Long-term follow-up of cystic thyroid nodules treated with percutaneous ethanol injection (PEI) using two different approaches

Abstract

Background and aim. Cystic thyroid nodules (CNs), although generally benign, can cause compressive or aesthetic problems. Percutaneous ethanol injection (PEI) can represent an alternative to surgery. The present retrospective study evaluates: 1) the long-term outcome of CNs after PEI; 2) the differences between two different PEI protocols; 3) the CNs response according to the liquid component. Materials and methods. The study comprises 358 nodules post-PEI followed for at least two years. PEI was performed according two different treatment protocols with a single (Foggia) or double (Turin) alcohol injection. CNs were divided according to their composition: cystic (CYS) > 90%, mainly cystic (M-CYS) 75-90%, mixed (MIX) 50-75%, solid-mixed (S-MIX) 35-50%. The volume reduction rate (VRR) was defined as nodule volume (ml) after PEI/nodule volume (ml) before PEI x 100. Results. The 1-year VRR was significantly higher than that at 6 months (89.5% vs. 72.9%, p=0.0005), no differences were observed after one year. A significant difference between Turin and Foggia was observed only in VRR at early visit (79% vs. 86%, respectively, p=0.002) and recurrence rate (14% vs. 24%, respectively, p=0.001). Minor side-effects were infrequent. In 192 nodules with a 10-year follow-up CYS showed higher VRR than MIX and S-MIX nodules (p<0.001). Conclusion. Our study reported that the long-term outcome of CNs treated with PEI is excellent regardless of the PEI technique utilized; the larger the cystic amount, the higher the VRR. Based on present results, PEI can be considered as the first-line choice for treating thyroid CNs

Modified percutaneous ethanol injection method combined with microwave ablation for the treatment of symptomatic, predominantly cystic, benign thyroid nodules: a retrospective study of 201 cases

“…Both studies drew a conclusion that the therapeutic efficacy of RFA is equal to EA and EA is less expensive [25,26]. There are several studies investigated the effects of MWA on benign thyroid nodules showed that the VRR was up to 84.67%-90% and the treatment efficacy was effected by the different internal characteristics [17,[27][28][29]. Unfortunately, there are few comparative studies on EA and MWA for treatment of predominantly cystic thyroid nodules.…”

Clinical and functional results of radiofrequency ablation and microwave ablation in patients with benign thyroid nodules

“…[13][14][15] Minimally invasive procedures include ethanol ablation (EA), percutaneous laser ablation (PLA), microwave ablation (MWA), and radiofrequency ablation (RFA). [13][14][15][16][17] High-intensity focused ultrasound (HIFU) looks to be a noninvasive therapeutic option for BTN. With this method, a volume decreasing of over 50% was obtained at the end of a 24-month follow-up.…”

“…Alternative and minimally invasive methods include RFA, MWA, EA, and PLA. [14][15][16][17][18][19][20] Ethanol ablation is frequently used in the minimally invasive treatment of cystic thyroid nodules as an alternative to surgery. 16,17,26 Radiofrequency ablation has also been shown to be a successful alternative to surgical therapy as it provides local ablation of BTN via thermal energy.…”

“…[14][15][16][17][18][19][20] Ethanol ablation is frequently used in the minimally invasive treatment of cystic thyroid nodules as an alternative to surgery. 16,17,26 Radiofrequency ablation has also been shown to be a successful alternative to surgical therapy as it provides local ablation of BTN via thermal energy. In benign cold nodules treated with RFA, a decrease in volume was found 32.7-58.2% at the first one month follow-up, 50.7-84.8% at 6 months follow-up, and a decrease was observed in cosmetic complaints and compression symptoms.…”

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

“…The full text of the remaining 28 papers was retrieved, and nine studies were finally included in the meta‐analysis (Figure 1). 20–28 No additional studies were retrieved from the references of the included studies.…”