Abstract
BackgroundTo evaluate the efficacy, safety, pain perception and health-related quality of life (QoL) of percutaneous ethanol injection treatment (PEIT) as an alternative to thyroid surgery in symptomatic thyroid cysts.MethodsThirty consecutive patients (46 ± 10 years; 82 % women) with symptomatic benign thyroid cysts relapsed after drainage were included. In all cases, cytology prior to treatment, maximum cyst diameter and volume were determined. PEIT was conducted using the established procedure, and the volume of fluid removed and pain perceived by the patient were assessed. In each procedure, the volume of alcohol instilled was <2 ml. After follow-up, final cyst diameter and volume were determined and the persistence of symptoms and QoL were assessed by a questionnaire (SF-36).ResultsMean symptom duration was 10 ± 20 months. A single session of PEIT was required to complete the procedure in 45 % of patients, two in 31 % and three in 13 %. Mean initial maximum cyst diameter was 3.5 ± 1.0 cm and mean extracted liquid volume 61 ± 36 ml. During PEIT, 39 % of patients experienced virtually no pain, 43 % mild pain and 17 % moderate pain. No complications of PEIT were observed. After 12.1 ± 1.4 months of follow-up, cysts were reduced more than 70 % in volume in 86.3 % of patients, more than 80 % in 61.9 % and more than 90 % in 42 %. On the health-related QoL SF-36 questionnaire, patient scores 6 months post-PEIT did not differ significantly from those of the healthy Spanish population. With respect to cosmetic complaints or local symptoms of compression, PEIT-treated patients presented an initial score of 22 ± 8 and 13 ± 5 after treatment (p < 0.05).ConclusionsIn our experience, percutaneous ethanol injection has prove to be an effective, safe and well-tolerated first-line treatment of symptomatic thyroid cysts.
Highlights
To evaluate the efficacy, safety, pain perception and health-related quality of life (QoL) of percutaneous ethanol injection treatment (PEIT) as an alternative to thyroid surgery in symptomatic thyroid cysts
Fine-needle aspiration (FNA) cytology was benign in all samples obtained from the predominantly cystic nodules and the other nodules with sonographic criteria for FNA cytology [13]
Initial calculated cyst volume was significantly greater in the group of patients who required three or more PEIT procedures compared with those treated with one or two PEITs (29.6 ± 25.5 ml vs. 15.5 ± 10.6 ml, respectively; p < 0.05)
Summary
Safety, pain perception and health-related quality of life (QoL) of percutaneous ethanol injection treatment (PEIT) as an alternative to thyroid surgery in symptomatic thyroid cysts. Hegedüs reported a significant 82 % volume reduction in the PEIT group (n = 33) compared to 18 % in the saline treated group (n = 33) [7], with few complications, thereby providing data permitting this technique to be considered as a reliable alternative to thyroid surgery. In this respect, recent guidelines in the USA and Europe [2] state that PEIT is a clinically-effective, non-surgical option for repeatedly drained recurrent thyroid cysts. There is a paucity of reports in the literature from few centres describing the outcomes of this technique for avoiding surgery in these patients when it is introduced in systematic clinical practice
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