Thyroid Cysts 101: Ethanol ablation PEI is significantly superior to radiofrequency (RF) ablation.

Thyroid Cysts 101: Ethanol ablation PEI is significantly superior to radiofrequency (RF) ablation.

Thyroid Cysts 101: Ethanol ablation PEI is significantly superior to radiofrequency (RF) ablation.

 Thyroid Cysts 101: Ethanol ablation PEI is significantly superior to radiofrequency (RF) ablation.

Dr.Guttler comments on this article.

  1. PEI is my choice over RF ablation as the first-line treatment modality for patients with cystic thyroid nodules.
  2. PEI and RF ablation showed no significant difference in achievement of therapeutic success and improvement of symptomatic and cosmetic problems and were not associated with any major complications in patients with cystic thyroid nodules.
  3. PEI is less expensive and can be done in my office without the expense of a hospital.
  4. The PEI procedure takes 10-minutes.
  5. PEI may be the first-line treatment modality for cystic thyroid nodules, which has comparable therapeutic efficacy to, but is less expensive than, RF ablation.
  6. Call me at 310-393-8860 for details. also [email protected]
  7. Richard Guttler MD,FACE,ECNU Interventional thyroidologist.

Single-Session Treatment of Benign Cystic Thyroid Nodules with Ethanol versus Radiofrequency Ablation: A Prospective Randomized Study

Published Online:https://doi.org/10.1148/radiol.13122134

Purpose

To compare volume reduction of single-session ethanol ablation (EA) and radiofrequency (RF) ablation for cystic thyroid nodule treatment.

Materials and Methods

All patients gave written informed consent to participate in this prospective institutional review board–approved study. From May 6, 2010, to August 8, 2011, in this single-institutional, noninferiority trial, 50 patients, each with a single cystic thyroid nodule, were randomly assigned to EA (25 patients; mean age for women, 45.7 years, and for men, 37.5 years) or RF ablation (25 patients; mean age for women, 45.1 years, and for men, 43.7 years) treatment. Internal fluid was aspirated prior to EA or RF ablation. Primary end point was the volume reduction ratio (percentage) at 6-month follow-up; the noninferiority margin was chosen as −8% (EA minus RF ablation). Secondary end points included therapeutic success rate, improvement of symptoms and cosmetic problems, and number of major complications. Analysis was performed primarily in intention-to-treat manner. A one-sided 95% confidence interval (CI) for the mean difference in volume reduction ratio 6 months after treatment was calculated to test for noninferiority. Subsequent superiority comparison of EA with RF ablation on a condition of establishment of the noninferiority of EA to RF ablation was preplanned and used two-sided 95% CI of the outcome difference.

Results

The mean volume reduction was 96.9% in EA and 93.3% in RF ablation (n = 21 for each) (difference, 3.6%; lower bound of the one-sided 95% CI of the difference, 1.2%), thus demonstrating the noninferiority of EA to RF ablation. Two-sided 95% CI of the outcome difference was 0.7% to 6.5%, demonstrating significant superiority of EA to RF ablation. All patients demonstrated therapeutic success (P > .99). Mean symptom and cosmetic scores showed no significant difference in either group (P = .806 and P = .682, respectively). There were no major complications (P > .99).

Conclusion

EA may be the first-line treatment modality for cystic thyroid nodules, which has comparable therapeutic efficacy to, but is less expensive than, RF ablation.

© RSNA, 2013

Figure 2a:

Figure 2a: Axial US scans in 30-year-old woman. (a) Huge cystic nodule in the left thyroid gland before EA. (b)During EA, cystic lumen was filled with instilled ethanol via an 18-gauge needle (arrow). (c) Thyroid nodule (arrow) shows marked decrease in size.
Figure 2b:

Figure 2b: Axial US scans in 30-year-old woman. (a) Huge cystic nodule in the left thyroid gland before EA. (b)During EA, cystic lumen was filled with instilled ethanol via an 18-gauge needle (arrow). (c) Thyroid nodule (arrow) shows marked decrease in size.
Figure 2c:

Figure 2c: Axial US scans in 30-year-old woman. (a) Huge cystic nodule in the left thyroid gland before EA. (b)During EA, cystic lumen was filled with instilled ethanol via an 18-gauge needle (arrow). (c) Thyroid nodule (arrow) shows marked decrease in size.
Figure 3a:

Figure 3a: Transverse US scans in 54-year-old woman. (a) A cystic nodule in the left thyroid gland before RF ablation. (b) Echogenic bubbles (arrow) in the cystic thyroid nodule during RF ablation. (c) Thyroid nodule (arrow) shows marked decrease in size.
Figure 3b:

Figure 3b: Transverse US scans in 54-year-old woman. (a) A cystic nodule in the left thyroid gland before RF ablation. (b) Echogenic bubbles (arrow) in the cystic thyroid nodule during RF ablation. (c) Thyroid nodule (arrow) shows marked decrease in size.
Figure 3c:

Figure 3c: Transverse US scans in 54-year-old woman. (a) A cystic nodule in the left thyroid gland before RF ablation. (b) Echogenic bubbles (arrow) in the cystic thyroid nodule during RF ablation. (c) Thyroid nodule (arrow) shows marked decrease in size.

 

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