More Neck Surgery for Thyroid Cancer Local Recurrence? Maybe It is Time for New Ideas. Try Ethanol or Radiofrequency ablation RFA.
Comments: Mayo clinic has lead the fight against continued use of neck dissections to treat recurrent neck lymph node disease. It is a cause of the high rate of bankruptcy of thyroid cancer patients and causes more pain and suffering and expense of another hospital visit for more of the same.
Call Matt at 310-393-8860 or [email protected] if you are told to have another neck surgery. We do PEI and prevent more surgery for the patient just like Dr.Hay’s group at Mayo Clinic.
Richard Guttler MD,FACE,ECNU
Long-term outcome of ultrasound-guided percutaneous ethanol ablation PEI of selected “recurrent” neck nodal metastases in 25 patients with TNM stages III or IVA papillary thyroid carcinoma previously treated by surgery and 131I therapy.
Ultrasound-guided percutaneous ethanol ablation (PEI) of neck nodal metastases (NNM) has rarely been reported in papillary thyroid carcinoma (PTC) patients with advanced localized disease.
We ablated 25 PTC patients with stage III or IVA disease (mean age 58 years) who had “recurrent” NNM after surgery and 131I therapy. Diagnosis of 37 selected NNM was proven by ultrasound-guided biopsy. UPEA was usually performed in 2 outpatient sessions.
Ultrasound of a Positive lymph node before and after the first PEI treatment.
Patient needed two session to ablate.
- After PEI, 35 of 37 NNM (95%) decreased in size. None had significant Doppler flow.
- Seventeen (46%) disappeared on rescanning.
- Serum thyroglobulin fell in 19 of 22 (86%) without thyroglobulin autoantibodies. 4
- None of the PEI-treated NNM, followed on average for 5.4 years, required further intervention.
- Six patients (24%) subsequently developed 18 “new” recurrences.
- Of the 18, 15 (83%) were managed successfully by PEI rather than operation.
- None of the 25 patients developed permanent hoarseness or have died from PTC.
- At our institution, patients undergoing nodal dissections are charged $35-45,000.
- Each outpatient PEI procedure saves health providers approximately $38,400.
- Our 25 ablated patients, by avoiding 40 further neck re-explorations, on average, saved $61,440 in charges.
- That is $1,525,000 savings.
- Endocrinologists send your patient for PEI and Surgeons put your instruments down and send the patient for PEI or RFA to Mayo or my center.
PEI for NNM in advanced localized PTC has proved safe and effective. It is also considerably less expensive than the conventional operative alternative of nodal dissection.