Ultrasound-Guided Percutaneous Ethanol Injection Protocol to Treat Solid and Mixed Thyroid Nodules

Abstract

ContextUltrasound (US)-guided percutaneous ethanol injection (PEI) has been proposed for treatment of benign thyroid nodules (TNs). However, there is no consensus for the optimal amount of ethanol injection, number of applications, and time to re-evaluation in order to achieve maximum volume reduction with minimum adverse effects.ObjectiveThe purpose of the present study was to analyze the effectiveness of an US-guided PEI protocol to treat solid and mixed TNs based on a new target outcome.Patients and methodsWe performed a prospective study evaluating the results of PEI in 52 patients with benign solid and mixed TNs. The ethanol dose was fixed in 30% of the nodular volume per session. Patients returned 1 month after each session for US re-evaluation. Therapeutic success was defined as volume reduction of at least 30% associated with disappearance of clinical symptoms and a complete esthetic satisfaction reported by the patient.ResultsWe performed a mean of 2.8 ± 1.9 PEI sessions, with an average total volume of ethanol injected of 9.1 ± 10.3 ml, and a follow-up time of 10.0 ± 8.7 months. There was a reduction of at least 50% of the initial nodular volume in 33 patients (63.5%). In 11 patients (21.2%), the reduction did not reach 50% (mean reduction of 31 ± 11%), but 6 of them reported esthetically satisfactory results and treatment was stopped. Our therapeutic success rate considering the patients with esthetic improvement was 75%. There were no severe complications.ConclusionOur protocol is effective and safe to treat solid and mixed benign TNs based on our established outcome.

Non-Surgical and Non-Radioiodine Techniques for Ablation of Benign Thyroid Nodules: Consensus Statement and Recommendation

“…Treatment of recurrent thyroid cysts with ethanol leads to better results than simple evacuation of cystic fluid [12]. In small case series, treatment with ethanol resulted in a mean nodule volume reduction of 51 % in one series (n = 30 ) and in 31 ± 11 % at least 50 % in another study (n = 52) [13,14]. Reported adverse events were pain, transient hyperthyroidism, transient and permanent recurrent nerve palsy, permanent ipsilateral facial dysaesthesia, and paranodular fibrosis with need of surgery.…”

Image‐guided chemical and thermal ablations for thyroid disease: Review of efficacy and complications

“…Tissue heating results in pain for patients who undergo thermal ablation, and the use of pericapsular lidocaine has been suggested to anesthetize surrounding sensory nerves . Rates of discomfort vary between studies with groups reporting rates between 2% and 60% . Severe pain is unusual, although in a series of 125 toxic nodules treated with ethanol, Tarantino et al found that 2% of patients refused treatment due to pain.…”

Interventional radiology of the thyroid gland: critical review and state of the art

“…According to the new guidelines, PEI represents the first-line treatment for relapsing and symptomatic benign cystic lesions and for nodules with an important fluid component. This is due to its safety, tolerability, effectiveness in volume reduction, cost effectiveness, low rates of recurrence, and short-and longterm complications (1,36,(39)(40)(41)(42)(43). PEI was initially used also to treat hyper-functioning nodules or nodular goiters.…”

“…The procedure stops in case ethanol leakage is observed out of the nodule or if the patient refers severe pain. Some authors inject a saline solution or lidocaine during final withdrawal of the needle at the end of the procedure (36,(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50). Usually, PEI is a well-tolerated and safe technique.…”