Ultrasound-guided Percutaneous Ethanol Injection Research Articles

Ethanol ablation of thyroid cysts in the young with a focus on efficacy and quality of life.

Ultrasound-guided percutaneous ethanol injection therapy (US-PEIT) is used in patients with recurrent symptomatic thyroid cysts as a credible alternative to surgery. Young patients commonly do not wish to undergo surgery and prefer ethanol ablation, if available. The effect of this approach on quality of life is an essential factor in deciding on the treatment options, especially in the young with a long life expectancy and no comorbidity. We performed US-PEIT in a cohort of young patients, 15-30 years, from 2015 to 2020. The patients' general quality of life (QoL), self-reported compression symptoms and neck appearance were evaluated. The cohort comprised 59 patients with 63 cysts, more women than men, with a mean age of 23.8 years. About 1.5 mL of injected alcohol were needed to reach a 90.7% mean cyst volume reduction ratio in 12 months. The method did not fail in any of the patients; a single US-PEIT session was undertaken in 46% of them. The procedure significantly improved each of the patients' symptoms with a significant total score difference (P < 0.001). The total symptom score correlated with the initial cyst volume (P = 0.002; r = 0.395). The mean QoL score by SF-36 6 months after the last US-PEIT was significantly different for physical component summary 56.5 (P < 0.001) but not different for mental component summary 47.7 (P = 0.125), compared to age-corresponding norms. US-PEIT is a safe and effective method for the young, leading to improvements in cosmetic and subjective complaints, and should also be considered as first-line treatment in the young.

Efficacy and Safety of Ultrasound-Guided Percutaneous Polidocanol Sclerotherapy Vs Percutaneous Ethanol Injection in Benign Cystic Thyroid Nodules: Preliminary Results

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

The safety and efficacy of add-on use of oxytocin in uterine leiomyoma patients undergoing high-intensity focused ultrasound and ultrasound-guided intratumoral ethanol injection: a randomized controlled trial.

Uterine leiomyoma is one of the most common benign tumors in females. High-intensity focused ultrasound (HIFU) has been widely used in the therapy of uterine leiomyomas. However, HIFU method has a prolonged duration of operation and poor patient tolerance, which need improvement. This study sought to explore the efficacy and safety of add-on use of oxytocin in uterine leiomyomas patients who received HIFU and ultrasound-guided percutaneous anhydrous ethanol injection. This is a randomized controlled trial. A total of 60 patients with uterine leiomyomas were included and randomly divided into study group and control group. The patients in the control group were treated with HIFU and ultrasound-guided percutaneous anhydrous ethanol injection, while the study group received oxytocin injection in addition to the treatment measures of the control group. The efficacy and safety of the treatments were assessed by using the volume ablation rate of the tumor and the Society of Interventional Radiology (SIR) Practice Guidelines, respectively. Finally, all of the 60 patients (30 in the study group and 30 in the control group) completed the treatments. There were no statistically significant differences between the 2 groups in terms of leiomyoma volume ablation rate (94.48%±2.07% vs. 94.91%±2.53%, P=0.36), crumb gray time (150.70±57.51 vs. 165.77±77.13 s, P=0.37), total treatment energy (556,835.0±202,583 vs. 512,610.0±158,004 J, P=0.19), and total treatment time (116.70±28.61 vs. 107.40±23.22 mins, P=0.14). The pain score of the oxytocin group was significantly greater than that in the control group (4.53±1.55 vs. 3.60±1.19, P=0.008). At 3 months and 1-year post-therapy, no statistically significant differences were observed in the residual necrotic leiomyoma volume between the 2 groups. The add-on use of oxytocin in uterine leiomyomas patients undergoing HIFU and ultrasound-guided intratumoral ethanol injection could not improve treatment effect. Chinese Clinical Trial Registry identifier: ChiCTR2200058584.

Sklerotizace krčních cyst alkoholem pod ultrasonografickou kontrolou jako alternativa operačního řešení

Summary Introduction: Some extrathyroidal cervical cystic lesions can be treated in selected situations by minimally invasive, low-risk method – ultrasound--guided percutaneous ethanol injection therapy (US-PEIT). Here we present 6 cases of neck cysts of various origins – ranula, thyroglossal duct cyst, branchial cleft cyst, midline neck cyst of the pyramidal lobe and dermoid cyst. Method and material: The cohort consisted of 6 patients (mean age 58 ± 13.3 years), who were followed for recurrent cervical cysts located outside the thyroid gland. The cysts were visible, palpable, aesthetically unpleasant and also mechanically compressing the surrounding tissue. After repeated evacuations, they filled in again. The patients repeatedly refused the recommended surgery and demanded an alternative solution. US-PEIT of thyroid cysts is used worldwide as a full-fledged alternative to surgical treatment. We used the same procedure for the treatment of presented neck cysts. Results: The initial volume of cysts was 2–35 mL (mean 17.7 mL); the patients underwent 1–6 sclerotization sessions (mean 3.6). The patients were followed for 12 months; the final volume of solid residue was 0.1–2 mL (mean 1 mL) representing volume reduction by 80–99% (mean 92%). Therapeutic success (volume reduction &gt; 50%) was achieved in all patients. Conclusion: US-PEIT of cervical cysts as an alternative to surgery can be used especially in elderly patients with increased surgical risk or in patients refusing surgery. In middle-aged and older adults, the possibility of a necrotic metastatic lymph node should always be considered. Therefore, a benign cytological examination and an unsuspecting ultrasonographic and CT finding are the basic conditions before performing the ethanol ablation. Key words neck cysts – ultrasound-guided percutaneous ethanol injection therapy

Percutaneous ethanol injection therapy as the first line of treatment of symptomatic thyroid cysts

BackgroundOur aim was to evaluate the efficacy and security of ultrasound-guided percutaneous ethanol injection therapy (US-PEIT) for the treatment of recurrent symptomatic thyroid cysts in two high-resolution consultations of thyroid nodule in the Valencian Community. Patients and methodsThe study comprised thirty-three consecutive patients (51 ± 12 years, 76% women) with symptomatic benign thyroid cysts relapsed after drainage and benign cytology prior to treatment. Through ultrasound, maximum cyst diameter and volume were determined, and the content of the cyst was drained. We then instilled between 2 and 4 ml of ethanol (according to initial volume). We followed up with ultrasound at one, 3, 6 and 12 months and we calculated the total volume and the Volume Reduction Rate (VRR). We evaluated the perceived pain using a visual analog scale. ResultsThe initial median cyst volume was 11.6 ml (8.5–16.5) A single session of US-PEIT was required in 22 patients (67%), two in 8 (24%) and three in 3 (9%). During PEIT, 49% of the patients experienced virtually no pain, 39% mild pain and 12% moderate pain. There were no complications. After 6 months of follow up the median VRR was 93% (84–98). All the patients achieved a volume reduction of more than 50%, 94% of more than 70% and 56% of more than 90%. Twenty-four patients completed a year of follow-up, achieving a VRR of 97% (93–98). ConclusionsIn our experience US-PEIT has proven to be an effective, safe treatment of symptomatic thyroid cysts. For this reason it can be considered as the first line of treatment and included in the portfolio of services of a high-resolution consultation.

Long-term efficacy evaluation of a protocol for the management of symptomatic thyroid cysts with ultrasound-guided percutaneous ethanol injection

AimTo evaluate the long-term efficacy of percutaneous ethanol injection treatment (PEIT) as an alternative to thyroid surgery in symptomatic thyroid cysts. Patients and methods100 subjects (48±12 years; 58% women) with symptomatic thyroid cysts relapsing after drainage were prospectively included. PEIT was conducted using an established procedure, and the initial cyst volume, symptoms and pain perceived by the patient were assessed. The volume of instilled alcohol was ≤2ml without re-extraction in all cases. Patients were followed-up for more than 3 years and final cyst volume and symptom improvement were assessed. ResultsMean maximum cyst diameter before drainage was 3.1±1.2cm. In 71% of patients ≤2 PEIT sessions were required. Median maximum cyst volume was 12.7 (5.4–21.7)ml before the first drainage and median total volume extracted from the cysts was 13.0 (6.2–37.0)ml. After a mean follow-up period of 52±10 months, 98% of patients reported a complete absence of symptoms. The final median volume for the whole group was 0.8 (0.1–2.0)ml with a median volume reduction of 94 (81–99)%. A final volume reduction greater than 65% was observed in 90% of cases. Reported pain during the procedure was absent or mild in 76.4% of cases. ConclusionsPEIT is a safe and well-tolerated first-line treatment for symptomatic thyroid cysts with long-term effectiveness.

Inclusión de la inyección percutánea de etanol como primera línea de tratamiento de los quistes tiroideos sintomáticos

BackgroundOur aim was to evaluate the efficacy and security of ultrasound-guided percutaneous ethanol injection therapy (US-PEIT) for the treatment of recurrent symptomatic thyroid cysts in two high-resolution consultations of thyroid nodule in the Valencian Community. Patients and methodsThe study comprised thirty-three consecutive patients (51±12 years, 76% women) with symptomatic benign thyroid cysts relapsed after drainage and benign cytology prior to treatment. Through ultrasound, maximum cyst diameter and volume were determined, and the content of the cyst was drained. We then instilled between 2 and 4mL of ethanol (according to initial volume). We followed up with ultrasound at one, 3, 6 and 12 months and we calculated the total volume and the Volume Reduction Rate (VRR). We evaluated the perceived pain using a visual analog scale. ResultsThe initial median cyst volume was 11.6mL (8.5-16.5) A single session of US-PEIT was required in 22 patients (67%), two in 8 (24%) and three in 3 (9%). During PEIT, 49% of the patients experienced virtually no pain, 39% mild pain and 12% moderate pain. There were no complications. After 6 months of follow up the median VRR was 93% (84-98). All the patients achieved a volume reduction of more than 50%, 94% of more than 70% and 56% of more than 90%. Twenty-four patients completed a year of follow-up, achieving a VRR of 97% (93-98). ConclusionsIn our experience US-PEIT has proven to be an effective, safe treatment of symptomatic thyroid cysts. For this reason it can be considered as the first line of treatment and included in the portfolio of services of a high-resolution consultation.

Long-term efficacy evaluation of a protocol for the management of symptomatic thyroid cysts with ultrasound-guided percutaneous ethanol injection

AimTo evaluate the long-term efficacy of percutaneous ethanol injection treatment (PEIT) as an alternative to thyroid surgery in symptomatic thyroid cysts. Patients and methods100 subjects (48±12 years; 58% women) with symptomatic thyroid cysts relapsing after drainage were prospectively included. PEIT was conducted using an established procedure, and the initial cyst volume, symptoms and pain perceived by the patient were assessed. The volume of instilled alcohol was ≤2ml without re-extraction in all cases. Patients were followed-up for more than 3 years and final cyst volume and symptom improvement were assessed. ResultsMean maximum cyst diameter before drainage was 3.1±1.2cm. In 71% of patients ≤2 PEIT sessions were required. Median maximum cyst volume was 12.7 (5.4–21.7)ml before the first drainage and median total volume extracted from the cysts was 13.0 (6.2–37.0)ml. After a mean follow-up period of 52±10 months, 98% of patients reported a complete absence of symptoms. The final median volume for the whole group was 0.8 (0.1–2.0)ml with a median volume reduction of 94 (81–99)%. A final volume reduction greater than 65% was observed in 90% of cases. Reported pain during the procedure was absent or mild in 76.4% of cases. ConclusionsPEIT is a safe and well-tolerated first-line treatment for symptomatic thyroid cysts with long-term effectiveness.

A Case of Accessory Parotid Cyst Treated with Ultrasound-Guided Percutaneous Ethanol Injection

A cyst in the accessory parotid gland (APG) is extremely rare, with only three cases having been reported recently in English literature. They were all treated with sclerotherapy, where a cyst may appear as a painless superficial mass in the mid-cheek area. In sclerotherapy, the most commonly used materials are ethanol and OK-432, which report good therapeutic results for the treatment of benign cervical cystic mass. An 85-year-old man came to our clinic with superficial, well-margined ovoid mass on the left cheek. The mass was diagnosed as a benign cyst in APG through imaging studies and core needle biopsy. We performed the ultrasoundguided percutaneous ethanol injection and the cyst disappeared, leaving only the fused cystic wall. We report this very rare and interesting case with a literature review.

Safe and effective percutaneous ethanol injection therapy of 200 thyroid cysts.

Ultrasound-guided percutaneous ethanol injection therapy (US-PEIT) is a minimally invasive procedure that may be performed as an alternative to surgery for the treatment of recurrent symptomatic thyroid cysts for which simple aspiration failed. The present study aimed at assessing US-PEIT in a large cohort of patients, identifying factors influencing treatment outcome. Retrospective analysis of 193 patients with 200 thyroid cysts who underwent US-PEIT in 2004-2018. The initial median cyst volume was 8.5 mL [5.5-16.0]; median final volume at 12 months after the completion of therapy was 0.5 mL [0.2-1.3]. A Volume Reduction Rate (VRR) of 95.0% [86.7-98.0] was achieved. For successful US-PEIT, relatively small total amount of ethanol was needed, on average corresponding to 20.0% [16.7-28.6] of the initial cyst volume. VRR positively correlated with the initial cyst volume and negatively with the presence of complex cyst. Multiple regression analysis showed the presence of complex cyst as an independent predictor of treatment efficacy. US-PEIT of thyroid cysts of all sizes was very successful with using total amounts of ethanol, corresponding to ≈20% of the initial cyst volume.

Ultrasound-Guided Percutaneous Ethanol Injection Protocol to Treat Solid and Mixed Thyroid Nodules.

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.

Treatment of liver cancer of middle and advanced stages using ultrasound-guided percutaneous ethanol injection combined with radiofrequency ablation: A clinical analysis.

Liver cancer is a malignancy of the digestive system and has a high morbidity and mortality rate. Local intervention has become a viable option in identifying liver treatment. The aim of the present study was to analyze the clinical effects of treating liver cancer in middle and advanced stages using ultrasound-guided percutaneous ethanol injection (PEI) in tumors combined with radiofrequency ablation (RFA). A total of 100 patients with stage III–IV liver cancers were selected to participate in the study. Patients were divided into groups. In group A, treatment was initiated with PEI and after 1–2 weeks RFA was applied while in group B treatment was initiated with RFA and after 1–2 weeks PEI was applied. Patients in group C received PEI and RFA simultaneously. The clinical effects in the 3 groups were compared after 6-month follow ups. The volume of tumor ablation necrosis in group A was significantly greater than that in the groups B and C, while the size was significantly smaller compared to groups B and C after ablation. For group A, the complete ablation rate was significantly higher than that in groups B and C, and the differences were statistically significant (P<0.05). Liver damage indices, including raising levels of glutamic-pyruvic transaminase and total bilirubin, were significantly decreased in group A (P<0.05). The survival rate in group A was also significantly higher than in groups B and C (P<0.05). In conclusion, for patients with liver cancer in middle and advanced stages, the treatment method using PEI followed by RFA was more beneficial in terms of improving the tumor ablation rate, alleviating liver damages and increasing survival rates.

Ultrasound-guided percutaneous ethanol injection in papillary thyroid cancer metastatic lymph-nodes

Post-operative neck nodal metastases are detected in 9-20 % of papillary thyroid cancer (PTC). Ultrasound-guided ethanol injection (UPEI) has been used with promising results in the treatment of PTC patients with limited number of lymph-node metastases. We report the imaging and biochemical documentation of UPEI results in four metastatic neck lymph-nodes of papillary thyroid-cancer. A significant reduction both in the diameter of the lymph-nodes and in the serum thyroglobulin levels were observed in all cases and have been reported in a step-by-step sequence. the UPEI treatment is a simple and suitable tool for the treatment of PTC cervical lymph-node metastases.

Ultrasound-guided percutaneous ethanol injection of small and medium-sized thyroid cysts with relatively small amounts of ethanol

Ultrasound-guided percutaneous ethanol injection (US-guided PEI) is used in patients with recurring symptomatic thyroid cysts in whom simple drainage was not successful. It is an alternative non-surgical approach in patients refusing or at risk during surgery. US-guided PEI was performed in 33 patients, with a success rate of 100% and significantly decreased cyst volume after 1, 3 and 6 months after the last PEI compared with the initial volume. The mean number of PEI procedures was 1.5±0.7 with a mean 96% ethanol volume of 2.4±1.2 mL. In the entire group, the initial cyst volume was significantly reduced to the final volume at 6 months after PEI (10.82±5.03 mL vs. 0.78±0.84 mL; P<0.001). Also in all patients, mean volume reduction rates were significantly increased (P<0.001) at check-ups at 1 month (83.1±8.1%), 3 months (89.9±6.3%) and 6 months (92.6±6.4%). In case of medium-sized cysts, more PEI procedures were needed than in small cysts (1.1±0.4 vs. 2.0±0.5). The total amount of 96% ethanol was equal to 22.7±7.9% of the initial cyst volume. Our experiences confirm that small and medium-sized cysts may be successfully treated with relatively small amounts of ethanol. In case of medium-sized cysts, more PEI procedures were needed. Final reduction of complex cysts was achieved later. Apart from temporary localized pain, no serious complications were observed in most cases.

Tiroid kistlerine perkütan etanol enjeksiyonu

Objective: To present the results of 28 patients who were treated by Doppler ultrasound guided percutaneous ethanol injection (PEI) into benign cystic thyroid nodules. Methods: Before percutaneous injection of ethanol, malignancies were excluded with fine needle aspiration biopsy. Volume of the nodule was calculated according to length χ width χ depth χ π/6 formula. During the application, 95% ethanol solution was injected about half of the initial cystic volume. At follow-up nodule diameter, formation of fibrosclerosis and nodule vascularization were evaluated. More than 50% reduction in nodule volume relative to the initial volume was defined success. Results: The success rate with single application of PEI was found 88.5 percent. With administration of the second application of PEI on unsuccessful cases success rate increased to 92.9 percent. Conclusion: Doppler ultrasound-guided PEI injection is a reliable, effective and inexpensive method in the treatment of thyroid cysts with high success rates.

Image-guided Ablation of Postsurgical Locoregional Recurrence of Biopsy-proven Well-differentiated Thyroid Carcinoma

PurposeTo evaluate the clinical outcomes of ultrasound-guided percutaneous radiofrequency (RF) ablation and percutaneous ethanol injection (PEI) as salvage therapy for locoregional recurrence after resection of well-differentiated thyroid carcinoma. Materials and MethodsThere were 42 locoregional, biopsy-proven, papillary and follicular thyroid carcinoma lesions (0.5–3.7 cm) treated, 21 with RF ablation and 21 with PEI. Of treated lesions, 35 were located in the lateral compartments, and 7 were located in the central compartment. Data points in the retrospective analysis, determined beforehand by the investigators, were progression at the ablation site, serum thyroglobulin levels before and after the procedure, and procedural complications. ResultsAverage follow-up after RF ablation was 61.3 months and after PEI was 38.5 months. No progression was detected in the region of ablation for any of the lesions treated with RF ablation. Local progression was detected 4–11 months after ablation in 5 of the 21 lesions treated with PEI, 3 in the lateral compartment and 2 in the central compartment; all of the lesions were successfully retreated with repeat PEI, RF ablation, or surgery. Permanent vocal cord paralysis occurred after one RF ablation procedure of a lateral compartment supraclavicular node. There were no complications after PEI. ConclusionsThis case series provides long-term follow-up evidence of the safety and efficacy of ultrasound-guided RF ablation and PEI for control of locoregional recurrence of well-differentiated thyroid carcinoma after surgery.

Ultrasound-guided Percutaneous Ethanol Injection Was not Mentioned

I wish to add three comments regarding the initiation of prospective studies. Scintigraphy: the AACE/AME guidelines only ascribe evidence level IV C to this procedure (1). Instead of recommending “baseline scintigraphy” (the radiation exposure is that of some 45 thoracic x-ray films) (2), the gain in diagnostic-therapeutic insights should be questioned (1, 3), so the procedure is not, as a German saying goes, as “unnecessary as a goiter.” Routine clinical practice has shown that scintigraphy does not show the majority of sonographically and surgically exposed nodules/cancers and focal autonomies with a size of less than 1–1.5 cm. Without blinded studies of its meaningfulness, the widespread use of scintigraphy should not be promoted. Measuring calcitonin: the extent to which this should be done in every case of nodular goiter (2) or, in a targeted manner, in sonomorphologically suspect thyroid nodules, in order to detect sporadic medullary thyroid cancer, is—in the absence of prospective studies— the subject of controversy (1, 3, 4). Generalized measurements entail risks and unsettle patients because of technical problems in the laboratory and the many false-positive/false-negative results. Measuring calcitonin in specialized thyroid outpatient clinics with valid laboratory testing facilities and expertise in assessing the result seems a viable alternative (4). Ultrasound-guided Percutaneous Ethanol Injection/PEI was not mentioned as the definitive treatment of focal autonomies (1–3). The procedure has been conducted successfully in several thousand patients worldwide and is a routine procedure in intervention centers. Its advantages are a rapid therapeutic effect even after exposure to iodine, cost-effectiveness in the outpatient setting, high acceptability for patients. In unifocal or bifocal autonomies, percutaneous sonography-guided PEI should be discussed with each patient in the interdisciplinary case conference as a low-risk alternative to surgery/radio-iodine treatment. Because of its potential side effects, the procedure should be undertaken in specialized centers with the appropriate expertise (3).

Cutaneous Metastasis of Hepatocellular Carcinoma Following Skin Injury after Transcatheter Arterial Chemoembolization

Dear Editor: Transcatheter arterial chemoembolization (TACE) is widely used as an approach for patients with hepatocellular carcinoma (HCC). Cutaneous complications related to TACE such as erythema, necrosis, and scarring may rarely occur1. This report describes the first known case of cutaneous metastasis of HCC following skin injury after TACE. A 39-year old man had been diagnosed with HCC in January 2010. On the initial computed tomography (CT) image, a 7.8 cm sized tumor was noted. The patient was treated with TACE from February 2010 via the femoral artery. On a follow-up CT in May 2010, the tumor size decreased, however, daughter nodules were noted. The 7th TACE was performed via the internal mammary artery (IMA) due to the presence of collateral pathways. In November 2010, an 8th course of TACE of the IMA was performed. However, an erythematous to violaceous patch developed shortly after the infusion of chemotherapeutic agents and resulted in pigmentation and induration. In January 2011, the patient was referred to the dermatology clinic with two erythematous papules on the right chest that developed at the end of December 2010 (Fig. 1). The papules had developed within the pigmented induration, which was associated with skin injury after the TACE in November 2010. Fig. 1 Two, asymptomatic, erythematous papules and underlying pigmentation and wood plate-like induration on the right chest. Histopathologic examination of the erythematous papule showed asymmetrical, lobulated nests invading the dermis (Fig. 2A). The large cells had a polyhedral shape, eosinophilic cytoplasm, large central nuclei and prominent nucleoli (Fig. 2B). The specimen was negative for AFP (Fig. 2C). CD31 stain did not show evidence of hematogenous spread of tumor nests (Fig. 2D). Fig. 2 (A) Asymmetrical, lobulated cords and nests invading the dermis (H&E, ×40). (B) The large epithelial cells of polyhedral shape showed granular, eosinophilic cytoplasm, large, vesicular, central nuclei and prominent nucleoli (H&E, ... As the papules occurred on the scar and a series of examinations showed no other metastasis, the lesions were thought to be associated with the skin injury after TACE. The biopsy specimen was negative for AFP. However, positive staining for AFP has been reported to be present in 2 to 61% of HCC2. Expression of AFP can be weak, especially in small biopsies. Tumor seeding of HCC after interventional procedures is a rare complication. Cutaneous tumor seeding of HCC along the tract of the needle used in the diagnosis has been reported3. The frequency of needle tract implantation after radiofrequency ablation ranges from 0 to 4.4%.3 Iatrogenic cutaneous tumor seeding by ultrasound-guided percutaneous ethanol injection has also been rarely reported4. TACE via the IMA may be performed when collateral pathways are evident. Repetitive TACEs or large tumor sizes may be associated with the presence of collateral pathways. In our case, TACE-induced injury may have caused inflammatory changes or adhesion of the chest wall that helped the progression of the residual viable tumor along the liver surface to the skin. Adhesion between the HCC and other tissues including vessels such as the peritoneum and/or omentum after TACE has been shown in a laparoscopic study5. We have presented a case of cutaneous metastasis from HCC following skin injury after TACE that was thought to be relevant to the cutaneous complication of the chemoembolization procedure. The potential cutaneous complications of TACE must be taken into consideration.

Short-term efficacy of ultrasound-guided percutaneous ethanol injection enhanced single needle radiofrequency ablation in the treatment of liver cancer

Objective To investigate the short-tern efficacy of ultrasound-guided percutaneous ethanol injection (PEI) enhanced single needle radiofrequency ablation ( RFA) in the treatment of liver cancer.Methods The clinical data of 71 patients who were admitted to the Xijing Hospital from June 2010 to June 2011 were retrospectively analyzed.All patients were divided into the RFA group (25 patients ) and RFA + PEI group (46 patients).In the RFA group,the needle of RFA was injected into the tumor for coagulation with the guidence of ultrasound.In the RFA + PEI group,95％ ethanol was injected into the tumor with the guidence of ultrasound,and then RFA was performed.The tumor necrosis volumes of the 2 groups were assessed by contrast-enhanced ultrasound at 2 weeks after RFA.The relationship between the average RFA energy and volume of ethanol applied and necrosis volume was analyzed.All data were analyzed by using the chi-square test,t test and Pearson correlation coefficient.Results The volume of coagulative necrosis of the RFA group was (22 ± 17) cm3,which was significantly smaller than (55 ± 44) cm3 of the RFA + PEI group (t =3.85,P ＜ 0.05 ).In the RFA + PEI group,the volume of ethanol injected was positively correlated with the volume of coagulative necrosis (r =0.615,t =5.86,P ＜ 0.05 ),but negatively correlated with the treatment efficacy ( r =- 0.709,t =- 7.52,P ＜ 0.05 ).The amount of required energy was positively correlated with the volume of coagulative necrosis (r =0.884,t =14.13,P ＜0.05 ),whereas no significant correlation was detected between the amount of required energy and the treatment efficacy ( r =- 0.225,t =- 1.72,P ＞ 0.05 ).The equation for calculating the volume of ethanol required was conducted:Y =2.526X - 2.693 [ Y:volume of ethanol required ( ml),X:diameter of the tumor (cm) ].Three patients in the RFA + PEI group were complicated by transient pain,flushing and cardiac acceleration after the operation,and the symptoms were alleviated by symptomatic treatment.The levels of transaninase were increased in the 3 groups,and then back to normal at 2 weeks after the treatment.No complications such as hepatic rupture,intestinal perforation,bile leakage or tumor implantation were detected in the 2 groups.The levels of alphafetoprotein (AFP) were significantly decreased.The AFP expressions of 20 patients (80％) in the RFA group and 39 patients (85％) in the RFA + PEI group changed to negative,with no significant difference between the 2 groups ( x2 =0.42,P ＞ 0.05 ).Conclusion PEI helps to increase the volume of coagulative necrosis and to reduce the energy requirement of routine RFA,and enhances the efficacy of single needle RFA. Key words: Liver neoplasms; Ultrasound guidence; Percutaneous ethanol injection; Radiofrequency ablation, single needle

Efficacy of Ultrasound-Guided Percutaneous Ethanol Injection Treatment in Patients with a Limited Number of Metastatic Cervical Lymph Nodes from Papillary Thyroid Carcinoma

Efficacy of Ultrasound-Guided Percutaneous Ethanol Injection Treatment in Patients with a Limited Number of Metastatic Cervical Lymph Nodes from Papillary Thyroid Carcinoma