Ethanol ablation of benign thyroid cysts and predominantly cystic thyroid nodules: factors that predict outcome. Poster No.: C-0322 Congress: ECR 2014 Type: Authors: Keywords: DOI: Scientific Exhibit J. Park, D. W. Kim; Busan/KR Cysts, Ablation procedures, Ultrasound, Thyroid / Parathyroids, Head and neck 10.1594/ecr2014/C-0322 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 11
Aims and objectives No study has investigated the relationship between aspirate color or degree of aspiration on the success of ethanol ablation (EA) of cystic thyroid nodules. We aimed to evaluate the efficacy of EA of benign cystic thyroid nodules and assess the relevant factors influencing the outcome. Page 2 of 11
Methods and materials Over a 2-year period, 64 benign cystic thyroid nodules in 62 patients were treated with EA. Several factors related to EA efficacy were evaluated, including the cystic component volume, volume and color of aspirates, degree of aspiration, and volume of injected ethanol. In all 64 cases, we performed ultrasound (US) follow-up at least 12 months after the last EA session to evaluate the collapsed cystic component. Page 3 of 11
Results The 64 treated nodules had aspirate colors that were red bloody (n = 3), dark bloody (n = 31), brownish (n = 15), yellow-greenish (n = 13), and colorless (n = 2). The degrees of aspiration were scant (n = 8), mild (n = 3), moderate (n = 8), and complete (n = 45). Success rate of each group classifed as degrees of aspiration is as followed; complete group(93.3%), moderate group(8%), mild group(33.3%), scant group(37.5%). There was successful collapse of the cystic component after initial EA in 52 cases, but a repeat EA was employed in 12 failed cases. Statistical analysis showed that the degree of aspiration and color of aspirates correlated significantly with the success of EA. This study has several limitations. The main limitations are that all the EAs and thyroid USs were performed by a single radiologist and the number of patients with mild aspiration, red bloody fluid, and clear fluid was small. Furthermore, we did not perform a detailed analysis of the aspirates, including the viscosity, presence of colloid materials, and percentage of colloid contents. Finally, 3 needle calibers (18-, 21-, and 23-gauge) were used in this study, but a larger-caliber needle (14- or 16-gauge) was not employed. Page 4 of 11
Images for this section: Fig. 1: A case of complete aspiration with successful result after initial ultrasound (US)- guided percutaneous ethanol ablation (EA) in a 59-year-old man. (A) Longitudinal grayscale image shows a predominantly cystic thyroid nodule (1.8 1.9 2.3 cm) in the right lobe (aspiration of 3 ml dark bloody fluid and injection of 2.5 ml 100% ethanol). (B) Longitudinal gray-scale follow-up US image obtained 3 months after EA, shows complete loss of the cystic component and replacement with hypoechoic materials (0.6 0.7 1.0 cm). (C) Longitudinal gray-scale follow-up US image obtained 18 months after EA, shows marked shrinkage of the nodule (0.3 0.4 0.5 cm). Inje University Pusan Paik Hospital - Busan/KR Page 5 of 11
Fig. 2: A case of moderate aspiration with successful result after initial ultrasound (US)- guided percutaneous ethanol ablation (EA) in a 54-year-old woman. (A) Longitudinal gray-scale US image shows a predominantly cystic thyroid nodule (2.7 3.5 4.4 cm) in the right lobe (aspiration of 10.5 ml dark bloody fluid and injection of 8 ml 100% ethanol). (B) Longitudinal gray-scale follow-up US image obtained 1 month after EA, shows complete disappearance of the cystic component and replacement with hypoechoic materials (1.3 1.7 2.5 cm). (C) Longitudinal gray-scale follow-up US image obtained 22 months after EA, shows marked shrinkage of the nodule (0.7 0.8 1.1 cm). Inje University Pusan Paik Hospital - Busan/KR Page 6 of 11
Fig. 3: A case of scant aspiration with unsuccessful result after initial ultrasound (US)- guided percutaneous ethanol ablation (EA) in a 44-year-old man. (A) Longitudinal gray-scale US image shows a cystic thyroid nodule (2.1 2.9 3.4 cm) in the left lobe (aspiration of 0.1 ml yellow-greenish material and injection of 1 ml 100% ethanol). (B) Longitudinal gray-scale follow-up US image obtained 3 months after the initial EA session, shows moderate decrease in size (1.3 1.6 2.0 cm) but residual cystic component. (C) Longitudinal gray-scale follow-up US image obtained 15 months after the repeat EA session, shows marked shrinkage (0.3 0.4 0.8 cm) without residual cystic component. Inje University Pusan Paik Hospital - Busan/KR Page 7 of 11
Fig. 4 Inje University Pusan Paik Hospital - Busan/KR Page 8 of 11
Fig. 5 Inje University Pusan Paik Hospital - Busan/KR Page 9 of 11
Conclusion The results of this study suggest that complete aspiration of cystic contents was the most important factor in the efficacy of EA of benign cystic thyroid nodules, and yellow-greenish contents were closely related to scant or mild aspiration. In addition, two-stage EA may be useful for the successful treatment of benign cystic thyroid nodules with scant aspiration. Page 10 of 11
References 1. Park NH, Kim DW, Park HJ, Lee EJ, Park JS, Park SI, Bae JM, Lee JH 2011 Thyroid cysts treated with ethanol ablation can mimic malignancy during sonographic follow-up. J Clin Ultrasound 39:441-446. 2. Sung JY, Kim YS, Choi H, Lee JH, Baek JH 2011 Optimum first-line treatment technique for benign cystic thyroid nodules: ethanol ablation or radiofrequency ablation? AJR Am J Roentgenol 196:W210-214. 3. Kim DW, Rho MH, Park HJ, Kwag HJ 2012 Ultrasonography-guided ethanol ablation of predominantly solid thyroid nodules: a preliminary study for factors that predict the outcome. Br J Radiol 85:930-936. 4. Kim YJ, Baek JH, Ha EJ, Lim HK, Lee JH, Sung JY, Kim JK, Kim TY, Kim WB, Shong YK 2012 Cystic versus predominantly cystic thyroid nodules: efficacy of ethanol ablation and analysis of related factors. Eur Radiol 22:1573-1578. Page 11 of 11