Ethanol Ablation of Mostly Cystic thyroid nodules Left with Continued symptoms? The place for Radiofrequency ablation?
RFA image of the cyst being ablated.
Dr.Guttler’s comments:
- Failure to relieve symptoms after PEI can be treated by RFA.
- 24/94 cases treated with PEI needed additional RFA treatment .
- < 50% reduction in symptoms or cosmetic score or persistent solid component caused the need for RFA.
- RFA after a single session of EA was effective in reducing mean symptom score from 4.8 to 1.1 ( p < 0.001), mean cosmetic score from 3.5 to 1.4 ( p < 0.001) and mean nodule volume from 11.3 to 0.9 mL ( p < 0.001).
- PEI is less effective if the solid component is > 20%.
- RFA is as effective as PEI for thyroid cysts but should not be used for cysts with < 20% solid component as PEI is less expensive.
- RFA should be the treatment of choice for cysts that are >20% solid.
- RFA is effective in treatment of benign predominantly cystic thyroid nodules in patients whose clinical problems were incompletely resolved after EA.
- RFA should be the method of choice as it effectively treats both cyst and large solid component with one visit avoiding the double expense of two procedures.
- I have a long history of treating cysts with PEI, and in last 5 years RFA for both solid and cystic nodules.
- Call me at 310-393-8860 or secure email to thyroid.manager@thyroid.com.
- Ask for Alicia for details.
- DR.G.
How to manage the patients with unsatisfactory results after ethanol ablation for thyroid nodules: Role of radiofrequency ablation
Purpose
Although ethanol ablation (EA) is effective in the treatment of cystic thyroid nodules, it is less effective in nodules with solid component. Therefore refractory cases with solid component require another treatment modality such as radiofrequency ablation (RFA), which is effective in both solid and cystic thyroid nodules. We prospectively evaluated the efficacy of additional RFA and factors related to volume reduction in patients showing unsatisfactory results after a single session of EA.
Materials and methods
Of 94 patients with predominantly cystic thyroid nodules who underwent EA, 20 patients underwent additional RFA because of incompletely resolved clinical problems (symptomatic score reduction <50%) and presence of residual solid component at 1-month follow-up on ultrasonography. Improvement of clinical symptoms and nodule volume reduction were evaluated 6 month later. We evaluated factors related to nodule volume reduction after EA and RFA.
Results
RFA after a single session of EA was effective in reducing mean symptom score from 4.8 to 1.1 ( p < 0.001), mean cosmetic score from 3.5 to 1.4 ( p < 0.001) and mean nodule volume from 11.3 to 0.9 mL ( p < 0.001). The only independent factor related to volume reduction after EA was the presence of a solid component ( p < 0.001), and EA was less effective in nodules when solid component >20% ( p = 0.001). We identified no factors related to volume reduction after RFA.
Conclusion
RFA is effective in treatment of benign predominantly cystic thyroid nodules in patients whose clinical problems were incompletely resolved after EA.
Abbreviations:
EA ( ethanol ablation), RFA ( radiofrequency ablation), US ( ultrasonography), FNAC ( fine needle aspiration cytology)
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