Long‐term efficacy and safety of percutaneous ethanol injection (PEI) in cystic thyroid nodules: A systematic review and meta‐analysis

Abstract

Background Percutaneous ethanol injection (PEI) is used for the treatment of benign cystic thyroid nodules. This systematic review and meta‐analysis aimed to obtain strong evidence of its long‐term efficacy and safety. Methods PubMed, CENTRAL, Scopus and Web of Science databases were searched until November 2020 for studies reporting data on volume reduction rate (VRR), compressive symptoms and cosmetic concerns. Associated complications were assessed. A random‐effects model was designed to pool the data. Results Out of 385 papers, nine studies evaluating 1667 nodules were finally included. Overall, VRR at 6, 12, 24, 36, 60 and 120 months was 77%, 81%, 72%, 68%, 74% and 69%, respectively. Significant reductions in the compressive symptoms and cosmetic concerns were observed. No permanent complications were observed. Conclusions The present meta‐analysis showed that PEI could significantly reduce the volume of benign cystic thyroid nodules. This reduction was already effective at 6 months post‐treatment, and the effect was stable over time.

Nonsurgical Management of Thyroid Nodules: The Role of Ablative Therapies

“…The meta-analysis by Cesareo et al ( 56 ) identified no permanent complications in these studies and, reassuringly, the thyroid function was unaffected in all patients. However, early postprocedure complications include mild to moderate pain or local burning sensation, transient dysphonia, vasovagal reaction, and bleeding into the cyst ( 55 ).…”

“…Four patients (20%) reported mild and transient symptoms (mild pain, a vasovagal reaction, and bleeding into cyst) but none were deemed serious. A recently published systematic review and meta-analysis evaluated a total of 1667 nodules with up to 10 years of follow up ( 56 ). They noted volume reductions of 81% at 12 months, 74% at 5 years, and 69% at 10 years, along with significant reductions in compressive symptoms and cosmetic concerns.…”

Minimally-invasive treatments for benign thyroid nodules: recommendations for information to patients and referring physicians by the Italian Minimally-Invasive Treatments of the Thyroid group

“…Spongiform nodules are defined as nodules containing multiple small cysts <5 mm interspersed within solid tissue for nearly all the volume. EA is the preferred technique to use in case of cystic or predominantly cystic thyroid nodules, because it has fewer side effects and lower costs as compared to the other techniques [8]. The other techniques, particularly RFA, LA, and MWA are indicated for the treatment of spongiform, predominantly solid, or solid nodules [18,19].…”

“…With EA, due to the aspiration of the fluid component, the nodule is immediately reduced in size after the treatment, with an immediate improvement of patients' symptoms. In the following time, the nodule continues to slightly reduce its volume, and generally it achieves a volume reduction of 60 to 80% at 6 months from treatment [8,21,22]. The technique efficacy of EA, which is defined as a volume reduction of at least 50% as compared to the initial nodule volume, is generally achieved in as much as 90% of cases.…”

“…In the last years, minimally-invasive treatments for the thyroid (MITT), including ethanol ablation (EA) and thermal ablation (TA), have gained an increasingly promising role in the management of symptomatic benign thyroid nodules and nowadays they are included as therapeutic alternatives to surgical excision in several guidelines [4][5][6][7][8]. However, despite the increasing evidence of safety and efficacy of MITT for benign thyroid nodules, there is still a large variation in the application of the different available techniques among different countries [9], and not uniform knowledge among patients and referring physicians on MITT.…”