Ultrasound-guided percutaneous ethanol injection of small and medium-sized thyroid cysts with relatively small amounts of ethanol

Abstract

Background. Ultrasound-guided percutaneous ethanol injection (US-guided PEI) is used in patients with recurring symptomatic thyroid cysts in whom simple drainage was not successful. It is an alternative non-surgical approach in patients refusing or at risk during surgery. Methods and Results. US-guided PEI was performed in 33 patients, with a success rate of 100% and significantly decreased cyst volume after 1, 3 and 6 months after the last PEI compared with the initial volume. The mean number of PEI procedures was 1.5±0.7 with a mean 96% ethanol volume of 2.4±1.2 mL. In the entire group, the initial cyst volume was significantly reduced to the final volume at 6 months after PEI (10.82±5.03 mL vs. 0.78±0.84 mL; P<0.001). Also in all patients, mean volume reduction rates were significantly increased (P<0.001) at check-ups at 1 month (83.1±8.1%), 3 months (89.9±6.3%) and 6 months (92.6±6.4%). In case of medium-sized cysts, more PEI procedures were needed than in small cysts (1.1±0.4 vs. 2.0±0.5). The total amount of 96% ethanol was equal to 22.7±7.9% of the initial cyst volume. Conclusion. Our experiences confirm that small and medium-sized cysts may be successfully treated with relatively small amounts of ethanol. In case of medium-sized cysts, more PEI procedures were needed. Final reduction of complex cysts was achieved later. Apart from temporary localized pain, no serious complications were observed in most cases.

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.…”

Ultrasound-Guided Percutaneous Ethanol Injection Protocol to Treat Solid and Mixed Thyroid Nodules

“…Some authors have demonstrated a positive correlation between the volume of ethanol instilled and the volume reduction rate of cysts, without an increase of side effects with more ethanol injected ( 38 , 59 ). However, most authors do not recommend administering a single dose of more than 10 ml of ethanol ( 63 ). In our study, we basically adopted a short time between evaluations.…”

“…Percutaneous ethanol injection is a safe procedure without serious complications ( 2 ). The most common reported adverse effects, caused by ethanol leakage into the surrounding tissues ( 63 ), are local pain, dysphonia, flushing, and dizziness ( 46 , 47 , 49 ). Although rare, other complications have been reported, such as recurrent nerve palsy, Graves’ disease, Graves’ orbitopathy, Horner’s syndrome, facial dysesthesia with increased tear flow, necrosis of the larynx and skin, and impairment of post-PEI surgery due to local fibrosis ( 57 , 64 ).…”

Ultrasound-guided ethanol ablation for cystic thyroid nodules: effectiveness of small amounts of ethanol in a single session

“…amount of ethanol [2,11,12,24,26,[28][29][30]. Present study also used the small amount of ethanol (mean 3.5mL, range 1-5mL) for cystic thyroid nodules and showed similar efficacy.…”