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Su C, Liu YJ, Qian LX. Modified percutaneous ethanol injection method combined with microwave ablation for the treatment of symptomatic, predominantly cystic, benign thyroid nodules: a retrospective study of 201 cases. Int J Hyperthermia 2021; 38:995-1001. [PMID: 34180768 DOI: 10.1080/02656736.2021.1924407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Percutaneous ethanol injection (PEI) and microwave ablation (MWA) are both important methods used in treating benign thyroid nodules. This study aimed to investigate the efficacy and safety of a modified PEI method combined with MWA for the treatment of symptomatic, predominantly cystic and benign thyroid nodules. MATERIALS AND METHODS This study included 201 patients who underwent treatment in our department between April 2015 and August 2018. Predominantly cystic thyroid nodules were treated by the modified PEI procedure, which included short-term boiling ethanol ablation (STBEA) and was combined with MWA. Complications, the volume reduction ratio (VRR), symptoms and cosmetic scores were recorded at 1, 3, 6 and 12 months after treatment and every 6 months thereafter. RESULTS No major complications were observed during or after the treatment. Ten patients (4.8%) experienced temporary voice change, which resolved within 3 months. Of 200 (97.6%) out of 205 nodules showed significant volume reduction at the final follow-up. Recurrence occurred for only 5 (2.4%) nodules. The mean thyroid nodule volume decreased from 17.40 ± 3.21 mL at baseline to 1.17 ± 0.37 mL at 12 months. The greatest VRR was observed within the first 3 months after treatment. CONCLUSIONS The modified PEI method combined with MWA is safe and effective for the treatment of predominantly cystic benign thyroid nodules and provides a shorter operating time and lower recurrence rate than traditional treatments.
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Affiliation(s)
- Chen Su
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Yu-Jiang Liu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Lin-Xue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
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Iñiguez-Ariza NM, Lee RA, Singh-Ospina NM, Stan MN, Castro MR. Ethanol Ablation for the Treatment of Cystic and Predominantly Cystic Thyroid Nodules. Mayo Clin Proc 2018; 93:1009-1017. [PMID: 30078409 DOI: 10.1016/j.mayocp.2018.05.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/01/2018] [Accepted: 05/24/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the efficacy and safety of percutaneous ethanol injection (PEI) for the treatment of symptomatic cystic thyroid nodules. PATIENTS AND METHODS Retrospective analysis of patients with benign cystic thyroid nodules treated with PEI from February 1, 2000, through October 31, 2016. The main outcomes were efficacy, defined as symptom relief or reduction in nodule volume of 50% or more, and safety, defined as no or minor adverse events. RESULTS Twenty patients had PEI. Mean age at the time of PEI was 50 years, and 13 (65%) were women; all patients were euthyroid. Twelve patients (60%) had complex cystic thyroid nodules (>50% cystic component), with the rest being purely cystic. The median largest diameter of the thyroid cyst was 4.5 cm (interquartile range [IQR], 3.2-5.3 cm; range, 2.3-8.0 cm); the median volume pre-PEI was 19.6 mL (IQR, 10.4-48.5 mL; range, 2.8-118.1 mL). The median amount of cystic fluid drained before PEI was 13.5 mL (IQR, 6.8-32.3 mL), and the median amount of ethanol administered was 3 mL (IQR, 2-5 mL; range, 0.5-20 mL). After median follow-up of 2 years, 17 of 19 patients (89%) were asymptomatic. Of 10 patients with available imaging on follow-up, 7 (70%) had a 50% or greater reduction in nodule volume (median volume decrease, 75.64% [IQR, 41.40%-91.99%]). Adverse effects occurred in 4 patients (20%) and were mild and temporary (slight pain, vagal reaction, and bleeding into the cyst). CONCLUSION Percutaneous ethanol injection seems to be a safe and effective alternative to surgical resection for patients with purely or predominantly cystic thyroid nodules and compressive symptoms who decline surgery or are not good surgical candidates.
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Affiliation(s)
- Nicole M Iñiguez-Ariza
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN; Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Robert A Lee
- Division of Radiology, Mayo Clinic, Rochester, MN
| | - Naykky M Singh-Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville
| | - Marius N Stan
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - M Regina Castro
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN.
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Nixon IJ, Angelos P, Shaha AR, Rinaldo A, Williams MD, Ferlito A. Image-guided chemical and thermal ablations for thyroid disease: Review of efficacy and complications. Head Neck 2018; 40:2103-2115. [PMID: 29684251 DOI: 10.1002/hed.25181] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/03/2018] [Accepted: 02/20/2018] [Indexed: 01/03/2023] Open
Abstract
Image-guided ablation of thyroid disease is increasingly being commonly reported. Techniques including ethanol injection and thermal ablation using radio-frequency, laser, and microwave devices have been described. Minimally invasive approaches to the management of benign cystic, solid, and functional thyroid nodules as well as both primary and recurrent thyroid malignancy have been reported. The purpose of this article is to review the current evidence relating to image-guided ablation of thyroid disease with a focus on clinical outcomes and complication rates for patients treated with this minimally invasive approach.
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Affiliation(s)
- Iain J Nixon
- Ear, Nose, and Throat Department, NHS Lothian, Edinburgh, UK
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Ethics, The University of Chicago Medicine, Chicago, Illinois
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Michelle D Williams
- Department of Pathology, Division of Pathology/Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alfio Ferlito
- Coordinator of The International Head and Neck Scientific Group
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Barile A, Quarchioni S, Bruno F, Ierardi AM, Arrigoni F, Giordano AV, Carducci S, Varrassi M, Carrafiello G, Caranci F, Splendiani A, Di Cesare E, Masciocchi C. Interventional radiology of the thyroid gland: critical review and state of the art. Gland Surg 2018; 7:132-146. [PMID: 29770309 DOI: 10.21037/gs.2017.11.17] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Thyroid nodules are a common incidental finding during a routinely ultrasound (US) exam unrelated to the thyroid gland in the healthy adult population with a prevalence of 20-76%. As treated before with surgery, in the last years new minimally invasive techniques have been developed as an alternative to surgery. The aim of this review, based on newly revised guidelines, is to provide some information regarding the basic principles, indications, materials, techniques, and results of mini-invasive procedures or treatments for thyroid nodules. We performed a narrative review including both newest and representative papers and guidelines based on the different procedures of ablation techniques developed in the last years for the diagnosis and the treatment of thyroid nodules. All examined papers referred very good results in term of volume nodule reduction, improvement in related symptoms and cosmetic problems, with a very low rate of complications and side effects for all the minimally invasive technique analyzed. Obviously, some differents between technique based on different kind of thyroid nodules and different indication were found. In conclusion, many thyroid nodules nowadays could be treated thanks to the advent of new mini-invasive technique that are less expensive and present a lower risk of major complications and side effects compared to surgery.
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Affiliation(s)
- Antonio Barile
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Simone Quarchioni
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Federico Bruno
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | | | - Francesco Arrigoni
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Aldo Victor Giordano
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Sergio Carducci
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Marco Varrassi
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Giampaolo Carrafiello
- Department of Health Sciences, Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Ferdinando Caranci
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Alessandra Splendiani
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
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Asilian A, Shahbazi M, Abtahi-Naeini B, Poostiyan N, Nilforoushzadeh MA. Percutaneous ethanol injection as a promising and minimally invasive treatment for axillary osmidrosis: Double-blinded randomized controlled trial. Indian J Dermatol Venereol Leprol 2018; 84:157-162. [PMID: 29393079 DOI: 10.4103/ijdvl.ijdvl_704_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Axillary osmidrosis is a common problem with a strong negative impact on the professional and social quality of life. Several options are available for its treatment. But there are no treatment guidelines. The objective of this study was to evaluate efficacy and safety of percutaneous ethanol injection for treatment of axillary osmidrosis. Methods A randomized, double-blind, placebo-controlled clinical trial to assess clinical efficacy and postoperative complications of percutaneous ethanol injection was performed among 60 patients (12-35 years of age) with axillary osmidrosis. The active agent used in the experimental group (n = 30) was sterile 90% ethanol and the placebo used in the control group (n = 30) was sterile normal saline administered in an identical syringe. The results of malodor elimination were graded by the patients as excellent, good, fair, and poor. All patients were followed-up for 10 months. Results Malodor elimination was graded as good by 15 (50%) patients treated with percutaneous ethanol injection. A significant difference in the improvement of axillary osmidrosis was found between the experimental and control groups (P < 0.001). The most common post-procedure complication was transient subjective skin stiffness in the experimental group, which regressed spontaneously. There were no serious permanent side effects. Limitations Relatively short duration of follow-up; and lack of histopathological evidence of destruction of the apocrine glands after treatment in most patients. Conclusions Percutaneous ethanol injection is an effective and safe treatment method for axillary osmidrosis and does not have permanent side effects.
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Affiliation(s)
- Ali Asilian
- Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoom Shahbazi
- Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahareh Abtahi-Naeini
- Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nazila Poostiyan
- Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Kim KH, McGreevy K, La Fortune K, Cramer H, DeWitt J. Sonographic and cyst fluid cytologic changes after EUS-guided pancreatic cyst ablation. Gastrointest Endosc 2017; 85:1233-1242. [PMID: 27650271 DOI: 10.1016/j.gie.2016.09.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/08/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The effect of EUS-guided pancreatic cyst ablation (PCA) on sonographic morphology and cyst fluid cytology is unknown. The aim of this study was to evaluate morphologic, cytologic, and change in cyst fluid DNA after PCA. METHODS In a prospective single-center study, consecutive patients with suspected benign 10- to 50-mm pancreatic cysts underwent baseline EUS-FNA and EUS-PCA followed 2 to 3 months later by repeat EUS, cyst fluid analysis, and possible repeat PCA. Surveillance imaging after ablation was performed at least annually and classified as complete response (CR), partial response, or persistent, with <5%, 5% to 25%, and 25% of the original cyst volume, respectively. RESULTS Thirty-six patients underwent EUS-PCA with ethanol alone (n = 8) or ethanol and paclitaxel (n = 28), and CR occurred in 19 patients (56%). After EUS-PCA, EUS showed an increase in wall diameter in 68%, decreased number of septations in 24%, increased debris in 24%, loss of mural nodule or novel calcification in 21%, and alteration of fluid viscosity in 48%. Follow-up cytology showed increased epithelial cellularity in 27%, loss or decreased cellular atypia in 15%, increased or appearance of macrophages in 24%, and inflammatory cells in 15%. Postablation DNA amount increased and quality decreased in 71% each. Between the CR and non-CR patients, there was no significant difference in frequency of sonographic or cytologic features. In the CR group, mean DNA quantity was significantly increased after ablation (P = .023) without a change in quality (P = .136). CONCLUSIONS EUS-PCA induces morphologic and cytologic changes of pancreatic cysts, none of which appears to predict overall imaging-defined response to ablation. (Clinical trial registration numbers: NCT00233038 and NCT01643460.).
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Affiliation(s)
- Kook Hyun Kim
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine University Hospital, Indianapolis, Indiana, USA; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Kathleen McGreevy
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine University Hospital, Indianapolis, Indiana, USA
| | - Kristin La Fortune
- Department of Cytopathology and Laboratory Medicine, Indiana University School of Medicine University Hospital, Indianapolis, Indiana, USA
| | - Harvey Cramer
- Department of Cytopathology and Laboratory Medicine, Indiana University School of Medicine University Hospital, Indianapolis, Indiana, USA
| | - John DeWitt
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine University Hospital, Indianapolis, Indiana, USA
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A Rare Complication following Thyroid Percutaneous Ethanol Injection: Plummer Adenoma. Case Rep Endocrinol 2017; 2017:1026139. [PMID: 28465846 PMCID: PMC5390557 DOI: 10.1155/2017/1026139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/23/2017] [Indexed: 11/30/2022] Open
Abstract
Percutaneous ethanol injection (PEI) is a technique used only for benign thyroid nodules, cystic or mixed cystic-solid with a large fluid component. It is a quite low-cost, safe, and outpatient method of treatment. Rare and severe complications have been described after PEI: jugular vein thrombosis and severe ethanol toxic necrosis of the larynx combined with necrotic dermatitis. Moreover, only four thyrotoxicosis cases due to Graves' disease have been reported. We report a case of 58-year-old female with a voluminous thyroid cystic nodule, occupying almost the entire left thyroid lobe. Our patient had already performed surgical visit and intervention of thyroidectomy had been proposed to her, which she refused. At baseline, our patient has a normal thyroid function with negative autoantibodies. According to the nodular structure, intervention of PEI has been performed with a significant improvement of compressive symptoms and cosmetic disorders. About 30 days after treatment, there was a significant volume reduction, but patient developed an acclaimed symptomatic thyrotoxicosis. After ruling out several causes of hyperthyroidism and according to the thyroid scintigraphy findings, we made the diagnosis of Plummer adenoma. To our knowledge, our patient is the first case of Plummer adenoma following PEI treatment of nontoxic thyroid nodule.
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Papini E, Gugliemi R, Pacella CM. Laser, radiofrequency, and ethanol ablation for the management of thyroid nodules. Curr Opin Endocrinol Diabetes Obes 2016; 23:400-6. [PMID: 27504993 DOI: 10.1097/med.0000000000000282] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The majority of benign thyroid nodules are nearly asymptomatic, remain stable in size, and do not require treatment. However, a minority of patients with growing nodules may complain of local symptoms or have cosmetic concerns, and thus seek surgical consultation. RECENT FINDINGS The timely use of ultrasound-guided minimally invasive procedures can change the natural history of benign enlarging thyroid nodules. The procedures produce persistent shrinkage of thyroid nodules and are associated with improvement of local symptoms. Among the various procedures, percutaneous ethanol injection represents the first-line treatment for relapsing thyroid cysts. In solid nonfunctioning nodules, laser and radiofrequency ablation produces a more than 50% reduction in nodular volume that remains persistent over several years. For hyperfunctioning nodules, thermal ablation techniques are not appropriate unless radioactive iodine is contraindicated or not accessible. SUMMARY MITs are best suited for the management of medium or large-sized nodules that are sonographically well visualized. Conversely, large nodules or nodular goiters that extend into the chest are difficult to treat. MITs are performed in outpatient clinics, are less expensive, and have a lower risk of complications, compared to surgery, and usually do not induce thyroid dysfunction. However, malignancy should be ruled out with a dedicated ultrasound neck assessment and repeat fine needle aspiration of the lesion before treatment.
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Affiliation(s)
- Enrico Papini
- aDepartment of Endocrinology and Metabolism bDepartment of Diagnostic Imaging, Regina Apostolorum Hospital, Via San Francesco, Albano, Rome, Italy
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Ferreira MC, Piaia C, Cadore AC. Percutaneous ethanol injection versus conservative treatment for benign cystic and mixed thyroid nodules. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2016; 60:211-6. [PMID: 26910622 PMCID: PMC10522299 DOI: 10.1590/2359-3997000000120] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 09/09/2015] [Indexed: 11/22/2022]
Abstract
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 follow-up 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 self-limited adverse events.
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Affiliation(s)
- Mari Cassol Ferreira
- Faculdade de Medicina da Universidade de São PauloLaboratório de Carboidratos LIM-18Faculdade de Medicina da Universidade de São Paulo (FMUSP), Laboratório de Carboidratos LIM-18;
- Universidade Comunitária da Região de ChapecóChapecóSCBrasilUniversidade Comunitária da Região de Chapecó (Unochapecó), Chapecó, SC, Brasil
| | - Camila Piaia
- Universidade Comunitária da Região de ChapecóChapecóSCBrasilUniversidade Comunitária da Região de Chapecó (Unochapecó), Chapecó, SC, Brasil
| | - Ana Carolina Cadore
- Universidade Comunitária da Região de ChapecóChapecóSCBrasilUniversidade Comunitária da Região de Chapecó (Unochapecó), Chapecó, SC, Brasil
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Perez CLS, Fighera TM, Miasaki F, Mesa Junior CO, Paz Filho GJD, Graf H, Carvalho GAD. Evaluation of percutaneous ethanol injections in benign thyroid nodules. ACTA ACUST UNITED AC 2015; 58:912-7. [PMID: 25627046 DOI: 10.1590/0004-2730000003444] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 08/10/2014] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Camila Luhm Silva Perez
- Department of Endocrinology and Metabolism, Hospital de Clinicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Tayane Muniz Fighera
- Department of Endocrinology and Metabolism, Hospital de Clinicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Fabiola Miasaki
- Department of Endocrinology and Metabolism, Hospital de Clinicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Cleo Otaviano Mesa Junior
- Department of Endocrinology and Metabolism, Hospital de Clinicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Gilberto Jorge da Paz Filho
- Department of Endocrinology and Metabolism, Hospital de Clinicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Hans Graf
- Department of Endocrinology and Metabolism, Hospital de Clinicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Gisah Amaral de Carvalho
- Department of Endocrinology and Metabolism, Hospital de Clinicas, Federal University of Paraná, Curitiba, PR, Brazil
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Papini E, Pacella CM, Hegedus L. Diagnosis of endocrine disease: thyroid ultrasound (US) and US-assisted procedures: from the shadows into an array of applications. Eur J Endocrinol 2014; 170:R133-46. [PMID: 24459238 DOI: 10.1530/eje-13-0917] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In patients with thyroid nodules, ultrasound (US) imaging represents an indispensable tool for assessment of the risk of malignancy. Over approximately four decades, innovative technology and successive improvements have facilitated its entry into the routine management and greatly improved its predictive value. When US features cannot reliably rule out thyroid cancer, US guidance allows a correct and safe sampling also of small or deeply located thyroid lesions. Obtained in this way, cytological or microhistological specimens may reliably define the nature of most thyroid nodules, and the information from histochemical or molecular markers shows promise in the classification of the remaining indeterminate cases. While a prompt surgical treatment can be offered in the minority of suspicious or definitely malignant cases, most individuals warrant only a follow-up. However, at initial evaluation, or over the years, a fraction of these benign lesions may grow and/or become symptomatic. Such cases may benefit from US-guided minimally invasive procedures as an alternative to surgery. Image-guided percutaneous treatments most often achieve relief of neck complaints, are inexpensive, and can be performed on an outpatient basis. The risk of major complications, after adequate training, is very low. Importantly, thyroid function is preserved. Currently, percutaneous ethanol injection for cystic lesions and thermal ablation, with laser or radiofrequency, for solid nodules are increasingly used and disseminated beyond the initial core facilities. In centres with expertise and high patient volume, their use should be considered as first-line treatment alternatives to surgery for selected patients with benign enlarging or symptomatic thyroid lesions.
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12
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Han X, Li F. Percutaneous ethanol injection for the treatment of axillary osmidrosis. Clin Exp Dermatol 2013; 38:484-8. [PMID: 23777489 DOI: 10.1111/ced.12020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2012] [Indexed: 12/16/2022]
Affiliation(s)
- X. Han
- Plastic Surgery Hospital; Chinese Academy of Medical Science and Peking Union Medical College; Beijing; China
| | - F. Li
- Plastic Surgery Hospital; Chinese Academy of Medical Science and Peking Union Medical College; Beijing; China
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13
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Schrut GCA, Miasaki FY, Paz-Filho G, Cavalcanti TCS, Graf H, de Carvalho GA. Changes associated with percutaneous ethanol injection in the treatment of thyroid nodules. Endocr Pathol 2011; 22:79-85. [PMID: 21494802 DOI: 10.1007/s12022-011-9156-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Percutaneous ethanol injection (PEI) is an alternative therapy for thyroid nodules (TN). However, some concern is raised on its carcinogenic effects. To evaluate the cytological and clinical changes caused by PEI in patients with benign TN. Thirty-nine patients with TN (23.1% hyperfunctioning) were submitted to a median of three PEI sessions. After a median of 17 months, patients were reassessed. A new ultrasound-guided fine needle biopsy (US-FNB) was performed, and the smears were analyzed after May-Grünwald-Giemsa staining. The diagnostic findings and the cellular characteristics were compared before and after treatment. There was an increase in the proportion of nondiagnostic/unsatisfactory results (from 2.5% to 18.9%). No malignant cases were observed. The proportion of moderate/intense macrophage infiltration decreased from 60% to 15%. Before treatment, 23.1% patients had hyperthyroidism, which was completely or partially resolved in 66.7%. By ultrasound, the percentage of homogeneous nodules decreased from 64.0% to 38.4% (p=0.0235), and the mean nodule volume decreased from 13.4 ± 12.2 to 5.3 ± 5.1 cm(3). We demonstrate that PEI increases the proportion of nondiagnostic/unsatisfactory results from US-FNB. Therefore, cytological findings after PEI must be evaluated with caution. Our results also suggest that PEI is an efficacious and safe therapeutic option, with no carcinogenic effects observed on cytological evaluations. Safety and efficacy must be evaluated in larger studies with longer follow-up periods.
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Affiliation(s)
- Gianna Carla Alberti Schrut
- SEMPR-Service of Endocrinology and Metabolism, Federal University of Parana, Rua Agostinho Leão Junior, 285, Curitiba, Brazil
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Polyzos SA, Patsiaoura K, Zachou K. Histological alterations following thyroid fine needle biopsy: a systematic review. Diagn Cytopathol 2009; 37:455-65. [PMID: 19306421 DOI: 10.1002/dc.21055] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Thyroid fine-needle biopsy (FNB) is a simple, reliable, inexpensive, and generally safe diagnostic procedure in the management of thyroid nodules. However, the trauma inflicted by the needle may lead to various degrees of histological alterations, observed in histological specimens, if thyroidectomy follows. Post-FNB histological alterations of the thyroid (PFHAT) can generally be divided into acute and chronic. Hemorrhage is the most common acute and fibrosis the most common chronic PFHAT. Some of the PFHAT causes problems in histological assessment, making diagnosis difficult, even leading to misdiagnosis. In this review, we tried to collect and summarize all reported PFHAT cases and studies, aiming to make involved physicians, cytologists, and pathologists aware of the spectrum of PFHAT and to provide information to help in differential diagnosis and to avoid misdiagnoses, which could lead to unnecessary radical surgery and/or adjuvant therapy.
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Affiliation(s)
- Stergios A Polyzos
- Second Medical Clinic, Medical School, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Greece.
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15
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Song DE, Kim YM, Gong G. Cytomorphological changes after ultrasound-guided percutaneous ethanol injection in benign thyroid nodules. Cytopathology 2009; 20:183-7. [DOI: 10.1111/j.1365-2303.2008.00556.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Torlak V, Zemunik T, Modun D, Capkun V, Pesutić-Pisać V, Markotić A, Pavela-Vrancić M, Stanicić A. 131 I-induced changes in rat thyroid gland function. ACTA ACUST UNITED AC 2008; 40:1087-94. [PMID: 17665045 DOI: 10.1590/s0100-879x2006005000127] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Accepted: 04/03/2007] [Indexed: 11/21/2022]
Abstract
Therapeutic doses of (131)I administered to thyrotoxic patients may cause thyroid failure. The present study used a rat model to determine thyroid function after the administration of different doses of (131)I (64-277 microCi). Thirty male Fisher rats in the experimental group and 30 in the control group (untreated) were followed for 6 months. The animals were 4 months old at the beginning of the experiment and were sacrificed at an age of 9 months. Hormone concentration was determined before (131)I administration (4-month-old animals) and three times following (131)I administration, when the animals were 7, 8, and 9 months old. The thyroid glands were removed and weighed, their volume was determined and histopathological examination was performed at the end of the experiment. Significant differences in serum triiodothyronine and thyroid-stimulating hormone concentration, measured at the age of 7, 8, and 9 months, were found in the experimental group. During aging of the animals, the concentration of thyroxin fell from 64.8 +/- 8.16 to 55.0 +/- 6.1 nM in the control group and from 69.4 +/- 6.9 to 25.4 +/- 3.2 nM in the experimental group. Thyroid gland volume and weight were significantly lower in the experimental than in the control group. Thyroid glands from the experimental group showed hyaline thickness of the blood vessel wall, necrotic follicles, a strong inflammatory reaction, and peeling of necrotic cells in the follicles. In conclusion, significant differences in hormone levels and histopathological findings indicated prolonged hypothyroidism after (131)I administration to rats, which was not (131)I dose dependent.
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Affiliation(s)
- V Torlak
- Department of Nuclear Medicine, Clinical Hospital Split, University of Split, Soltanska 2, 21000 Split, Croatia
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17
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Lima MA, Fagundes TA, Raffaelli CM, Ferreira BP, Resende EM, Fonseca ECR, Borges MDF. Alcoolização de nódulo tiroidiano em região endêmica de bócio colóide. ACTA ACUST UNITED AC 2007; 51:1007-12. [DOI: 10.1590/s0004-27302007000600017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Accepted: 02/27/2007] [Indexed: 11/22/2022]
Abstract
A doença nodular tiroidiana é problema clínico comum, principalmente em regiões com carência de iodo. Esse estudo avaliou a eficácia da injeção percutânea de etanol (IPE) no tratamento de nódulos tiroidianos únicos, múltiplos, sólidos, císticos, de diferentes tamanhos com ou sem disfunção glandular, em região endêmica de bócio. Quarenta e dois pacientes com diagnóstico de bócio colóide ou hiperplasia nodular colóide, na punção biópsia aspirativa por agulha fina (PBAAF), foram selecionados para análise após terem sido submetidos a pelo menos duas IPEs. Os nódulos tiroidianos eram múltiplos (sólidos e ou císticos) em 52,4% dos pacientes, únicos e sólidos ou mistos em 35,7% e únicos e císticos em 11,9%. A redução média dos nódulos após injeção de etanol foi de 58,2% para os únicos e 60,8% nos císticos. Nos nódulos múltiplos, avaliou-se a redução de todo o lobo tiroidiano, alcançando 52,4% de redução. Os efeitos colaterais registrados foram decorrentes apenas do desconforto na aplicação. Este estudo indica que a injeção percutânea de etanol (IPE), alcançando reduções médias de volume que variam de 49 a 60%, é método seguro, eficaz e simples para o tratamento de nódulos tiroidianos benignos.
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Affiliation(s)
- Marcus Aurelho Lima
- Associação de Combate ao Câncer do Brasil Central; Universidade Federal do Triângulo Mineiro
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18
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Barbaro D, Orsini P, Lapi P, Pasquini C, Tuco A, Righini A, Lemmi P. Percutaneous Laser Ablation in the Treatment of Toxic and Pretoxic Nodular Goiter. Endocr Pract 2007; 13:30-6. [PMID: 17360298 DOI: 10.4158/ep.13.1.30] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report data regarding treatment with use of percutaneous laser ablation (PLA) in autonomously functioning thyroid nodules (AFTN). METHODS We treated 18 patients (10 women and 8 men, 31 to 80 years old) who presented with a single hyperfunctioning thyroid nodule (8 patients) or a multi-nodular goiter (10 patients) with clearly hyperfunctioning areas on a thyroid scintiscan. In 5 cases, free thyroxine (FT4) and free triiodothyronine (FT3) levels were high, and in these patients and a further 9 patients with cardiovascular symptoms, methimazole therapy was initiated to restore euthyroidism. The total number of PLA sessions ranged from 1 to 5 (median, 3). Thyroid-stimulating hormone, FT4, FT3, thyroglobulin, and antithyroglobulin and anti-thyroid peroxidase antibodies were measured by a commercial kit the day after PLA treatment, then weekly during the first month, and monthly thereafter. The Student t test was used for statistical analyses, and data are reported as mean values +/- SE. RESULTS After each PLA session, there was a transient and mild increase in FT4 and FT3-5.2% to 18.1% (mean, 11.1 +/- 0.69%) (P<0.001) in patients not treated with methimazole and 4.0% to 8.3% (mean, 5.9 +/- 0.31%) (P<0.001) in patients treated with methimazole-relative to values before treatment; however, these values never reached the range of hyperthyroidism. In addition, thyroglobulin showed a remarkable increase after 24 hours- 115% to 390% (mean, 266.0 +/- 12.7%) (P<0.001). Thyroid-stimulating hormone increased in all cases and reached normal values in all patients with single AFTN and in 5 patients (50%) with multinodular goiter within 3 months after PLA. At 1-year follow-up, the decrease in nodular volume was 24% to 72% (mean, 59.3 +/- 8.2%; P<0.001). CONCLUSION Our data show that PLA can be a useful treatment in AFTN and particularly in single toxic nodules. Possible elective indications are patients who refuse surgical or radioiodine treatment and patients with cardiovascular comorbidity who need rapid restoration of the euthyroid state and who cannot tolerate the discontinuation of antithyroid drugs for radioiodine treatment.
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Affiliation(s)
- Daniele Barbaro
- The Sezione Endocrinologia, Spedali Riuniti Livorno, Livorno, Italy
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Hoyt K, Forsberg F, Merritt CRB, Liu JB, Ophir J. In vivo elastographic investigation of ethanol-induced hepatic lesions. ULTRASOUND IN MEDICINE & BIOLOGY 2005; 31:607-12. [PMID: 15866410 DOI: 10.1016/j.ultrasmedbio.2005.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2004] [Revised: 01/04/2005] [Accepted: 01/13/2005] [Indexed: 05/02/2023]
Abstract
Ethanol-induced hepatic lesions were investigated in swine for in vivo use as a strain imaging animal model. Lesions (n = 25) were induced by injecting ethanol (doses 0.33 to 2.0 mL) directly into the surgically exposed liver at depths of 12, 15 or 25 mm. Lesions were imaged with a modified HDI 1000 scanner (Philips Medical Systems, Bothell, WA, USA). The elastograms (n = 91) characterized lesions as being areas harder than the surrounding soft hepatic tissue. Elastographic lesion sizes and the corresponding injected ethanol dose used to induce the lesions were shown to be statistically significant (r(2) = 0.22; p = 0.029) using a linear regression analysis. Additionally, lesion depth was shown to be statistically insignificant (r(2) < 0.12; p > 0.10) when regressed against elastographic lesion size. An analysis of elastographic and gross pathology lesion sizes indicated no correlation (r(2) < 0.01; p = 0.973). Subsequently, lesion types were sorted by size and regression lines were computed from quasilinear regions of the corresponding run charts. Trend lines indicate a four-to-three size relationship between the selected elastographic and pathology lesion sizes. Comparison of elastogram lesion sizes from two independent observers using a paired t-test resulted in no statistically significant difference (p = 0.14). In conclusion, ethanol-induced hepatic lesions in swine is a suitable animal model for evaluation of strain-based imaging systems, due to the ease of generation and repeatability.
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Affiliation(s)
- Kenneth Hoyt
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Mauz PS, Maassen MM, Braun B, Brosch S. How safe is percutaneous ethanol injection for treatment of thyroid nodule? Report of a case of severe toxic necrosis of the larynx and adjacent skin. Acta Otolaryngol 2004; 124:1226-30. [PMID: 15768823 DOI: 10.1080/00016480410020284] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Since 1990, percutaneous ethanol injection therapy (PEIT) has been clinically applied as a treatment for autonomous functioning nodules of the thyroid as well as for cystic lesions. Some additional indications are currently under consideration, e.g. inoperable advanced cancer of the thyroid. Since its inception, PEIT has generally been regarded as an effective, low-risk, inexpensive procedure which can be performed on an ambulatory basis. MATERIAL AND METHODS We report the first case of severe ethyl toxic necrosis of the larynx combined with necrotic dermatitis in a patient treated with PEIT by a radiologist. RESULTS The patient was admitted to hospital, where the necrosis and dermatitis were treated conservatively. A cyst which developed in the right false vocal fold was removed by microsurgery 10 months later. Voice was restored almost to normal but a significant reduction in nodular volume was not seen, probably due to the inexperience of the operator. CONCLUSION PEIT for functional thyroid gland autonomy is an inexpensive method of treating hyperthyroidism with focal autonomy on an ambulatory basis if surgical intervention and radioiodine therapy are not feasible either for medical reasons or because of refusal by the patient. Severe complications must be taken into consideration and discussed with the patient. To avoid complications, substantial experience and a precise ultrasound-guided injection are required. In the case of complications the opinion of a specialist should be sought at anearly stage.
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Affiliation(s)
- Paul-Stefan Mauz
- Department of Otolaryngology--Head & Neck Surgery, University Hospital of Tübingen, Tübingen, Germany.
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