Abstract
To evaluate the efficacy and safety of percutaneous ethanol injection (PEI) in reducing the volume of cystic and mixed thyroid nodules. 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). 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). 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.
Highlights
Thyroid nodules are characterized by excessive structural growth, functional transformation, and/or cystic degeneration of one or several areas wi thin the gland [1]
Of 36 nodules treated with percutaneous ethanol injection (PEI), 13 were cystic, eight were predominantly cystic and 15 were predominantly solid
Thyroid nodules treated with PEI showed a mean volume reduction of 78.2%
Summary
Thyroid nodules are characterized by excessive structural growth, functional transformation, and/or cystic degeneration of one or several areas wi thin the gland [1]. These nodules are detected in 4 to 8% of the adult population when evaluated by palpa tion, and between 13 to 67% when evaluated by ultra sonography [2]. Conventional and conserva tive treatment modalities have shown unsatisfactory re sults in reducing the volume of the nodules and raised concern about possible side effects [3,4]. Surgery is a long-established therapeutic option for benign thyroid nodules. The cost of thyroid surgery, risk of temporary or permanent complications and impact on quality of life remain relevant concerns. At tempts have been made during the past two decades to conduct minimally invasive treatments without general anesthesia, and with minimal damage to the skin and cervical structures [5,6]
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