Ethanol Ablation of the Thyroid Nodules: 2018 Consensus Statement by the Korean Society of Thyroid Radiology

Minimally invasive treatment of symptomatic thyroid nodules is now commonplace. Ethanol ablation (EA) of thyroid cystic nodules has been performed since the 1990s, but there is no global consensus or guideline. Although various limitations of EA have been described, recommendations for practical application are necessary. Therefore, the Task Force Committee of the Korean Society of Thyroid Radiology initiated the present consensus statement and here we provide recommendations for the role of EA in the management of symptomatic thyroid nodules. These recommendations are based on evidence to date from the literature and expert opinion.

Summary of the 2017 thyroid radiofrequency ablation guideline and comparison with the 2012 guideline

Radiofrequency ablation (RFA) is a new, minimally invasive modality that serves as an alternative to surgery in patients with thyroid tumors. The Task Force Committee of the Korean Society of Thyroid Radiology developed recommendations for the optimal use of RFA for thyroid tumors in 2012 and revised them in 2017. Herein, we review and summarize the 2017 thyroid RFA guideline and compare it with the 2012 thyroid RFA guideline.

Comparison between EUS-guided ethanol ablation and surgical treatment of benign insulinoma / 中国内镜杂志

Objective To evaluate the safety and efficacy of endoscopic ultrasound (EUS) guided ethanol ablation of benign insulinoma and compare its' advantages and disadvantages with surgical treatment. Methods From April 2011 to February 2016, clinical data of 38 patients with benign insulinoma treated by EUS-guided ethanol ablation or surgical treatment were retrospectively analyzed. Results 97.4% (37/38) patients had a typical clinical manifestation of Whipple's triad, and the I/G ratio of 82.9% patients (29/35) was more than 0.3 with their onset of hypoglycemia. The positive preoperative etiologic diagnosis rates of transabdominal ultrasonography, CT, MRI, PET/CT and EUS were 50.0%, 67.6%, 66.7%, 75.0%, 89.7% respectively. In the current study, 18 patients underwent EUS-guided ethanol ablation (EUS-FNI group) and 20 patients received surgicaltreatment (surgical group). Compared with the surgical group, the operation time, intraoperative hemorrhage volume, postoperative complications, length of stay and hospitalization costs were significantly reduced in the EUS-FNI group (P < 0.05). No treatment-related complications was observed in EUS-FNI group, while 40.0% (8/20) patients in surgical group had complications. During the follow-up period, all these patients maintained stable blood glucose without taking medication, and there's no recurrence of insulinoma in EUS-FNI group after the last treatment with alcohol injection; In surgical group, only 90.0% (18/20) patients had no recurrence, episode of hypoglycemia was less after the operation in 10.0% (2/20) patients. Conclusion EUS-guided ethanol ablation of benign insulinoma is safe and effective, compared with traditional surgical treatment, EUS-guided ethanol ablation is minimally invasive, costs less, recovers fast after treatment and has fewer complications.

Ultrasound-guided treatment of benign partially cystic thyroid nodules: a comparative study between radiofrequency ablation and ethanol ablation / 中华超声影像学杂志

Objective To explore the efficacy of radiofrequency ablation (RFA) and ethanol ablation(EA) for treating partially cystic thyroid nodules.Methods One hundred and twenty-four patients with a single partially cystic thyroid nodules which caused pressure symptoms or cosmetic problems were treated with RFA (n =42),EA (n =39) or RFA + EA(n =43).The inactivation rate of the nodule,tumor volume reduction rate,symptom scores (0-10) and complications were evaluated before and after treatment.Results The mean inactivation rate of RFA,EA and RFA + EA groups was (87.50 ± 5.77) ％,(57.00 ± 6.12) ％,(90.03 ± 5.39) ％,respectively.The inactivation rate of the nodule was negatively related to the volume of the solid part of the nodule.As to nodules with the volume ranging from 30 to 45 ml,the inactivation rate of RFA group was lower than RFA + EA group.Nodule volume reduction ratio (percentage) at 12-month follow-up was 90.45％ for RFA group,69.88％ for EA group,and 93.28％ for RFA + EA group.Regarding mean volume reduction,there were no difference between RFA + EA and RFA group (P ＞0.05),while there were significant differences between RFA + EA and EA group (P ＜0.05),also RFA and EA group (P ＜0.05).The patients in EA subgroup with cystic part percentage less than 50％ had a unsatisfying outcome (the volume reduction ratio less than 50％),while there were no differences(P ＞0.05) on the volume reduction ratio of nodule based on cystic part percentage between RFA group and RFA + EA group.The rate of the complication was 7.14％,2.56％,2.33％,respectively.Conclusions Ultrasound-guided percutaneous aspiration combined with RF ablation yielded better results than EA ablation.But due to ethanol ablation being less expensive and simpler to perform than RFA,ethanol ablation should be the first line treatment technique for benign thyroid nodules with cystic part percentage more than 50％,while radiofrequency ablation as first-line treatment for benign thyroid nodules with cystic part percentage less than 50％.

Advances in research on ultrasound-guided percutaneous ethanol injection for treatment of benign cystic thyroid nodules / 中国癌症杂志

Because of development and popularization of the ultrasound techniques, the detection rate of nodal thyroid has increased. Surgery is the long-established therapeutic option. However, due to the surgical trauma, compli-cations and the effect on quality of life, various minimally invasive treatments have been proposed and widely used. A large number of foreign studies have shown that ultrasound-guided percutaneous ethanol injection is a more commonly used minimally invasive way to treat benign pure cystic and predominantly cystic thyroid nodules. This article provides an up-to-date review of the overseas studies and summarized on percutaneous ethanol injection for the treatment of benign cystic thyroid nodules.

Transhepatic arterial embolization-ablation therapy with Lipiodol-ethanol mixture for the treatment of VX2 liver cancer in experimental rabbits / 介入放射学杂志

Objective To determine the optimal volume proportion of iodize d oil (Lipiodol)-ethanol mixture by comparing the clinical efficacy of transhepatic arterial embolization-ablation therapy using different volume proportion of Lipiodol-ethanol mixture in treating experimental rabbit models with VX 2 liver cancer. Methods VX2 tumor was implanted in eighteen adult male New Zealand white rabbits. The 18 VX 2 rabbit models were randomly and equally divided into the following six groups according to the Lipiodol-ethanol volume ratio ∶ group A (3 ∶ 1), group B (2 ∶ 1), group C (1 ∶ 1), group D (1 ∶ 2), group E (1 ∶ 3) and group F (1 ∶ 4). One week after the treatment, all the rabbits were sacrificed and their livers were removed and sent for pathologic examination. The tumor growth rate, the microvascular density, the apoptosis index (AI) of tumor tissues and the injury of the hepatic tissue adjacent to the tumor were evaluated. Results After the treatment, the tumor’s size was increased in group A, E and F. The tumor growth rate of group A was significantly higher than that of the other five groups , and the difference was statistically significant (P 0.05). The proportion of ethanol in Lipiodol ∶ethanol mixture bore a negative relationship to the microvascular density counts (R2= 0.840, F = 89.432, P 0.05), while the difference in AI between group B and group C or between group B and group F was statistically significant (P 0.05). The injury extent of the hepatic tissue adjacent to the tumor in group A and B was remarkably milder than that of other groups (P < 0.05). Conclusion When considered in terms of safety, the optimal volume proportion of Lipiodol-ethanol mixture should be 2 ∶ 1. Successful super-selective catheterization of the tumor feeding artery, strict and close fluoroscopic monitoring of the injection and proper increase in the proportion of ethanol can definitely improve the therapeutic efficacy.

The Effect of Ethanol Ablation for the Treatment of Benign Cystic Thyroid Nodules / 대한내과학회지

Simple aspiration is the initial therapy in patients with the symptomatic benign thyroid cystic nodule, but treatment failure is very common. In patients with recurrent cystic thyroid nodules, ethanol ablation (EA), radiofrequency ablation, or laser ablation can be used to prevent reaccumulation of cystic fluid. EA is simple, cheap and needs no specialized equipment. Kim et al. reported the long-term efficacy and safety of ultrasound-guided percutaneous EA for cystic or predominantly cystic thyroid nodules. They also evaluated the clinical factors associated with treatment failure. Successful ablation was obtained in 31 of 40 (77.5%) patients, and initial large cystic volume was the factor associated with therapeutic failure. The side effect was negligible except transient local pain immediately after the procedure. Although this study had retrospective design and irregular follow-up, it is plausible that EA is a safe and effective therapy for treating cystic or predominantly cystic thyroid nodule.

Non-surgical Management of Thyroid Nodules / 대한내분비외과학회지

Thyroid nodules are a common clinical problem. Routine use of neck ultrasonography increase in the frequency of nodular thyroid disease, however, only a small percentage of the nodules currently being detected will prove to be malignant. The clinical importance of thyroid nodules rests with the need to exclude thyroid cancer, which occurs in 5??0% of cases. Most thyroid nodules are cytologically benign and can be managed nonsurgically. Fine-needle aspiration cytology has a central role in identification of malignant nodules, which are generally treated with surgery. Benign nodules that are completely asymptomatic require follow-up without treatment. Cosmetic problems with or without compressive symptoms may be indications for surgery. When surgery is contraindicated or refused, several nonsurgical approaches are available. These include TSH suppressive therapy, radioactive iodine treatment, ethanol ablations, laser ablation, and radiofrequency ablation. TSH suppressive therapy is the most widely used, however, its clinical efficacy and safety are controversial. When surgery is not available, radioactive iodine therapy is the therapy of choice for treatment of toxic nodules or symptomatic nodular goiters. Ethanol ablation can be used as the first-line therapy for treatment of symptomatic cystic nodules. Radiofrequency ablation is another safe and effective treatment for benign nodules and may also have an effective complementary role in management of recurrent thyroid cancers. Laser photocoagulation should be reserved for selected patients undergoing treatment in experienced centers. Through higher understanding of thyroid and neck anatomy, surgeons should actively participate in various non-surgical managements.

Thermal Ablation for Benign Thyroid Nodules: Radiofrequency and Laser

Although ethanol ablation has been successfully used to treat cystic thyroid nodules, this procedure is less effective when the thyroid nodules are solid. Radiofrequency (RF) ablation, a newer procedure used to treat malignant liver tumors, has been valuable in the treatment of benign thyroid nodules regardless of the extent of the solid component. This article reviews the basic physics, techniques, applications, results, and complications of thyroid RF ablation, in comparison to laser ablation.

Effect of Transurethral Ethanol Injection of Prostate for Recurrent Urinary Retention in Patients with a Poor Performace Status / 대한남성과학회지

PURPOSE: The goal of this study is to show the effect of Transurethral Ethanol Ablation of Prostate(TEAP) on voiding symptoms in patients with benign prostatic hyperplasia. MATERIALS AND METHODS: Between May 2003 and May 2005, 17 patients diagnosed with BPH who were not appropriate candidates for anesthesia because of their poor general condition underwent TEAP and were evaluated. Ethyl alcohol(99%) was injected into the prostate with endoscopic guidance. A urethral catheter was inserted postoperatively. All patients were evaluated with uroflowmetry, postvoid residual urine, international prostatic symptom score(IPSS), and quality of life at 3 months post-operatively. RESULTS: The mean total alcohol dose was 9.5 cc, and a catheter was required for a mean of 4.8 days postoperatively. The subjects' mean International prostate symptom score was 29.9 points before TEAP, and decreased to 24.5 points after 3 months(p=0.001). Mean quality of life index decreased from 4.2 points before TEAP to 3.1 points after 3 months(p=0.002). There were no major complications such as severe bleeding, incontinence, or urethral injury. However, 7 patients needed additional medication to improve voiding symptoms. CONCLUSIONS: TEAP caused minimal complications while improving the international prostate symptom score and quality of life. TEAP may be considered an effective minimally invasive treatment option for patients with benign prostatic hyperplasia who are not appropriate for anesthesia because of their poor general condition.