Efficacy and safety of USG-guided ethanol sclerotherapy in cystic thyroid nodules

Abstract

Objective:To study the effectiveness and safety of USG-guided ethanol sclerotherapy in cystic thyroid nodules.Materials and Methods:USG of the thyroid gland was performed in 54 patients suspected to have a thyroid nodule on clinical examination. All patients with a predominantly cystic nodule (i.e., when >2/3rd of the nodule was cystic) were included in the study. Ethanol was injected into the cyst under USG guidance. The amount of ethanol injected was about 50% of the amount of aspirated fluid. Follow-up USG was done every month for 3 months; ethanol was re-injected when there was no significant reduction in the cyst volume. The initial cyst volume was compared with the final volume; statistical significance was assessed using the paired t-test.Results:USG revealed predominant cystic nodules in 16 of the 54 patients. Fifteen patients were selected for the study. Following ethanol sclerotherapy, four out of the 15 patients (26.6%) showed complete disappearance of the cyst and nine (60%) showed significant reduction in the cyst volume (i.e., reduction of cyst volume by ≥50% of initial volume). Only two patients did not show significant reduction in cyst volume; both these patients had nodules with an initial volume of ≥20 cc. There were no complications attributable to ethanol injection during follow-up.Conclusion:Ethanol sclerotherapy is an effective and safe treatment for benign cystic thyroid nodules with volumes of <20 cc. Cystic nodules with volume >20 cc may need more number of alcohol injections and longer follow-up.

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

“…Moreover, when using the less frequent ethanol aspiration approach, the ethanol is left in the cavity for 2 to 10 min 8,14,17 . The amounts of ethanol administered during PEI procedures ranged from 36% to 100% of the initial cyst volume in various studies, such as those by Bennedbaek 5,8,14,15,[18][19][20] ). Although most authors do not recommend to administer a single dose of more than 10 mL of ethanol, Kim DW et al injected amounts equal to 100% of the volume of cysts smaller than 20 mL, that is, up to 20 mL of absolute ethanol and, in one case of an extremely large 135-mL cyst, even as much as 30 mL of ethanol 14 .…”

Therapeutic Applications of Ethanol: A Review

“…Ethanol remains the most commonly used compound for cyst sclerotherapy, due to its availability, low cost and good tolerance. The main indications are hepatic, renal and thyroid cysts [77,78]. After aspiration of the cyst content, a volume of ethanol corresponding to 50% of the aspirated cyst's volume is injected.…”

“…Ethanol's sclerosing mechanism may be due to dehydration of the epithelial cell walls and the denaturation of cyst proteins. This leads to coagulant necrosis, reactive fibrosis, small vessel thrombosis, and thus obliteration of the cyst [78]. After the injection of ethanol into the cyst, the patient is turned in different directions so that the alcohol comes into contact with the whole cyst wall.…”

“…The two patients who failed to show a significant reduction in cyst volume had nodules ≥ 20 mL. Even though no complications were attributable to ethanol injection during the study's three-months follow-up period, mild transient pain or a burning sensation at the injection site may be experienced following sclerotherapy [78]. In some cases of thyroid nodules, ethanol ablation has been coupled with radiofrequency ablation -thus increasing the procedure's effectiveness [82].…”

Interventions and turfs

“…[3] The first two articles mentioned above discuss only diagnostic procedures but nevertheless represent a growing part of IR. In fact, if IR as a discipline were to broaden its base to include those who perform guided biopsies as an integral part of the specialty, many of the problems of this subspecialty might perhaps get solved.…”