Intracystic Hemorrhage and Its Management During Ultrasound-Guided Percutaneous Microwave Ablation for Cystic Thyroid Nodules

Abstract

Background: Intracystic hemorrhage can present occasionally during ultrasound-guided percutaneous microwave ablation (PMWA) for cystic thyroid nodules. It can affect treatment outcome, can lead to ablation failure, and even conversion to open surgery. We aim to avoid such cases in the future by exploring their causes and management. Methods: From March 2017 to December 2019, we retrospectively studied 87 cystic thyroid nodules in 59 patients who underwent PMWA in the First Hospital of Jilin University. All patients were followed at 1, 3, 6, and 12 months after treatment. Results: All patients completed the treatment successfully. Nine cystic thyroid nodules presented with intracystic hemorrhage during the ultrasound-guided PMWA, giving an incidence of 10.3% (9/87 cysts). Larger cystic thyroid nodules were more likely to develop intracystic bleeding during ultrasound-guided PMWA. Intracystic hemorrhage resulted in significantly prolonged ablation time and had a negative effect on treatment outcome. No patients had other complications, but temporary post-operative pain and local swelling were more obvious in patients with intracystic hemorrhage. Conclusion: Intracystic hemorrhage is not rare during ultrasound-guided PMWA for cystic thyroid nodules. Doctors should pay more attention to it, learn to manage it and try to avoid it in clinical practice.

Ablating Aspiration Needle Tract Prior to Microwave Ablation Can Improve Therapeutic Outcomes for Predominantly Cystic Thyroid Nodules

“…Not surprisingly, our results showed that the incidence of intracystic hemorrhage in Group B was 40%. Compared with previous studies (4,8,15,18), the probability of intracystic hemorrhage was extremely high. The main reasons for our finding were as follows: First, these nodules with intracystic hemorrhage were large in mean volume (V=19.5 ml) and high in capsule wall tension.…”

“…Sometimes enlargement was visible to the naked eye, and even in some special cases, bleeding points and blood flow could be seen. Bleeding was confined to the cysts and did not affect other tissues (15). Once this happened, the puncture point was compressed for 3-5 min to staunch bleeding.…”

Ultrasound-Guided Thermal Ablation of Thyroid Nodules: Technicalities Progress and Clinical Applications, Especially in Malignant Thyroid Nodules

“…Further, US-guided percutaneous thermal ablation can lead to intracystic hemorrhage when used in the treatment and management of cystic thyroid nodules, which significantly prolongs ablation time and can negatively affect treatment outcome. Dong et al (34) reported an incidence of 10.3% (9/87 cysts) of intracystic hemorrhage, and larger cystic thyroid nodules were more likely to develop intracystic bleeding during US-guided percutaneous MWA. The efficacy of US-guided percutaneous LA is affected by thyroid nodule morphology (54).…”

“…Twelve months after treatment of nodules of metastatic PTC lymph nodes using single-fiber LA, mean baseline volumes reduced from 0.29 ± 0.12 to 0.03 ± 0.03 mL, and the mean VRR was 90.3 ± 7.6%. These findings indicate that thermal ablation, such as LA performed under US guidance, is promising and favorable for the treatment and management of metastatic lymph nodes in PTC, with appropriate ablation modes (34). Han et al ( 70) evaluated the safety and efficacy of percutaneous US-guided microwave ablation for 98 cervical metastatic lymph nodes in patients with PTC.…”

“…The ablation time has been reported to range from 2 to 16 min per nodule (mean time, 8 min) ( 25 ). Treatment is ceased when all thyroid parenchyma requiring treatment have been replaced by an echogenic gas artefact ( 33 , 34 ). In the “needle-selection” technique, the size of the nodule, cystic, or solid components and vascularity is taken into consideration when selecting needle types and performing the procedure.…”