Modified Percutaneous Ethanol Injection in the Treatment of Viscous Cystic Thyroid Nodules

Abstract

Here we describe a prospective 2-year evaluation of the efficiency of a new procedure of percutaneous ethanol injection (PEI) treatment of viscous thyroid cystic nodules (VTCN). Three patients with VCTN were selected from a group of 22 patients with solitary thyroid cystic nodules. A modified two-stage ethanol injection procedure was planned for these patients. Stage 1 was performed through the injection of a small dose of ethanol into the nodule. The viscosity of the content was reduced within 2 weeks after the injection. In the second stage the nodule was decompressed and an established dose of sterile 95% ethanol was injected. Patients were followed up for 2 years. In all cases a reduction in nodule volume was found. In the following 18 months further reduction was observed, with an average of 91.7%. The effect was stable throughout the follow-up period. No complications were observed. Therefore, our new two-stage PEI procedure appears all efficient alternative approach for the treatment of VCTNs even if further investigations on a larger series are required.

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

“…First, a small amount of ethanol is injected. This is followed by drainage and PEI procedure 2-4 weeks later 12,16 . This approach was successfully used in one case of a 19-mL cyst in our study.…”

“…During a single application, 1-3 mL of ethanol were instilled, an amount equal to approximately 20-30% of the initial cyst volume. In one case of a medium-sized, rather viscous cyst, only repeated partial drainage could be performed and an 18-gauge needle was used to successfully carry out two-step ethanol ablation 12 . Even in this case, relatively little ethanol was sufficient.…”

Intralesional saline injection for effective ultrasound-guided aspiration of benign viscous cystic thyroid nodules

“…However, simple cyst aspiration is sometimes difficult or impossible in viscous cystic thyroid nodules. These nodules are defined as nodules that cannot be aspirated, even with an 18-gauge needle, due to the high viscosity of their contents, and they may account for approximately 30% of all cystic thyroid nodules [7]. …”

Thyroid Ultrasound and Ultrasound-Guided FNA

“…Table 1 lists these sonographic characteristics and summarizes their published median sensitivities and specificities for detection of malignancy summarized from 10 published reports (9,10,(26)(27)(28)(29)(30)(31)(32)(33). For inclusion in this analysis, each study must (1) contain at least 100 nodules, (2) analyze at least three sonographic characteristics and (3) report both sensitivity and specificity for thyroid cancer.…”