Ethanol Ablation PEI of Thyroid Complex Cysts and solid Thyroid Basics 101: How is it done?
Richard Guttler MD,FACE,ECNU
The recommended PEI basic technique from the Korean thyroid ablation specialists.
- Ethanol ablation uses a high concentration (95–99%) of ethanol.
- The skin is punctured with a 16–21-gauge needle, and the target nodule is approached through the thyroid isthmus to prevent ethanol leakage during the procedure.
- The method of ethanol instillation depends on the solid component of the nodule.
- For a cystic or predominantly cystic nodule, the tip of the needle is inserted into the center of the cyst, as much fluid as possible is aspirated, and then ethanol is injected.
- If the cyst contents are viscous, the fluid is aspirated using a large-bore needle, followed by irrigation with normal saline to remove internal debris and colloid material before ethanol instillation.
- The volume of ethanol injected is usually 50% of the aspirated fluid volume. After 2 minutes of ethanol retention with the needle in place, the injected ethanol is removed completely and the needle is withdrawn.
- If a predominantly solid nodule contains a cystic component, the latter is punctured, almost completely aspirated, and an appropriate amount of ethanol is instilled.
- The tip of the needle is subsequently inserted into the solid component of the target nodule, followed by infusion of an appropriate volume of ethanol.
- That volume is based on nodule size and echogenicity of the solid portion.
- In treating a purely solid nodule, ethanol is injected directly into the nodule.
- Adequate coverage of the target nodule, as indicated by its echogenicity (called intranodular echo-staining), is achieved by adjusting the injection of ethanol under US guidance.
- After injection, the needle is rapidly withdrawn.
Ethanol ablation PEI is available in the USA for cysts,cystic/solid nodules, and cancer lymph nodes.Also as alternative to surgery or active surveillance for micro-papillary cancers.
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