Ethanol ablation for the treatment of benign thyroid nodules

Steinl, Gabrielle K.; Stewart, Latoya A.; McManus, Catherine; Lee, James A.; Kuo, Jennifer H.

doi:10.1016/j.amjsurg.2022.01.029

Cited by 4 publications

(6 citation statements)

References 16 publications

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“…The majority of cystic and partially cystic lesions are asymptomatic so that the treatment is unnecessary. [59][60][61][62] Nonetheless, some of them are likely to represent a palpable mass with cosmetic problems or other complaints. To solve these latter issues, the well-established, non-surgical treatment includes a simple aspiration to reduce/eliminate the cystic lesion and/or ethanol ablation.…”

Section: Management Of Cystic Lesionsmentioning

confidence: 99%

“…The majority of cystic and partially cystic lesions are asymptomatic so that the treatment is unnecessary 59–62. Nonetheless, some of them are likely to represent a palpable mass with cosmetic problems or other complaints.…”

Section: Management Of Cystic Lesionsmentioning

confidence: 99%

“…Nonetheless, some of them are likely to represent a palpable mass with cosmetic problems or other complaints. To solve these latter issues, the well-established, non-surgical treatment includes a simple aspiration to reduce/eliminate the cystic lesion and/or ethanol ablation 59–62. The former is usually the first option for the treatment of a cystic lesion, leading to both a diagnosis and a reduction of the cystic volume.…”

Section: Management Of Cystic Lesionsmentioning

confidence: 99%

“…To solve these latter issues, the well-established, non-surgical treatment includes a simple aspiration to reduce/eliminate the cystic lesion and/or ethanol ablation. [59][60][61][62] The former is usually the first option for the treatment of a cystic lesion, leading to both a diagnosis and a reduction of the cystic volume. However, several cases have recurrences after aspiration (from 50% to 80% of them), or if they show a stronger viscosity difficultly aspirated with needles, USguided ethanol ablation has been recommended and it is associated with good yields ranging from 68% to 97% (58)(59)(60)(61).…”

Section: Management Of Cystic Lesionsmentioning

confidence: 99%

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Approach to FNA of Thyroid Gland Cysts

Rossi¹,

Tralongo²,

Fiorentino³

et al. 2022

Advances in Anatomic Pathology

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Fine needle aspiration is a well-known procedure for the diagnosis and management of thyroid lesions, representing the first diagnostic tool for the definition of their nature. In clinical practice, a thyroid nodule can be classified as solid, cystic, and partially cystic based on its internal components. Different thyroid imaging reporting systems and cytologic diagnostic systems have focused their attention on solid nodules, which are more frequently linked with a malignant outcome. In fact, numerous papers demonstrated that nodules with microcalcifications, a taller-than-wide shape, hypoechogeneity, and irregular margins, are more likely to be malignant on histology. Nevertheless, according to the literature, the risk of malignancy in a partially cystic thyroid nodule ranges between 3.3 and 17-5%, including, for instance, the possible diagnosis of a cystic papillary thyroid carcinoma and other malignant entities. Therefore, in the current review article, we are going to discuss the approach to thyroid cystic lesions on fine needle aspiration cytology.

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Section: Management Of Cystic Lesionsmentioning

confidence: 99%

Section: Management Of Cystic Lesionsmentioning

confidence: 99%

Section: Management Of Cystic Lesionsmentioning

confidence: 99%

Section: Management Of Cystic Lesionsmentioning

confidence: 99%

See 2 more Smart Citations

Approach to FNA of Thyroid Gland Cysts

Rossi¹,

Tralongo²,

Fiorentino³

et al. 2022

Advances in Anatomic Pathology

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“…Based on prior experience with hepatocellular and parathyroid carcinomas, ethanol ablation was first used to treat benign cysts in 1985 ( 27 ) and to treat AFTN in 1990 ( 28 ). Ultrasound-guided PEI has since become a mainstay of treatment for benign cystic thyroid nodules ( 8 , 24 ) and has been reported to produce VRRs as high as 90% in functional nodules and 100% in cystic nodules ( 29 , 30 ). PEI is thought to induce ablation by a combination of coagulative necrosis via dehydration and ischemic necrosis by means of endothelial injury and thrombosis ( 31 , 32 ).…”

Section: Introductionmentioning

confidence: 99%

A clinical practice review of percutaneous ethanol injection for thyroid nodules: state of the art for benign, cystic lesions

Clark,

Luo,

Issa

et al. 2024

Gland Surg

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Percutaneous ethanol injection (PEI) is a widely used treatment option for cystic and predominantly cystic thyroid nodules. It has several advantages over other treatment modalities. Compared to surgery, PEI is less painful, can be performed in the outpatient setting, and carries less risk of transient or permanent side effects. Compared to other minimally invasive techniques such as radiofrequency ablation (RFA), PEI is less expensive and does not require specialized equipment. PEI performs well in the context of cystic nodules. PEI does not perform as well as other techniques in solid nodules, so its use as a primary treatment is limited to cystic and predominantly cystic thyroid nodules. However, PEI is also being explored as an adjunct treatment to improve ablation of solid nodules with other techniques. Here, we provide a clinical review discussing the genesis, mechanism of action, and patient selection with respect to ethanol ablation, as well as the procedure itself. Predictors of operative success, failure, and common adverse events are also summarized. Altogether, PEI allows impressive volume reduction rates with minimal complications. Several recent studies have also evaluated the long-term impact of PEI up to 10 years after treatment and revealed maintenance of robust treatment efficacy with no undesirable long-term sequelae. Thus, PEI remains the treatment of choice for benign but symptomatic cystic and predominantly cystic thyroid nodules.

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General Principles for the Safe Performance, Training, and Adoption of Ablation Techniques for Benign Thyroid Nodules: An American Thyroid Association Statement

Sinclair,

Baek,

Hands

et al. 2023

Thyroid®

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Background: The primary goal of this interdisciplinary consensus statement is to provide a framework for the safe adoption and implementation of ablation technologies for benign thyroid nodules. Summary: This consensus statement is organized around three key themes: (1) safety of ablation techniques and their implementation, (2) optimal skillset criteria for proceduralists performing ablative procedures, and (3) defining expectations of success for this treatment option given its unique risks and benefits. Ablation safety considerations in pre-procedural, peri-procedural, and post-procedural settings are discussed, including clinical factors related to patient selection and counseling, anesthetic and technical considerations to optimize patient safety, peri-procedural risk mitigation strategies, post-procedural complication management, and safe follow-up practices. Prior training, knowledge, and steps that should be considered by any physician who desires to incorporate thyroid nodule ablation into their practice are defined and discussed. Examples of successful clinical practice implementation models of this emerging technology are provided. Conclusions: Thyroid ablative procedures provide valid alternative treatment strategies to conventional surgical management for a subset of patients with symptomatic benign thyroid nodules. Careful patient and nodule selection are critical to the success of these procedures as is extensive pre-procedural patient counseling. Although these emerging technologies hold great promise, they are not without risk and require the development of a unique skillset and environment for optimal, safe performance and consistent outcomes.

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Ethanol ablation for the treatment of benign thyroid nodules

Cited by 4 publications

References 16 publications

Approach to FNA of Thyroid Gland Cysts

Approach to FNA of Thyroid Gland Cysts

A clinical practice review of percutaneous ethanol injection for thyroid nodules: state of the art for benign, cystic lesions

General Principles for the Safe Performance, Training, and Adoption of Ablation Techniques for Benign Thyroid Nodules: An American Thyroid Association Statement

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