-guided percutaneous ethanol injection of small and medium-sized thyroid cysts with relatively small amounts of ethanol

Ultrasound-guided percutaneous ethanol injection of small and medium-sized thyroid cysts with relatively small amounts of ethanol

Combination Therapy Consisting of Ethanol and Radiofrequency Ablation for Predominantly Cystic Thyroid Nodules

Image‐guided chemical and thermal ablations for thyroid disease: Review of efficacy and complications

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