Hye Sun Park et al
- There are three ways of combining PEI and RFA: additional RFA is effective for treatment of incompletely resolved symptoms and solid residual portions of a thyroid nodule after PEI.
- Additional PEI can be performed for the residual unablated solid portion of a nodule after RFA if it is adjacent to critical structures (e.g., trachea, esophagus, and recurrent laryngeal nerve).
- In the concomitant procedure, ethanol is injected to control venous oozing after aspiration of cystic fluid prior to RFA of the remaining solid nodule.
- Although surgery is usually curative, it may result in clinically significant morbidities, including voice change associated with damage to the recurrent and superior laryngeal nerves, hypoparathyroidism, and, more rarely, airway obstruction associated with bilateral vocal cord dysfunction, hematoma, or infection.ncbi.nlm.nih.gov/pmc/articles/PMC5390615
- Image-guided ablation methods, including ethanol ablation (PEI), and radiofrequency ablation (RFA), are non-surgical modalities increasingly used to treat benign thyroid nodules.
- Currently, PEI is the recommended first-line treatment for predominantly cystic nodules because it is easier to perform and less expensive than RFA.ncbi.nlm.nih.gov/pmc/articles/PMC5390615
- Although PEI is effective for cystic thyroid nodules, the recurrence rate after a single session of EA is as high as 38.3%.
- A stepwise combinations of PEI and RFA to manage nodules with residual unablated areas and resolve residual symptoms can be used.
- Moreover, concomitant use of PEI and RFA may be effective during aspiration of predominantly cystic nodules, where PEI is used to control bleeding within the nodule prior to RFA.
- Combo therapy with PEI/RFA.
57-year-old man with right thyroid nodule.
A. Ethanol ablation of 10.2-mL predominantly cystic nodule (white arrows) showing internal and peripheral vascularity. B. One month after ethanol ablation, volume of nodule (white arrows) was reduced by 88%, to 1.2 mL. C. Three years after ethanol ablation, volume of nodule (white arrows) had gradually increased to 4.9 mL. Recurrent nodule was managed by radiofrequency ablation. D. Three years after radiofrequency ablation, nodule volume (white arrows) was significantly reduced by 98%, and patient’s residual symptoms had improved.
65-year-old woman with right thyroid nodule.
A. Ultrasound images showing predominantly cystic mass (white arrows) with increased vascularity, both in internal solid component and periphery. Initial nodule volume was 5.9 mL. B. Prior to radiofrequency ablation, internal fluid was aspirated, but nodule (white arrows) increased in size because of internal venous oozing. C. After bleeding was controlled by ethanol ablation, radiofrequency ablation was successfully performed using moving shot technique. Black arrows indicate electrode. D. Six months after radiofrequency ablation, nodule volume (white arrows) was significantly reduced by 98.5%, and patient’s residual symptoms had improved.
Using both PEI and RFA in different situations makes for better over all
result for the patient. PEI and RFA are available at my center and by referral to Italy or Korea after my evaluation to see if you are a candidate.
call or email Matt at 310-393-8860 or email@example.com for details.
Richard Guttler MD,FACE,ECNU