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.

Radiofrequency versus Ethanol Ablation for Treating Predominantly Cystic Thyroid Nodules: A Randomized Clinical Trial

OBJECTIVE: To compare single-session radiofrequency ablation (RFA) and ethanol ablation (EA) for treating predominantly cystic thyroid nodules (PCTNs). MATERIALS AND METHODS: This single-blind, randomized trial was approved by the Institutional Review Board of two centers and informed consent was obtained from all patients before enrollment. Fifty patients with a single PCTN (cystic portion less than 90% and greater than 50%) were randomly assigned to be treated by either RFA (25 patients) or EA (25 patients) at two hospitals. The primary outcome was the tumor volume reduction ratio (%) at the six-month follow-up and the superiority margin was set at 13% (RFA minus EA). Analysis was performed primarily in an intention-to-treat manner. The secondary outcomes were the therapeutic success rate, improvement of symptomatic and cosmetic problems, and the number of major complications. RESULTS: The mean volume reduction was 87.5 ± 11.5% for RFA (n = 22) and 82.4 ± 28.6% for EA (n = 24) (p = 0.710; mean difference [95% confidence interval], 5.1% [-8.0 to 18.2]), indicating no significant difference. Regarding the secondary outcomes, therapeutic success (p = 0.490), mean symptom (p = 0.205) and cosmetic scores (p = 0.710) showed no difference. There were no major complications in either group (p > 0.99). CONCLUSION: The therapeutic efficacy of RFA is not superior to that of EA; therefore, EA might be preferable as the first-line treatment for PCTNs.

Percutaneous ethanol injection efficacy in benign thyroid nodules: a descriptive retrospective study

Background: In benign nodular thyroid diseases, percutaneous ethanol injection (PEI) has been introduced as an alternative to surgery for more than 10 years. Previous studies confirmed the safety and efficacy of PEI in reducing the size of thyroid nodules, including cystic thyroid. PEI can be performed as an out-patient procedure. Objective: To evaluate the efficacy and safety of PEI treatment for reducing the size of benign thyroid nodules. Material and methods: Descriptive retrospective study was made for patients with non-toxic thyroid nodules treated by PEI at Theptarin Hospital (Bangkok, Thailand) during a five year period (Jan 2002 and Dec 2006). The volume of nodules was measured using ultrasound technique before and after PEI treatment. Any complications were also recorded. In the present analysis, the nodules were classified into four groups: solid, cystic, mixed solid-cystic nodules, and multinodular goiters. Results: Of the 167 treated nodules in the study, initial nodule volume was 10.14 ± 12.32 mL, median number of injections was 5 times with total ethanol volume injected 0.99 ± 0.54 mL per mL nodule volume. Percentage volume reduction was 66.67 ± 32.19% at the median time of 14 months follow-up. Overall, 80% of treated nodules achieved ≥ 50% volume reduction. The mean volume reduction in this group was 79.61%. In the subgroup of solid thyroid nodule (65 nodules), the mean volume reduction was 58.73 ± 35.33%. In the subgroup of cystic thyroid (8 nodules), the mean volume reduction was 92.38 ± 6.57%. In the subgroup of mixed solid-cystic nodule (44 nodules), the mean volume reduction was 67.35 ± 35.18%. In the subgroup of multinodular goiters (50 nodules), the mean volume reduction was 72.27 ± 23.76%. Only two patients developed temporary vocal cord paresis. No permanent or serious complications were experienced. Conclusion: PEI proved to be a safe and effective therapeutic procedure for patients with benign thyroid nodules. Recurrent thyroid cysts could be also managed with this treatment.