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

Abstract

Objective: To evaluate the efficacy and safety of percutaneous ethanol injection (PEI) in reducing the volume of cystic and mixed thyroid nodules. Materials and methods: A total of 36 patients with nodules treated with PEI and 13 individuals who declined PEI and were followed clinically or received other non surgical treatment (control group). Assessments were performed at baseline (immediately before treatment in the PEI group or evaluation of the nodule on ultrasonography in the control group) at short-term (on average 30 days after the last injection in the PEI group), and long-term (on average 14 months after baseline in the PEI group or 26 months after baseline in the control group). Results: In the PEI group, the mean baseline volume of 10.4 ± 9.8 cm³ reduced at short-term followup to 2.9 ± 3.1 cm³ (67.7 ± 19.9%, p < 0.001) and at long-term follow-up to 2.0 ± 2.5 cm³ (78.2 ± 19.5%, p < 0.01 versus baseline and p = 0.009 versus short-term follow-up). Both types of nodules showed similar degrees of reduction. In the control group, mean volume was 5.8 ± 3.4 cm³ at baseline and 6.2 ± 3.0 cm³ at long-term follow-up (p = 0.507). Compared with the control group, the PEI group showed larger reduction (p < 0.001). Conclusions: PEI is effective in reducing the volume of cystic and mixed benign thyroid nodules, with sustained long-term efficacy and better outcome when compared with conservative therapies. Treatment with PEI is a safe alternative, with minimal, transient and selflimited adverse events. Arch Endocrinol Metab. 2016;60(3):211-6

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

“…In 1994, Monzani et al reported a 95% success rate in treating 20 cysts with this technique. Similar success rates have been reported by other groups . In 2004, Valcavi and Frasoldati reported the results of a trial of 281 patients randomized to simple aspiration versus percutaneous ethanol.…”

“…Early chemical ablation using tetracycline was first described in thyroid nodules in the late 1980s . However, more commonly, ethanol is delivered under ultrasound guidance to lesions that develop an irreversible local injury with infarction, thrombosis, coagulative necrosis, and fibrosis . Potentially reversible changes to intracellular enzyme activity and ultrastructure are also seen within the zone of ablation.…”

Efficacy and Safety of Ultrasound-Guided Percutaneous Polidocanol Sclerotherapy in Benign Cystic Thyroid Nodules: Preliminary Results

“…However, the recurrence rate is up to 80% [17], even after repeated aspirations. Success rate of PEI, defined as near disappearance or marked size reduction (>50%), has been reported to vary from 72% to 95% [4, 8, 16]. PEI remains the first line treatment for pure thyroid cysts or predominantly cystic (cystic components comprising > 80%) benign nodules [18, 19].…”

“…According to the decrease in nodular volume, polidocanol results were categorized as incomplete response (if <70% decrease) or complete response (if ≥70% decrease) [16]. …”

A Rare Complication following Thyroid Percutaneous Ethanol Injection: Plummer Adenoma

“…Thyroid nodules are characterized by undue growth of structure, functional transformation, and/or cystic degeneration of one or more zones inside the gland. Thyroid nodules are frequently incidental findings, following noninvasive methods such as thyroid ultrasound or radionuclide thyroid scans [1–4]. …”