Comparison of Ultrasound‐Guided Percutaneous Polidocanol Injection Versus Percutaneous Ethanol Injection for Treatment of Benign Cystic Thyroid Nodules

Abstract

Ultrasound-guided percutaneous polidocanol injection can be an alternative for sclerotherapy of cystic or predominantly cystic thyroid nodules. However, its cost was higher than that of percutaneous ethanol injection.

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

“…Literature search and characteristics of the included studies A total of 1,772 non-duplicate potentially eligible studies were identified through screening the titles and abstracts, from which 46 articles were retrieved for full text review. 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].…”

“…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].…”

“…Overall, eight studies compared the VRR between EA and other non-surgical options [6,[8][9][10][11]13,31,32]. The pooled SMD of EA versus other types of non-surgical management concerning VRR was 0.381 (95% CI, 0.028 to 0.734; P=0.030; I 2 =79%) (Fig.…”

“…Ultrasound-guided percutaneous ethanol ablation (EA) is an effective and safe alternative to surgery in cases of recurrence. The reported volume reduction ratio (VRR) after EA in thyroid cysts (cystic portion >90%) and predominantly cystic thyroid nodules (PCTNs; typically defined as having a cystic portion of 50% to 90%) ranges from 80% to 100% and from 65% to 85.4%, respectively [6][7][8][9][10][11][12][13]. In contrast, the efficacy of EA for treating benign solid thyroid nodules remains controversial, and EA is not recommended in current guidelines for solid nodules [14].…”