Ultrasound‐Guided Ethanol Ablation as a Primary Treatment for Thyroglossal Duct Cyst: Feasibility, Characteristics, and Outcomes

Abstract

Objectives. To evaluate the feasibility, characteristics, and outcomes of ultrasound-guided ethanol ablation (US-EA) as a primary treatment for thyroglossal duct cysts (TGDCs).Study Design. Prospective case series.Setting. Single center study.Methods. The inclusion criteria were as follows: (i) patients with TGDC aged ≥18 years, (ii) benign TGDC in imaging and cytological examinations, and (iii) patients' need for nonsurgical scarless treatment. US-EA was used as the primary treatment strategy. The primary outcome variables were the volume reduction rate (VRR) and cosmetic score at the last follow-up.Results. We enrolled 28 patients with TGDC. The median TGDC volume at baseline was 6.7 mL. The median procedure time of the US-EA was 6.5 minutes. The median volumes of the cyst aspirate and injected ethanol were 4.0 and 2.0 mL, respectively. Overall, 18, 8, and 2 patients underwent 1, 2, and 3 treatment sessions, respectively. There were no complications. The median VRR was 96.2%, and the treatment success rate was 96.4%. The World Health Organization cosmetic score decreased from 4 (baseline) to 1 (after treatment) in all patients. The subjective grade for cosmetic satisfaction was satisfactory or highly satisfactory in all patients. The VRR, treatment success rate, and the number of treatment sessions did not differ as functions of the characteristics of the TGDC, including the initial volume, septation, debris, or viscosity of the cyst fluid. Conclusion.US-EA was feasible, safe, and effective in patients with TGDC. Therefore, US-EA can be used as a primary treatment for TGDC, evading general anesthesia and surgical scar.

Ultrasound-guided ethanol ablation versus the Sistrunk operation as a primary treatment for thyroglossal duct cysts

“…With respect to the specific EA technique, two major issues related to this study require clarification: (1) the volume of ethanol injection and (2) the retention or aspiration of the injected ethanol at the conclusion of EA. A literature review of seven studies on EA for TGDC published since 2010 revealed that five studies referenced 50% or more of the aspirate volume as the minimum limit for ethanol injection (up to 15 mL of ethanol) [7][8][9][10]16,19,22]. However, in the current study, a relatively small volume of ethanol was used (≤2.5 mL).…”

“…For the first EA session, the median volumes of aspirate and injected ethanol were 3.0 mL (IQR, 2.0 to 8.0 mL) and 2.0 mL (IQR, 1.3 to 2.0 mL), respectively, Treatment efficacy was assessed using the VRR, calculated as ([initial volume-final volume]/initial volume×100%), and treatment success. A VRR of ≥70% was used as the cutoff value for defining success, rather than a VRR of ≥50%, to avoid overestimating the treatment efficacy of EA compared to SO [10,16]. For the SO group, the VRR was considered to be 100% if the TGDC was completely excised during surgery.…”

“…This decision was based on the hypothesis that the effective volume of ethanol depends not on the initial cyst volume or aspirate volume, but rather on the collapsed cyst volume following aspiration. This is because the therapeutic effect of EA is achieved through the exposure of the secretory lining cells of the cystic wall to ethanol [16]. While limited research is available on the appropriate volume of ethanol injection in EA for TGDCs, a study on EA for cystic thyroid nodules by Cho et al in 2021 [23] reported a high treatment success rate (88.5%) even after a single EA session using a low dose of ethanol (≤5 mL).…”

Ethanol Ablation of a Thyroglossal Duct Cyst and Review of the Literature

“…Recent studies comprising fewer than 200 patients in Korea, Hong Kong, and Turkey have demonstrated mean VRRs ranging from 73% to 96.2% at final follow-up examination [ 1-7 , 10 ]. The largest among them was performed by Park et al in Korea, with 77 patients undergoing EA for TGDC.…”

“…Another, less invasive treatment option for TGDCs is ultrasound-guided ethanol ablation (EA). EA is currently rarely used for TGDC in the United States; however, it has been used successfully in Europe and Asia for the last decade, with increasing frequency [ 1-7 , 10 ]. In this case report we describe the successful treatment of a TGDC with EA at our institution in the United States.…”