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Review
. 2019 Dec;36(5):381-385.
doi: 10.1055/s-0039-1696651. Epub 2019 Dec 2.

Ethanol Ablation of Neck Metastases from Differentiated Thyroid Carcinoma

Ricardo Paz-Fumagalli  1 , Xi Li  1   2 , Robert C Smallridge  3
Affiliations
Review

Ethanol Ablation of Neck Metastases from Differentiated Thyroid Carcinoma

Ricardo Paz-Fumagalli et al. Semin Intervent Radiol. 2019 Dec.

Abstract

Differentiated thyroid cancer often metastasizes to cervical lymph nodes, characteristically with slow growth rate and low-level aggressiveness. Cervical lymph node resection is the treatment of choice, but ethanol ablation offers a therapeutic option for patients with few nodes unresponsive to radioiodine therapy and who are poor surgical candidates. The ethanol ablation procedure is minimally invasive, guided sonographically, easily and safely repeated, and easily implemented with minimal technology and cost. Transient nerve injury is infrequent and virtually the only important complication. Current experience indicates that ethanol ablation has the safest therapeutic profile compared to surgery and thermal ablation, and the effectiveness is comparable to thermal ablation and approaches that of surgery. Well-designed clinical trials are lacking.

Keywords: ethanol; lymph node metastasis; nerve injury; thyroid carcinoma; ultrasound.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Sonographic image of biopsy-proven level VI metastatic lymph node from papillary thyroid carcinoma (arrowheads). The needle tip bevel is clearly seen in the middle of the node (arrow).
Fig. 2
Fig. 2
During injection of ethanol, the lymph node (arrowheads) becomes uniformly echogenic indicating satisfactory diffusion of ethanol in the substance of the node. Compare the echotexture to Fig. 1 , obtained immediately before the injection.
Fig. 3
Fig. 3
Sonographic image obtained from another patient during injection of ethanol into level VI lymph node (arrowheads). The tip of the injection needle is clearly seen well positioned in the node (straight arrow). Ethanol has leaked deep to the lymph node, creating a hyperechogenic zone that extends posteriorly, clearly outside of the lymph node (curved arrows). Ethanol leak in this location between the common carotid artery and the airway (central compartment or level VI) is the high-risk zone for ethanol injury of the recurrent laryngeal nerve. This leak was well tolerated without any change in voice.
See this image and copyright information in PMC

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