Thyroid Ethanol Ablation for Recurrent Papillary Cancer 101: Why aren’t we doing more to use this procedure to save the patient the pain and suffering of another neck dissection? Shame on all the physicians who refuse to consider PEI for their thyroid cancer patients

Thyroid Ethanol Ablation for Recurrent Papillary Cancer 101: Why aren’t we doing more to use this procedure to save the patient the pain and suffering of another neck dissection? Shame on all the physicians who refuse to consider PEI for their thyroid cancer patients

Thyroid Ethanol Ablation for Recurrent Papillary Cancer 101: Why aren’t we doing more to use this procedure to save the patient the pain and suffering of another neck dissection? Shame on all the physicians who refuse to consider PEI for their thyroid cancer patients

Thyroid Ethanol Ablation for Recurrent Papillary Cancer 101: Why aren’t we doing more to use this procedure to save the patient the pain and suffering of another neck dissection? Shame on all the physicians who refuse to consider PEI for their thyroid cancer patients. Also it saves money >35,000/ PEI treatment over a another neck dissection.

Controlling recurrent papillary thyroid carcinoma in the neck by ultrasonography-guided percutaneous ethanol injection

Byung Moon Kim et al

European Radiology

, Volume 18, Issue 4, pp 835–842

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First step is to biospy the suspicious lymph node and collect needle washout for thyroglobulin.

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Even if the whole lymph node is not invaded the thyroglobulin washout can still be positive if the needle only hits the normal  lymph part at the top.

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The use of medical grade 200 proof ethyl alcohol (<1.5 cc) amounts per session can render the node ablated.

 The purpose of this study was to retrospectively evaluate the efficacy of ultrasonography-guided percutaneous ethanol injection (PEI) for neck recurrence of papillary thyroid carcinoma (NR-PTC). Twenty-seven patients (19–80 years old; mean, 53.2) with 47 NR-PTCs were treated by PEI and were followed-up (14–38 months; mean, 28.2). Ethanol (99%) was repeatedly injected with adjusting needle position until the entire volume of NR-PTC was ablated. All patients received follow-up ultrasonography at 3–6-month intervals, and the percent volume decrease was measured. The NR-PTCs with decreased volume and no tumor vascularity on power-Doppler study were regarded as treatment-effective. The NR-PTCs with stable or enlarged volume or with tumor vascularity were considered as treatment-failed, in which case PEI was repeated. The number of sessions and the total volume of ethanol per NR-PTC, and the volume of ethanol per session per NR-PTC were evaluated. All NR-PTCs significantly decreased in volume (range, 30–100%; mean, 93.6%). The mean number of sessions, the total volume of ethanol per NR-PTC, and the mean volume of ethanol per session per NR-PTC were 2.1 sessions (range 1–6), 2.4 ml (range 0.3–10.1), and 1.1 ml/session (range 0.3–3.0), respectively.

Conclusion:

PEI appears to be an alternative option for controlling NR-PTCs in the selected patients who are poor surgical candidates.

Comments: Since this article there are many more showing it is a safe alternative to another neck dissection even in patients that are not a poor candidate for surgery.

PEI is a routine ablation procedure at my center for cysts and cancer lymph node recurrence. Call Matt for details 310-393-8860.

Richard Guttler  MD,FACE,ECNU

thyroid.com

Keywords

Percutaneous ethanol injection Ultrasonography Interventional Papillary thyroid carcinoma Lymph node Cervical 

Ultrasound image of a lateral neck nodal metastatic papillary cancer with microcalcifications.
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