Injeção percutânea de etanol no tratamento de nódulos tiroidianos sólidos, císticos e autônomos

Bianchini, Elizabeth X.; Ikejiri, Elza S.; Mamone, Maria Conceição; Paiva, Elias Rodrigues de; Maciel, Rui M. B.; Furlanetto, Reinaldo P.

doi:10.1590/s0004-27302003000500007

Cited by 7 publications

(8 citation statements)

References 29 publications

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“…Lee and Ahn (11) observed an even greater reduction in volume during longterm followup: 70.1% and 66.1% immediately after PEI and 75.1% and 73.2% after an average of 36 months in sol id and cystic nodules respectively. These authors also showed that PEI was effective in both types of nodules, but even though both types eventually achieved simi lar responses to therapy, the rate of volume reduction and the number of nodules with complete response to treatment were higher among cystic nodules as also shown by others (12,16,17). It is unclear why the ef fects of ethanol are different immediately after PEI and at long term.…”

Section: Discussionmentioning

confidence: 76%

Percutaneous ethanol injection versus conservative treatment for benign cystic and mixed thyroid nodules

Ferreira

Piaia²,

Cadore³

2016

Arch. Endocrinol. Metab.

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Objective: To evaluate the efficacy and safety of percutaneous ethanol injection (PEI) in reducing the volume of cystic and mixed thyroid nodules. Materials and methods: A total of 36 patients with nodules treated with PEI and 13 individuals who declined PEI and were followed clinically or received other non surgical treatment (control group). Assessments were performed at baseline (immediately before treatment in the PEI group or evaluation of the nodule on ultrasonography in the control group) at short-term (on average 30 days after the last injection in the PEI group), and long-term (on average 14 months after baseline in the PEI group or 26 months after baseline in the control group). Results: In the PEI group, the mean baseline volume of 10.4 ± 9.8 cm³ reduced at short-term followup to 2.9 ± 3.1 cm³ (67.7 ± 19.9%, p < 0.001) and at long-term follow-up to 2.0 ± 2.5 cm³ (78.2 ± 19.5%, p < 0.01 versus baseline and p = 0.009 versus short-term follow-up). Both types of nodules showed similar degrees of reduction. In the control group, mean volume was 5.8 ± 3.4 cm³ at baseline and 6.2 ± 3.0 cm³ at long-term follow-up (p = 0.507). Compared with the control group, the PEI group showed larger reduction (p < 0.001). Conclusions: PEI is effective in reducing the volume of cystic and mixed benign thyroid nodules, with sustained long-term efficacy and better outcome when compared with conservative therapies. Treatment with PEI is a safe alternative, with minimal, transient and selflimited adverse events. Arch Endocrinol Metab. 2016;60(3):211-6

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Section: Discussionmentioning

confidence: 76%

Percutaneous ethanol injection versus conservative treatment for benign cystic and mixed thyroid nodules

Ferreira

Piaia²,

Cadore³

2016

Arch. Endocrinol. Metab.

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“…Nestas situações, a US é fundamental tanto na orientação da injeção intranodal do etanol (34,35) quanto no posicionamento adequado dos eletrodos para ablação por radiofreqüência (36). Com a detecção precoce de metástases cervicais pela US e pelo prognóstico favorável, é provável que terapias alternativas ganhem mais espaço, especialmente a alcoolização (34,35), poupando os pacientes dos riscos da cirurgia e dos efeitos adversos do radioiodo.…”

Section: Ultra-sonografia Auxiliando O Tratamento De Metástases Cerviunclassified

Emprego da ultra-sonografia cervical no seguimento de pacientes com carcinoma diferenciado de tireóide

Rosário

Júnior²,

Biscolla

et al. 2007

Arq Bras Endocrinol Metab

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RESUMOA ultra-sonografia (US) cervical é recomendada na avaliação de todos pacientes com carcinoma de tireóide após a terapia inicial, pois mesmo indivíduos de baixo risco com tireoglobulina (Tg) estimulada indetectável podem apresentar metástases cervicais. Para estas metástases, a US é o método mais sensível, superior à pesquisa de corpo inteiro (PCI) com 131 I. Linfonodos cervicais com diâmetro ≥ 5 mm com calcificações finas e/ou degeneração cística quase sempre são de etiologia maligna. Na ausência destas características, o formato arredondado e a ausência do hilo ecogêni-co são achados "suspeitos", enquanto linfonodos alongados e com hilo ecogênico visível são considerados benignos. A avaliação do fluxo, através do doppler, auxilia no diagnóstico diferencial, usualmente revelando hipervascularização periférica ou mista nos casos malignos. Na presença de linfonodos "suspeitos" na US, a avaliação citológica do material obtido através da punção aspirativa por agulha fina (PAAF) e a dosagem da Tg, obtida do lavado da agulha, são testes úteis e complementares para definir a etiologia, com elevada sensibilidade quando combinados e especificidade de 100%. A US também é útil antes da tiroidectomia, auxiliando e até, em alguns casos, modificando o planejamento cirúrgico; e antes da ablação, para mensuração dos remanescentes tireoidianos e pesquisa de metástases linfonodais persistentes. Outra aplicação desse método de imagem é guiar a injeção de etanol (escleroterapia) ou a introdução de eletrodos para ablação com radiofreqüência em casos selecionados de metástases linfonodais isoladas, como alternativa às terapias convencionais. Neck ultrasonography (US) is recommended for the assessment of all patients with thyroid carcinoma after initial therapy, since even low-risk patients with undetectable stimulated thyroglobulin (Tg) may present cervical metastases. In the case of these metastases, US is the most sensitive method and is superior to whole-body 131 I scanning. Cervical lymph nodes with a diameter ≥ 5 mm presenting thin calcifications and/or cystic degeneration have almost always a malignant etiology. In the absence of these characteristics, a round shape and the absence of an echogenic hilum are "suspicious" findings, whereas elongated lymph nodes with a visible echogenic hilum are considered benign. Doppler flow analysis helps with the differential diagnosis, usually revealing peripheral or mixed hypervascularization in malignant cases. In the presence of "suspicious" lymph nodes upon US, fine-needle aspiration cytology and measurement of Tg in the needle lavage fluid are useful and complementary exams for the definition of the etiology, with the combination of the two methods showing elevated sensitivity and 100% specificity. US is also useful before thyroidectomy, even contributing in some cases to modify the surgical planning, and before ablation for the measurement of thyroid remnants and detection of persistent lymph node metastases. Another application of this imaging method is to guide the injection of...

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“…Bianchini and cols. (19) evaluated 50 patients (26 with solid nodules, 17 with cystic nodules, and 7 with autonomous nodules). After 1 year of treatment, solid nodules showed a 74% reduction in the initial volume, whereas cystic nodules decreased by 92% with no recur- rences.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of percutaneous ethanol injections in benign thyroid nodules

Perez

Fighera

Miasaki

et al. 2014

Arq Bras Endocrinol Metab

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Objective: The objective of this study was to evaluate the efficacy and safety of percutaneous ethanol injection (PEI) in the treatment of benign thyroid nodules. Subjects and methods: We evaluated 120 patients with benign thyroid nodules. Patients underwent evaluation of serum TSH and free T4, cervical ultrasound, and thyroid scintigraphy (in those with suppressed TSH levels). The application of sterile ethanol 99% was guided by ultrasound, with the injected volume amounting to one-third of the nodule volume. Response was considered complete (reduction of 90%); partial (reduction between 50 and 90%); or none (reduction of < 50%). Autonomous nodules were evaluated for normalization of TSH levels. Results: Among the nodules studied, 30.8% were solid, 56.7% were mixed, 12.5% were cystic, and 21.6% were hyperfunctioning. The initial volume of the treated nodules ranged from 0.9 to 74.8 mL (mean 13.1 ± 12.4 mL). We performed 1-8 sessions of PEI, applying an average of 6.2 mL of ethanol for patient. After 2 years of follow-up, 17% of patients achieved a complete response (94% reduction); 53%, a partial response (70% reduction); and 30%, no response. A reduction in the volume of autonomous nodules was noted in 70% of cases, and 54% had a normalized value of TSH. The main side effect is local pain, lasting less than 24 hours in most cases. Conclusion: This study showed that PEI is a safe and effective procedure for treatment of benign, solid or mixed thyroid nodules. Most cases resulted in significant reduction in nodule volume, with normalization of thyroid function. Arq Bras Endocrinol Metab. 2014;58(9):912-7 Keywords Nodule, thyroid, goiter; percutaneous ethanol injection; sclerotherapy RESUMO Objetivo: O objetivo deste estudo foi avaliar a eficácia e segurança da injeção percutânea de etanol (IPE) no tratamento de nódulos tireoidianos benignos. Sujeitos e métodos: Foram avaliados 120 pacientes com nódulos benignos de tireoide. Todos realizaram dosagens de TSH, T4 livre, ecografia cervical (US) e cintilografia de tireoide (em pacientes com TSH suprimido). A aplicação de etanol estéril a 99% foi guiada por US e o volume de etanol injetado correspondeu a um terço do volume nodular calculado. A resposta foi considerada completa (redução de 90%); parcial (redução entre 50 e 90%) ou ausência de resposta (redução menor que 50%). Nos nódulos autônomos, foi avaliada a normalização do TSH. Resultados: Entre os nódulos estudados, 30,8% eram sólidos, 56,7% eram mistos, 12,5% eram císticos e 21,6%, nódulos hiperfuncionantes. O volume inicial dos nódulos tratados variou de 0,9 a 74,8 mL (média 13,1 ± 12,4 mL). Foram realizadas de 1 a 8 sessões de IPE (média 2,8), com aplicação média de 6,2 mL de etanol por paciente. Após dois anos de seguimento, 17% dos pacientes obtiveram resposta completa (redução de 94%), 53% obtiveram resposta parcial (redução de 70%) e 30% não responderam. Houve redução de volume nos nódulos autônomos em 70% dos casos, e 54% normalizaram o valor do TSH. Os efeitos colaterais registrados foram decorr...

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Injeção percutânea de etanol no tratamento de nódulos tiroidianos sólidos, císticos e autônomos

Cited by 7 publications

References 29 publications

Percutaneous ethanol injection versus conservative treatment for benign cystic and mixed thyroid nodules

Percutaneous ethanol injection versus conservative treatment for benign cystic and mixed thyroid nodules

Emprego da ultra-sonografia cervical no seguimento de pacientes com carcinoma diferenciado de tireóide

Evaluation of percutaneous ethanol injections in benign thyroid nodules

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