Ethanol injection PEI for Branchial Cleft Cyst.

Ethanol injection PEI for Branchial Cleft Cyst.

Ethanol injection PEI for Branchial Cleft Cyst.

Dr.Guttler’s comments:

  1. In addition to thyroid, parathyroid and thyroglossal  cysts we add brancial cleft cysts as treatment of choice with ethanol ablation therapy.
  2. We show 2 articles using ethanol ablation.
  3. Call  Alicia for details at 310-393-8860 or secure email to thyroid.manager@protonmail.com
  4. Dr.G.

Efficacy and Safety of Ethanol Ablation for Branchial Cleft Cysts

E.J. Ha et al 

Abstract

BACKGROUND AND PURPOSE: Branchial cleft cyst is a common congenital lesion of the neck. This study evaluated the efficacy and safety of ethanol ablation as an alternative treatment to surgery for branchial cleft cyst.

MATERIALS AND METHODS: Between September 2006 and October 2016, ethanol ablation was performed in 22 patients who refused an operation for a second branchial cleft cyst. After the exclusion of 2 patients who were lost to follow-up, the data of 20 patients were retrospectively evaluated. All index masses were confirmed as benign before treatment. Sonography-guided aspiration of the cystic fluid was followed by injection of absolute ethanol (99%) into the lesion. The injected volume of ethanol was 50%–80% of the volume of fluid aspirated. Therapeutic outcome, including the volume reduction ratio, therapeutic success rate (volume reduction ratio of >50% and/or no palpable mass), and complications, was evaluated.

RESULTS: The mean index volume of the cysts was 26.4 ± 15.7 mL (range, 3.8–49.9 mL). After ablation, the mean volume of the cysts decreased to 1.2 ± 1.1 mL (range, 0.0–3.5 mL). The mean volume reduction ratio at last follow-up was 93.9% ± 7.9% (range, 75.5%–100.0%; P < .001). Therapeutic success was achieved in all nodules (20/20, 100%), and the symptomatic (P < .001) and cosmetic (P < .001) scores had improved significantly by the last follow-up. In 1 patient, intracystic hemorrhage developed during the aspiration; however, no major complications occurred in any patient.

CONCLUSIONS: Ethanol ablation is an effective and safe treatment for patients with branchial cleft cysts who refuse, or are ineligible for, an operation.

Article Figures & Data

Figures

  • Fig 1.

    Flowchart of the patient enrollment process.

  • Fig 2.

    A 22-year-old woman with a right-neck mass. A, A CT scan reveals a 6.5-cm second branchial cleft cyst anteromedial to the sternocleidomastoid muscle and lateral to the carotid sheath. B, After 3 sessions of ethanol ablation, it is nearly obliterated on follow-up CT (arrow). C and D, Transverse sonogram also shows a large cystic mass in the right neck (volume, 48.1 mL) nearly disappeared after the treatment (arrow).

  • Fig 3.

    A 15-year-old adolescent boy with a right-neck mass. A and B, Transverse US and CT scans show a 7-cm cystic mass in the right neck (volume, 36.6 mL). C, During the ethanol ablation, intracystic hemorrhage developed after aspiration of internal contents. D, However, after a second session of ethanol ablation, the cystic mass had disappeared on follow-up US (arrow).

Tables

  • Table 1:

    Initial patient, brachial cleft cyst, and treatment characteristics and changes in the cysts (before versus after ethanol ablation)

    Patient Sex Age (yr) Index Volume (mL) Aspiration Volume (mL) Ethanol Volume (mL) Treatment Sessions (No.) Fluid Volume (mL) at Follow-Up VRR (%) Therapeutic Success
    1–2 mo (n = 17) 3–6 mo (n = 9) 7–12 mo (n = 7) Final Evaluation (n = 15)
    1 M 17 29.4 30.0 10 2 57.9a 0.4 (14) 98.6 Yes
    2 F 13 3.8 3.0 2 2 1.1 4.4a 0.3 0.3 (8) 92.1 Yes
    3 M 33 41.4 40.0 20 2 35.6a 2.4 NA 2.4 (4) 94.2 Yes
    4 M 15 36.6 36.0 10 2 33.7a 9.7 1.2 0.1 (25) 99.7 Yes
    5 M 30 49.9 50.0 20 1 NA NA NA NA (12) NA Yes
    6 F 60 6.1 5.8 4 1 0.2 0.2 0.0 (18) 100.0 Yes
    7 F 38 38.2 20.0 10 2 6.6a NA NA NA (12) NA Yes
    8 F 25 38.0 21.0 10 6 5.7a/25.12a 30.4a/9.3a 2.2 0.5 (16) 98.7 Yes
    9 M 6 12.4 12.0 4 1 NA NA NA NA (22) NA Yes
    10 M 37 42.2 31.0 10 2 15.1a 1.2 0.3 0.3 (12) 99.3 Yes
    11 M 41 7.5 7.0 7 2 7.4a NA NA NA (12) NA Yes
    12 F 26 11.8 12.0 5 1 1.4 0.4 NA 0.4 (6) 96.6 Yes
    13 F 49 32.8 30.0 10 1 0.8 NA NA 0.8 (2) 97.6 Yes
    14 F 34 37.7 15.0 10 2 30.3a NA NA NA (12) NA Yes
    15 F 22 48.1 33.0 25 3 116.1a 86.4a 2.5 2.5 (9) 94.8 Yes
    16 F 25 13.9 10.0 6 2 13.0a 4.3a 2.2 2.2 (7) 84.2 Yes
    17 F 32 5.5 5.0 4 1 1.1 NA NA 1.1 (1) 80.0 Yes
    18 F 72 25.1 17.0 20 1 3.5 NA NA 3.5 (1) 86.1 Yes
    19 M 2 37.6 36.0 10 1 0.7 NA NA 0.7 (2) 98.1 Yes
    20 F 38 10.6 10.0 6 1 2.6 NA NA 2.6 (2) 75.5 Yes
    Mean 30.8 ± 17.0 26.4 ± 15.7 21.2 ± 13.6 10.2 ± 6.3 1.8 ± 1.2 17.3 ± 28.3 15.5 ± 28.2 9.5 ± 21.4 1.2 ± 1.1 93.0 ± 7.9
    • Note:—VRR indicates volume reduction rate; NA, not available.

    • a Additional EA treatment during the follow-up period. The clinical follow-up duration for each patient is shown in parentheses.

  • Table 2:

    Efficacy of ethanol ablation according to the number of treatment sessionsa

    No. of Sessions Single Session (n = 9) Multiple Sessions (n = 11) P Value
    Initial volume 21.3 ± 15.8 30.6 ± 15.3 .160
    Symptom score 8.1 ± 2.2 10.0 ± 0.0 .011
    Cosmetic score 3.9 (3–4) 4.0 (4) .710
    Final volume (VRR) 1.3 ± 1.3 1.1 ± 1.1 .487
        P value .028 .018
    Symptomatic score 0.4 (0–1) 0.5 (0–2) .809
        P value .017 .004
    Cosmetic score 1.2 (1–2) 1.2 (1–2) .827
        P value .009 .003
    • Note:—VRR indicates volume reduction rate.

    • a Data are means unless otherwise indicated. Range is shown in parentheses.

  • Table 3:

    Summary of published data for chemical ablation in patients with brachial cleft cystsa

    Study Year No. of Patients Sclerosing Agent Mean Treatment Sessions (No.) Complete Response Partial (≥50%) Response Partial (<50%) Response No Response Complications
    Fukumoto et al2 1994 3 Ethanol 1.0 100.0% (3/3) None
    Roh et al5 2006 12 OK-432 2.3 58.3% (7/12) 25.0% (3/12) 16.7% (2/12) Fever
    Kim et al4 2009 23 OK-432 1.7 60.8% (14/23) 13.0% (3/23) 8.7% (2/23) 17.4% (4/23) Fever, local pain
    Ohta et al6 2010 12 OK-432 2.9 50.0% (6/12) 16.7% (2/12) 8.3% (1/12) 25.0% (3/12) Fever
    • a Numbers in parentheses are the numbers of patients among all those included in the study.

Ethanol injection sclerotherapy for branchial cleft cyst.

3 with branchial cleft cysts were treated with percutaneous aspiration and absolute ethanol sclerotherapy using a 7-French pigtail catheter.  The results of this series suggest that ethanol sclerotherapy is the treatment of choice for branchial cleft cyst, and thyroglossal duct cyst.
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