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Association of Race, Ethnicity, Language, and Insurance with Time to Treatment Initiation Among Women with Breast Cancer at an Urban, Academic, Safety-Net Hospital. Ann Surg Oncol 2024; 31:1608-1614. [PMID: 38017122 DOI: 10.1245/s10434-023-14612-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/31/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Initial treatment for nonmetastatic breast cancer is resection or neoadjuvant systemic therapy, depending on tumor biology and patient factors. Delays in treatment have been shown to impact survival and quality of life. Little has been published on the performance of safety-net hospitals in delivering timely care for all patients. METHODS We conducted a retrospective study of patients with invasive ductal or lobular breast cancer, diagnosed and treated between 2009 and 2019 at an academic, safety-net hospital. Time to treatment initiation was calculated for all patients. Consistent with a recently published Committee on Cancer timeliness metric, a treatment delay was defined as time from tissue diagnosis to treatment of greater than 60 days. RESULTS A total of 799 eligible women with stage 1-3 breast cancer met study criteria. Median age was 60 years, 55.7% were non-white, 35.5% were non-English-speaking, 18.9% were Hispanic, and 49.4% were Medicaid/uninsured. Median time to treatment was 41 days (IQR 27-56 days), while 81.1% of patients initiated treatment within 60 days. The frequency of treatment delays did not vary by race, ethnicity, insurance, or language. Diagnosis year was inversely associated with the occurrence of a treatment delay (OR: 0.944, 95% CI 0.893-0.997, p value: 0.039). CONCLUSION At our institution, race, ethnicity, insurance, and language were not associated with treatment delay. Additional research is needed to determine how our safety-net hospital delivered timely care to all patients with breast cancer, as reducing delays in care may be one mechanism by which health systems can mitigate disparities in the treatment of breast cancer.
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Comparison of McGrath videolaryngoscope-assisted insertion versus standard blind technique for flexible laryngeal mask airway insertion in adults. Singapore Med J 2022; 63:342-344. [DOI: 10.11622/smedj.2022080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Computer-Aided Diagnostic System for Thyroid Nodules on Ultrasonography: Diagnostic Performance Based on the Thyroid Imaging Reporting and Data System Classification and Dichotomous Outcomes. AJNR Am J Neuroradiol 2020; 42:559-565. [PMID: 33361374 DOI: 10.3174/ajnr.a6922] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 09/29/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Artificial intelligence-based computer-aided diagnostic systems have been introduced for thyroid cancer diagnosis. Our aim was to compare the diagnostic performance of a commercially available computer-aided diagnostic system and radiologist-based assessment for the detection of thyroid cancer based on the Thyroid Imaging Reporting and Data Systems (TIRADS) and dichotomous outcomes. MATERIALS AND METHODS In total, 372 consecutive patients with 454 thyroid nodules were enrolled. The computer-aided diagnostic system was set up to render a possible diagnosis in 2 formats, the Korean Society of Thyroid Radiology (K)-TIRADS and the American Thyroid Association (ATA)-TIRADS-classifications, and dichotomous outcomes (possibly benign or possibly malignant). RESULTS The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the computer-aided diagnostic system for thyroid cancer were, respectively, 97.6%, 21.6%, 42.0%, 93.9%, and 49.6% for K-TIRADS; 94.6%, 29.6%, 43.9%, 90.4%, and 53.5% for ATA-TIRADS; and 81.4%, 81.9%, 72.3%, 88.3%, and 81.7% for dichotomous outcomes. The sensitivities of the computer-aided diagnostic system did not differ significantly from those of the radiologist (all P > .05); the specificities and accuracies were significantly lower than those of the radiologist (all P < .001). Unnecessary fine-needle aspiration rates were lower for the dichotomous outcome characterizations, particularly for those performed by the radiologist. The interobserver agreement for the description of K-TIRADS and ATA-TIRADS classifications was fair-to-moderate, but the dichotomous outcomes were in substantial agreement. CONCLUSIONS The diagnostic performance of the computer-aided diagnostic system varies in terms of TIRADS classification and dichotomous outcomes and relative to radiologist-based assessments. Clinicians should know about the strengths and weaknesses associated with the diagnosis of thyroid cancer using computer-aided diagnostic systems.
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LigGrep: a tool for filtering docked poses to improve virtual-screening hit rates. J Cheminform 2020; 12:69. [PMID: 33292486 PMCID: PMC7656723 DOI: 10.1186/s13321-020-00471-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/19/2020] [Indexed: 01/21/2023] Open
Abstract
Structure-based virtual screening (VS) uses computer docking to prioritize candidate small-molecule ligands for subsequent experimental testing. Docking programs evaluate molecular binding in part by predicting the geometry with which a given compound might bind a target receptor (e.g., the docked "pose" relative to a protein target). Candidate ligands predicted to participate in the same intermolecular interactions typical of known ligands (or ligands that bind related proteins) are arguably more likely to be true binders. Some docking programs allow users to apply constraints during the docking process with the goal of prioritizing these critical interactions. But these programs often have restrictive and/or expensive licenses, and many popular open-source docking programs (e.g., AutoDock Vina) lack this important functionality. We present LigGrep, a free, open-source program that addresses this limitation. As input, LigGrep accepts a protein receptor file, a directory containing many docked-compound files, and a list of user-specified filters describing critical receptor/ligand interactions. LigGrep evaluates each docked pose and outputs the names of the compounds with poses that pass all filters. To demonstrate utility, we show that LigGrep can improve the hit rates of test VS targeting H. sapiens poly(ADPribose) polymerase 1 (HsPARP1), H. sapiens peptidyl-prolyl cis-trans isomerase NIMA-interacting 1 (HsPin1p), and S. cerevisiae hexokinase-2 (ScHxk2p). We hope that LigGrep will be a useful tool for the computational biology community. A copy is available free of charge at http://durrantlab.com/liggrep/ .
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Treatment of latent tuberculous infection among health care workers at a tertiary hospital in Korea. Int J Tuberc Lung Dis 2019; 22:1336-1343. [PMID: 30355414 DOI: 10.5588/ijtld.18.0280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the acceptance of, adherence to, and outcomes of latent tuberculous infection (LTBI) treatment among health care workers (HCWs). DESIGN This was a retrospective study in a tertiary hospital in Korea. From May to August 2017, 2190 HCWs simultaneously underwent a tuberculin skin test (TST) and interferon-gamma release assay (IGRA). LTBI was diagnosed if the TST induration was 10 mm or IGRA results were positive. RESULTS Of 2190 HCWs tested, 1006 (45.9%) were diagnosed with LTBI. Of these, 655 (65.1%) HCWs visited out-patient clinics, 234 (35.7%) of whom were advised treatment by physicians. Among these, 120 (51.3%) accepted the physicians' recommendations. In general, HCWs who were older, male and smoked were less likely to visit out-patient clinics. Sixty (50%) HCWs received 3 months of isoniazid plus rifampicin (3HR) and 57 (47.5%) HCWs received 4 months of rifampicin (4R). The proportion of HCWs with 2 side effects (3HR 20% vs. 4R 7.0%, P = 0.041) and drug stoppage rate (3HR 20% vs. 4R 5.3%, P = 0.017) were higher in the 3HR group than in the 4R group. Of the 120 HCWs, 78 (65%) completed LTBI treatment. CONCLUSION Overall, the acceptance and completion rate for LTBI treatment was not adequate. For effective LTBI management in HCWs, further programmatic strategies are needed.
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Comparison of Clinical Outcomes of Intracranial Aneurysms: Procedural Rupture versus Spontaneous Rupture. AJNR Am J Neuroradiol 2017; 38:2126-2130. [PMID: 28860217 DOI: 10.3174/ajnr.a5344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/09/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Procedural rupture of an intracranial aneurysm is a devastating complication in endovascular treatment. The purpose of this study was to evaluate the clinical outcomes of patients with procedural rupture of unruptured saccular intracranial aneurysms compared with those with spontaneously ruptured aneurysms. MATERIALS AND METHODS A retrospective review was performed for 1340 patients with 1595 unruptured saccular intracranial aneurysms that underwent endovascular coil embolization between February 2010 and December 2014. The clinical outcomes of patients with procedural rupture of unruptured saccular intracranial aneurysms were compared with those of 198 patients presenting with spontaneously ruptured aneurysms. RESULTS In this series, procedural rupture developed in 19 patients (1.4% per patient and 1.2% per aneurysm), and the morbidity related to procedural rupture was 26.3% (95% confidence interval, 8.5%-61.4%) with no mortality. Hunt and Hess scale grades and hospitalization days of patients with procedural rupture were equivalent to those of patients presenting with spontaneous aneurysm rupture. Subsequent treatment procedures after hemorrhage (including lumbar drainage, extraventricular drainage, decompressive craniectomy, and permanent shunt) showed no difference between the 2 groups. The hemorrhage volumes were smaller in the procedural-rupture group (P = .03), and the endovascular vasospasm therapies tended to be more frequently required in the spontaneous aneurysm-rupture group (P = .08). At postictus 6 months, the proportion of modified Rankin Scale scores of ≥2 were lower in the procedural-rupture group (5.3% versus 26.8%, P = .049). In multivariate analysis, spontaneous aneurysm rupture was a significant risk factor for worse clinical outcome (OR = 14.9; 95% CI, 1.2-193.1; P = .039). CONCLUSIONS This study showed better clinical outcomes in the procedural-rupture group. Even though there is a potential chance of aneurysm rupture during treatment, the clinical outcomes after procedural bleeds seem to be more favorable than those of spontaneous rupture.
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Efficacy and Safety of Ethanol Ablation for Branchial Cleft Cysts. AJNR Am J Neuroradiol 2017; 38:2351-2356. [PMID: 28970243 DOI: 10.3174/ajnr.a5373] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 07/10/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Branchial cleft cyst is a common congenital lesion of the neck. This study evaluated the efficacy and safety of ethanol ablation as an alternative treatment to surgery for branchial cleft cyst. MATERIALS AND METHODS Between September 2006 and October 2016, ethanol ablation was performed in 22 patients who refused an operation for a second branchial cleft cyst. After the exclusion of 2 patients who were lost to follow-up, the data of 20 patients were retrospectively evaluated. All index masses were confirmed as benign before treatment. Sonography-guided aspiration of the cystic fluid was followed by injection of absolute ethanol (99%) into the lesion. The injected volume of ethanol was 50%-80% of the volume of fluid aspirated. Therapeutic outcome, including the volume reduction ratio, therapeutic success rate (volume reduction ratio of >50% and/or no palpable mass), and complications, was evaluated. RESULTS The mean index volume of the cysts was 26.4 ± 15.7 mL (range, 3.8-49.9 mL). After ablation, the mean volume of the cysts decreased to 1.2 ± 1.1 mL (range, 0.0-3.5 mL). The mean volume reduction ratio at last follow-up was 93.9% ± 7.9% (range, 75.5%-100.0%; P < .001). Therapeutic success was achieved in all nodules (20/20, 100%), and the symptomatic (P < .001) and cosmetic (P < .001) scores had improved significantly by the last follow-up. In 1 patient, intracystic hemorrhage developed during the aspiration; however, no major complications occurred in any patient. CONCLUSIONS Ethanol ablation is an effective and safe treatment for patients with branchial cleft cysts who refuse, or are ineligible for, an operation.
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Spinal Accessory Nerve: Ultrasound Findings and Correlations with Neck Lymph Node Levels. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2016; 37:487-491. [PMID: 25520295 DOI: 10.1055/s-0034-1385673] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Purpose: To evaluate the ultrasound characteristics of the spinal accessory nerve (SAN) and correlate nerve location with neck lymph node level. Materials and Methods: 50 participants with 100 SANs were enrolled in this study. The SAN was traced from the trapezius muscle to the upper neck and was identified by a hypoechoic linear structure without color Doppler flow. The ultrasound characteristics of the SAN, such as visibility, diameter, relationship with adjacent structures, and its correlation with lymph node levels, were evaluated. Results: The SAN was identified in 96 %-100 % of segments. The mean diameter of the SAN was 0.54 ± 0.09 mm. The SANs was located between the trapezius and levator scapulae muscles and 90.8 % were traced into the trapezius muscle. In the upper neck, the SAN passed deep into the sternocleidomastoid (SCM) muscle in 38 % of cases and between the two heads of the SCM muscle in 62 % of cases. The SAN was found at neck lymph node levels II, III, IV, and V, but not I or VI. Conclusion: Continuous ultrasound monitoring of the SAN and its correlation with lymph node levels is possible in most patients. Our current findings may assist in the future prevention of SAN injury during ultrasound-guided procedures.
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Prophylactic Antiplatelet Medication in Endovascular Treatment of Intracranial Aneurysms: Low-Dose Prasugrel versus Clopidogrel. AJNR Am J Neuroradiol 2016; 37:2060-2065. [PMID: 27390320 DOI: 10.3174/ajnr.a4864] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 05/09/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Prophylactic antiplatelet medication is beneficial in decreasing thromboembolic complications during endovascular treatment of unruptured intracranial aneurysms. The efficacy may be limited by variability of individual response to antiplatelet medication, especially clopidogrel. We compared the efficacy of 2 antiplatelet medications, low-dose prasugrel and clopidogrel, in patients undergoing endovascular treatment of unruptured aneurysms. MATERIALS AND METHODS From November 2014 to July 2015, 194 patients with a total of 222 unruptured aneurysms underwent endovascular treatment at a single institution. Laboratory and clinical data from the prospectively maintained registry were used in this study. Antiplatelet medication was given the day before endovascular treatment (prasugrel 20 mg or 30 mg or clopidogrel 300 mg). Response to the antiplatelet medication was measured by the VerifyNow system. Periprocedural adverse event rates between the 2 groups were compared. RESULTS There were no significant differences in the baseline characteristics of patients and aneurysms between the 2 groups. The P2Y12 reaction unit values were lower (clopidogrel group versus prasugrel group, 242.7 ± 69.8 vs 125.7 ± 79.4; P < .0001) and percentage inhibition values were higher (22.1% ± 19.7% vs 60.2 ± 24.7%; P < .0001) in the prasugrel group. There were no thromboembolic events, but there was 1 procedural bleed in each group, without any clinical consequences. CONCLUSIONS The prasugrel group showed more effective and consistent platelet inhibition. We may omit the antiplatelet response assay with the low-dose prasugrel premedication before the endovascular treatment of patients with unruptured aneurysms. Further study is required to determine whether there is benefit of this strategy regarding clinical outcome.
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Abstract P1-14-15: A randomized phase lll trial of neoadjuvant sequential chemotherapy with 4 cycles of adriamycin plus cyclophosphamide followed by 4 cycles of docetaxel (AC4-D4) versus shorter 3 cycles of FEC followed by 3 cycles of docetaxel (FEC3-D3) in node-positive breast cancer (Neo-Shorter): First report of efficacy & toxicity profile. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-14-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The addition of a taxane to anthracycline-based chemotherapy provided an improved outcome in neoadjuant setting. Two neoadjuvant chemotherapy with 4 cycles of AC followed by 4 cycles of docetaxel (AC4-D4) and 3 cycles of FEC followed by 3 cycles of docetaxel (FEC3-D3) are widely used. Short duration of chemotherapy, 6 cycles rather than 8 cycles might be an attractive approach.
Methods: This is a randomized, single-center, prospective, parallel group, comparative phase III trial (NCT02001506). Patients (pts) with breast cancer of clinically stage II or III, or sized 1.5 cm with histologically proven lymph-node involvement were included. Pts were stratified according to hormone receptor and HER2 expression status and randomized to AC4-D4 and 3 cycles of FEC3-D3 treatment. The primary endpoint was pathological complete response, defined as the absence of invasive disease in the breast and axillary lymph nodes, analyzed by intention to treat.
Results: At the time of submission, a total of 207 pts were enrolled; 1 pt failed screening; 25 pts dropped out (5 pts in AC4-D4 arm and 2 pts in FEC3-D3 arm discontinue treatment due to progressive disease); 39 pts are still receiving neoadjuvant chemotherapy; 142 pts, who received surgery, were included for this analysis. In AC4-D4 arm, among 64 pts, 57 pts achieved clinical response (6 complete response [CR] and 51 partial response [PR]) and among them 9 pts achieved pathologic complete response [pCR]. In FEC3-D3 arm, among 78 pts, 66 pts achieved clinical response (7 CR and 59 PR) and among them 11 pts achieved pCR. Addition of docetaxel increased clinical response in both arms. The most common adverse event was febrile neutropenia. Without prophylactic G-CSF, grade ≥3 febrile neutropenia (FN) occurred 23/661 cycles (3.5%) in AC4-D4 arm and 23/552 cycles (4.2%) in FEC3-D3 arm, respectively. Grade 3 and 4 toxicities other than FN were reported at expected levels in both groups. Sixty-one severe adverse events were reported; 33 (including 23 FN) in AC4-D4 arm and 28 (including 23 FN) in FEC3-D3 arm.
Conclusion: Compared to AC4-D4, shorter duration of FEC3-D3 neoadjuvant chemotherapy showed similar efficacy of pCR rate of 14.0% (versus 14.1% in AC4-D4 arm). The most common and important adverse event was febrile neutropenia in both arms. Updated study findings will be provided.
Citation Format: Kim JE, Ahn J-H, Jung KH, Lee HJ, Gong G-Y, Lee E-M, Ha EJ, Son B-H, Ahn S-H, Ahn SD, Kim H-H, Shin HJ, Kim S-B. A randomized phase lll trial of neoadjuvant sequential chemotherapy with 4 cycles of adriamycin plus cyclophosphamide followed by 4 cycles of docetaxel (AC4-D4) versus shorter 3 cycles of FEC followed by 3 cycles of docetaxel (FEC3-D3) in node-positive breast cancer (Neo-Shorter): First report of efficacy & toxicity profile. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-14-15.
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The Role of Core Needle Biopsy and Its Impact on Surgical Management in Patients with Medullary Thyroid Cancer: Clinical Experience at 3 Medical Institutions. AJNR Am J Neuroradiol 2015; 36:1512-7. [PMID: 25929882 DOI: 10.3174/ajnr.a4317] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 01/04/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE Medullary thyroid carcinoma is an uncommon malignancy that is challenging to diagnose. Our aim was to present our experience using core needle biopsy for the diagnosis of medullary thyroid carcinoma compared with fine-needle aspiration. MATERIALS AND METHODS Between January 2000 and March 2012, 202 thyroid nodules in 191 patients were diagnosed as medullary thyroid cancer by using sonography-guided fine-needle aspiration, core needle biopsy, or surgery. One hundred eighty-three thyroid nodules in 172 patients were included on the basis of the final diagnosis. We evaluated the sensitivity and positive predictive value of fine-needle aspiration and core needle biopsy for the diagnosis of medullary thyroid cancer. We compared the rate of a delayed diagnosis, a diagnostic surgery, and surgery with an incorrect diagnosis for fine-needle aspiration and core needle biopsy and investigated the factors related to the fine-needle aspiration misdiagnosis of medullary thyroid cancer. RESULTS Fine-needle aspiration showed 43.8% sensitivity and 85.1% positive predictive value for the diagnosis of medullary thyroid cancer; 25.7% (44/171) of patients had a delayed diagnosis, while 18.7% (32/171) underwent an operation for accurate diagnosis, and 20.5% (35/171) underwent an operation with an incorrect diagnosis. Core needle biopsy achieved 100% sensitivity and positive predictive value without a delay in diagnosis (0/22), the need for a diagnostic operation (0/22), or an operation for an incorrect diagnosis (0/22). A calcitonin level of <100 pg/mL was the only significant factor for predicting the fine-needle aspiration misdiagnosis of medullary thyroid cancer (P = .034). CONCLUSIONS Core needle biopsy showed a superior sensitivity and positive predictive value to fine-needle aspiration and could optimize the surgical management in patients with medullary thyroid cancer. Because the ability of fine-needle aspiration to diagnose medullary thyroid cancer significantly decreases in patients with serum calcitonin levels of <100 pg/mL, core needle biopsy could be indicated for these patients to optimize their surgical management.
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Combination therapy consisting of ethanol and radiofrequency ablation for predominantly cystic thyroid nodules. AJNR Am J Neuroradiol 2013; 35:582-6. [PMID: 23969340 DOI: 10.3174/ajnr.a3701] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY Predominantly cystic thyroid nodules are often aspirated before radiofrequency ablation to enhance its efficacy; however internal bleeding during the aspiration is a problem. We evaluated the feasibility and safety of ethanol ablation to control internal bleeding that occurred during preparatory aspiration. Between September 2010 and August 2011, 11 of 40 predominantly cystic nodules bled internally during fluid aspiration before radiofrequency ablation. To control the bleeding, 99% ethanol was injected. The efficacy of ethanol in controlling bleeding, final nodule volume and complications were assessed. Control of the bleeding by ethanol ablation and subsequent radiofrequency ablation was feasible in all patients. Ninety-one percent (10/11) could be treated in 1 session. The mean nodule volume dropped from 17.1 to 4.3 mL (P < .018). There were no major complications. Ethanol ablation and radiofrequency ablation combination therapy is a feasible and safe technique for treating predominantly cystic thyroid nodules that exhibit internal bleeding during preparatory aspiration.
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