Percutaneous ethanol injection for benign cystic thyroid nodules: is aspiration of ethanol-mixed fluid advantageous?

Abstract

Background and purpose: We evaluated the differences between percutaneous ethanol injection with and without aspiration of ethanol-mixed fluid for treatment of benign cystic thyroid nodules.

Methods: We examined 60 patients with benign cystic thyroid nodules confirmed by fine-needle aspiration biopsy and divided them into 2 groups according to nonaspiration (group A, n = 30) or aspiration (group B, n = 30) of ethanol-mixed fluid after intracystic ethanol injection. We evaluated in both groups the complete disappearance of the cystic portion of the thyroid nodule on follow-up ultrasonography (first follow-up ultrasonography; mean, 4.6 months in group A; mean, 4.4 months in group B) (chi-square test), side effects or complications during and after the procedure (chi-square test), and the total procedure time (Student t test).

Results: Most patients showed complete disappearance of the cystic portion of the thyroid nodule (group A, n = 29; group B, n = 28), and they revealed no recurrence on follow-up ultrasonography. There was no statistical difference in the success rates between group A and group B (P > .05). Pain, the most common side effect, and other mild side effects or complications occurred in small numbers of patients in each group, but there was no significant difference in side effects or complications between the 2 groups (P > .05), except for intracystic hemorrhage (P < .05) and the complaint of all group B patients due to a double puncture (P < .001). The total procedure time was nearly double in group B than in group A because of the additional procedures, such as complete evacuation of the ethanol-mixed fluid and the 10-minute compression.

Conclusion: Percutaneous ethanol injection without aspiration of ethanol-mixed fluid seems to be the preferable method of treatment of benign cystic thyroid nodules from the perspective of both the physician and the patient.

Fig 1.

16-year-old boy with a purely cystic thyroid nodule (group A). A, Ultrasonogram obtained before ethanol sclerotherapy shows a huge hemorrhagic thyroid nodule. B, Ultrasonogram obtained 2 months after ethanol sclerotherapy reveals the complete disappearance of the cystic portion of the thyroid nodule and replacement by echogenic material. C, Ultrasonogram obtained 9 months after ethanol sclerotherapy shows a decrease in the size of the postsclerotic thyroid nodule.

Fig 2.

46-year-old woman with a cystic thyroid nodule (group B). A, Ultrasonogram obtained before ethanol sclerotherapy shows a nearly pure thyroid cyst with an intracystic blood clot (arrow). B, Ultrasonogram obtained after aspiration of infused ethanol shows the disappearance of the cystic portion and incomplete collapse of the cystic nodule due to the blood clot (arrow). C, Ultrasonogram obtained 24 months after ethanol sclerotherapy shows the markedly decreased size of the thyroid nodule (arrow) without the cystic portion.