Effectiveness of Percutaneous Ethanol Injection Therapy in Benign Nodular and Cystic Thyroid Diseases: Long-term Follow-up Experience

Abstract

Abstract. This study was designed to clarify the long-term efficacy and safety of percutaneous ethanol injection (PEI) therapy in benign nodular and cystic thyroid diseases, and to evaluate response by criteria defined as disappearance of hot nodule. Solid nodule and complex cyst were classified into three groups in accordance with volume reduction. In autonomously functioning thyroid nodule (AFTN), disappearance of hot nodule with normalization of thyroid hormone level and restored extra-nodular uptake was defined to be curative. In solid nodule (n = 198) and complex cyst (n = 432), initial volume was significantly reduced to post-PEI and final volumes, and volume reduction persisted during follow-up period. Complete response, partial response and no response were as follows: 17.2%, 71.7%, 11.1% in solid nodule; 19.0%, 60.4%, 20.6% in complex cyst, respectively. Differences of volume reduction according to initial volume (³10 mL vs. <10 mL) were significant. Correlations between initial and final volumes, and between initial volume and volume reduction were also significant. In 24 patients with AFTN, when effectiveness was assessed by disappearance of hot nodule, only 1 case was curative. Reexpansion or recurrence was observed in 5 cases. Complications developed in 9.0% but there was no permanent or serious complication in this study. In conclusion, our data suggest that PEI therapy could be an effective and safe therapeutic modality for benign nodular and cystic thyroid diseases especially when initial volume is more than 10 mL, but may not induce disappearance of hot nodule itself in AFTN.

Percutaneous ethanol injection versus conservative treatment for benign cystic and mixed thyroid nodules

“…This suggests that the ethanol is continuously absorbed by the solid part of the nodule, resulting in a progressive volume reduction. Another study (11) evaluating the decrease in nodular size with time showed that the reduction at long term is similar in different types of nodules, confirming that solid nod ules do not respond as fast as cystic ones to the scleros ing effect of the ethanol.…”

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

“…Occasionally, temporary vocal fold paralysis and dysphonia or, rarely, transient thyrotoxicosis may occur 22 . In the largest set of 432 complex cysts, Lee and Ahn reported transient localized pain in 32 (7.9%) and temporary vocal fold paralysis in only 3 (0.7%) patients 10 . Apart from short-term localized pain, no other complications were noted in our study.…”

“…During regular check-ups, the decrease in cyst volume was measured using the volume reduction rate (VRR) calculated as follows: initial cyst volume -final cyst volume / initial cyst volume × 100 = result % (ref. 10 ). The VRR was calculated at 1, 3 and 6 months after the last PEI.…”

Efficacy and Safety of Ethanol Ablation for Thyroglossal Duct Cysts

“…[8][9][10][11][12] While most previous studies focused on thyroid cysts, only a few cases of TGDC have been reported. 13,14 Our thyroid team has applied EA to thyroid cysts and TGDC for several years.…”