Abstract
Ultrasound (US)-guided percutaneous ethanol injection (PEI) has been proposed for treatment of benign thyroid nodules (TNs). However, there is no consensus for the optimal amount of ethanol injection, number of applications, and time to re-evaluation in order to achieve maximum volume reduction with minimum adverse effects. The purpose of the present study was to analyze the effectiveness of an US-guided PEI protocol to treat solid and mixed TNs based on a new target outcome. We performed a prospective study evaluating the results of PEI in 52 patients with benign solid and mixed TNs. The ethanol dose was fixed in 30% of the nodular volume per session. Patients returned 1 month after each session for US re-evaluation. Therapeutic success was defined as volume reduction of at least 30% associated with disappearance of clinical symptoms and a complete esthetic satisfaction reported by the patient. We performed a mean of 2.8 ± 1.9 PEI sessions, with an average total volume of ethanol injected of 9.1 ± 10.3 ml, and a follow-up time of 10.0 ± 8.7 months. There was a reduction of at least 50% of the initial nodular volume in 33 patients (63.5%). In 11 patients (21.2%), the reduction did not reach 50% (mean reduction of 31 ± 11%), but 6 of them reported esthetically satisfactory results and treatment was stopped. Our therapeutic success rate considering the patients with esthetic improvement was 75%. There were no severe complications. Our protocol is effective and safe to treat solid and mixed benign TNs based on our established outcome.
Highlights
Thyroid nodules (TNs) are common entities, often detected in clinical practice, with a largely variable prevalence, depending on the diagnostic method [1, 2]
We performed a mean of 2.8 ± 1.9 percutaneous ethanol injection (PEI) sessions, with an average total volume of ethanol injected of 9.1 ± 10.3 ml, and a follow-up time of 10.0 ± 8.7 months
Considering all patients with nodular volume reduction ≥50% (n = 33) and those who reported esthetic improvement with reduction of 30–50% (n = 6), the therapeutic success rate of our PEI protocol increases to 75% (39/52)
Summary
Thyroid nodules (TNs) are common entities, often detected in clinical practice, with a largely variable prevalence, depending on the diagnostic method [1, 2]. Epidemiological studies have shown that 4–7% of women and 1% of men living in iodine-sufficient regions present palpable TNs [3, 4], whereas ultrasound (US) detects nodules in up to 76% of the adult population, with a greater incidence in women and elderly people [5,6,7,8,9]. Most TNs are benign (94–96%) [10, 11] small and remain asymptomatic, being usually managed only by observation and follow-up. The best treatment for benign nodules remains uncertain [13]. To thyroidectomy, the use of non-surgical, image-guided, minimally invasive methods has been proposed [12,13,14], such as US-guided percutaneous ethanol injection (PEI) [15, 16]
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