Alcohol Ablation of Thyroid and Parathyroid Lesions and Lymph Nodes

Abstract

Alcohol ablation, also known as percutaneous ethanol injection (PEI) and ethanol ablation (EA), has many applications for the treatment of endocrine neck diseases. Cell dehydration and protein denaturation, resulting in coagulative necrosis and fibrotic changes, are the immediate toxic effect induced by instillation of ethanol into the target tissue. EA is the first-line treatment for symptomatic cystic and predominantly cystic thyroid nodules. The efficacy of EA depends on a number of factors, e.g., the initial volume the lesion, the amount of ethanol instilled, the percentage of the solid component of the cyst. EA of thyroid cystic lesions is a safe procedure and no relevant side effects are usually recorded; nevertheless, being aware of the potential for recurrent laryngeal nerve (RLN) injury is required throughout the procedure. EA is not recommended for the treatment of either autonomously functioning thyroid nodules or solid cold thyroid nodules because of high recurrence rate, side effects, and the availability of other more effective ultrasound-guided interventional techniques. Regarding parathyroid (PT) lesions, EA can be used for treatment of large nonfunctional PT cysts and, in selected cases, for the treatment of hyperfunctioning PT glands in patients with chronic renal failure. Finally, EA can be used to treat metastatic lymph nodes from differentiated thyroid cancer in poor surgical candidates or patients seeking to avoid multiple reoperations.