Safe and effective percutaneous ethanol injection therapy of 200 thyroid cysts

Abstract

Introduction. Ultrasound-guided percutaneous ethanol injection therapy (US-PEIT) is a minimally invasive procedure that may be performed as an alternative to surgery for the treatment of recurrent symptomatic thyroid cysts for which simple aspiration failed. The present study aimed at assessing US-PEIT in a large cohort of patients, identifying factors influencing treatment outcome. Methods. Retrospective analysis of 193 patients with 200 thyroid cysts who underwent US-PEIT in 2004-2018. Results. The initial median cyst volume was 8.5 mL [5.5-16.0]; median final volume at 12 months after the completion of therapy was 0.5 mL [0.2-1.3]. A Volume Reduction Rate (VRR) of 95.0% [86.7-98.0] was achieved. For successful US-PEIT, relatively small total amount of ethanol was needed, on average corresponding to 20.0% [16.7-28.6] of the initial cyst volume. VRR positively correlated with the initial cyst volume and negatively with the presence of complex cyst. Multiple regression analysis showed the presence of complex cyst as an independent predictor of treatment efficacy. Conclusion. US-PEIT of thyroid cysts of all sizes was very successful with using total amounts of ethanol, corresponding to ≈20% of the initial cyst volume.

Efficacy of Ethanol Ablation for Benign Thyroid Cysts and Predominantly Cystic Nodules: A Systematic Review and Meta-Analysis

“…The final metaanalysis included 19 studies, consisting of eight two-arm parallel studies (four RCTs [10,11,13,31], two prospective cohort studies [6,32], and two retrospective cohort studies [8,9]), which compared EA with other types of non-surgical management, and 11 single-arm studies ( Fig. 1) [7,12,[33][34][35][36][37][38][39][40][41]. Of note, Verde et al [32] conducted a preliminary RCT followed by a prospective cohort, which was integrated into a larger cohort by pooling the VRRs at 1 month.…”

“…Almost all EA procedures described in the included studies involved subtotal or complete aspiration of the fluid content of cystic nodules prior to ethanol instillation. The injected ethanol was either evacuated (aspiration technique) or retained (retention technique) after the procedure in seven [8][9][10][11]13,32,35] and three [31,40,41] studies, respectively. Notably, among studies that enrolled PCTNs, none of them mentioned injection of ethanol into the solid component in addition to filling of the cystic cavity.…”

“…All the studies had a low risk of bias in the domain of selective outcome reporting, whereas most of them had an unclear risk of bias in the domain of blinding of outcome assessments. Six studies had a low risk of bias in the patient selection domain [6][7][8][9]35,38], while the others were given an unclear or high risk of bias due to an uncertain process of patient recruitment [12,33,39,41] and retrospective data collection [34,36,37,40] or selection of the intervention and control groups from different populations [32], respectively. One study had high risk of bias in the incomplete data domain due to a large number of dropout cases in long-term follow-up [7].…”

“…Lowgrade fever was a rare side effect documented by Valcavi and Frasoldati [31], which spontaneously resolved within 2 to 3 days without medication. Dysphonia was the major complication reported in eight patients from six studies [11,13,31,34,38,40], with symptom duration ranging from a few minutes to 2 months. Two of the cases complicated by transient dysphonia reported by Guglielmi et al [34] occurred in the other parallel group consisting of solid nodules, rather than the cystic nodules.…”

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.…”