World Journal of Endocrine Surgery

Register      Login

VOLUME 8 , ISSUE 3 ( September-December, 2016 ) > List of Articles

RESEARCH ARTICLE

Ultrasound-guided Ethanol Ablation: Where does It fit in the Treatment of Recurrent Metastatic Papillary Thyroid Cancer?

Natalie Seiser, Jesse D Pasternak, Wouter Kluijfhout, Jessica E Gosnell, Wen T Shen

Citation Information : Seiser N, Pasternak JD, Kluijfhout W, Gosnell JE, Shen WT. Ultrasound-guided Ethanol Ablation: Where does It fit in the Treatment of Recurrent Metastatic Papillary Thyroid Cancer?. World J Endoc Surg 2016; 8 (3):199-202.

DOI: 10.5005/jp-journals-10002-1191

Published Online: 00-12-2016

Copyright Statement:  Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction

Ethanol (ETOH) ablation of metastatic neck nodes has been described as a potentially safe and effective alternative to surgical excision. We sought to describe a subset of these patients well suited for ETOH ablation.

Materials and methods

We report ultrasound-guided ETOH ablation of metastatic papillary thyroid cancer (PTC) at a Tertiary Care Endocrine Surgery Unit over 5 years. A retrospective review of all reoperative lymph node dissections was undertaken. Ethanol injection was used as second-line treatment to operative excision and was standardized with ultrasound guidance and the use of 1 cc/cm3 of 100% ETOH solution.

Results

Five treatments of ultrasound-guided ETOH ablation were studied. All patients had been previously treated with radioactive iodine (RAI) (mean: 1.25 treatments of 174mCi), however, in three cases with pretreatment I-131 scan, no uptake of radioiodine was seen in the treated disease. In four cases with pretreatment fludeoxyglucose-positron emission tomography (FDG-PET), treated lesions were avid. Median follow-up time for treatment was 28.5 months, with no disease progression in all ablated lesions. Serum thyroglobulin (Tg) values in patients without Tg-antibody were lower after treatment. There were no complications.

Conclusion

Surgeons seeking a less-invasive approach for nodal metastases in the neck can consider ETOH ablation. Small ultrasound detectable lesions in scarred necks (irradiated and/or reoperative) which are radioiodine non-avid and FDG-PET avid may be best suited for this treatment. As demonstrated by a small set of patients in a Tertiary Care Endocrine Surgery Unit, ETOH ablation is safe and effective at controlling progression of targeted local disease.

How to cite this article

Pasternak JD, Kluijfhout W, Seiser N, Gosnell JE, Suh I, Duh Q-Y, Shen WT. Ultrasound-guided Ethanol Ablation: Where does It fit in the Treatment of Recurrent Metastatic Papillary Thyroid Cancer? World J Endoc Surg 2016;8(3):199-202.


PDF Share
  1. Thyroid cancer nodal metastases: biologic significance and therapeutic considerations. Surg Oncol Clin N Am 1996 Jan;5(1):43-63.
  2. Percutaneous ethanol injection for treatment of cervical lymph node metastases in patients with papillary thyroid carcinoma. AJR Am J Roentgenol 2002 Mar;178(3):699-704.
  3. Radiofrequency ablation and percutaneous ethanol injection treatment for recurrent local and distant well-differentiated thyroid carcinoma. Ann Surg 2006 Aug;244(2):296-304.
  4. Percutaneous ethanol injection therapy for locally recurrent papillary thyroid carcinoma. Thyroid 2007 Apr;17(4):347-350.
  5. Controlling recurrent papillary thyroid carcinoma in the neck by ultrasonography-guided percutaneous ethanol injection. Eur Radiol 2008 Apr;18(4):835-842.
  6. Efficacy of ultrasoundguided percutaneous ethanol injection treatment in patients with a limited number of metastatic cervical lymph nodes from papillary thyroid carcinoma. J Clin Endocrinol Metab 2011 Sep;96(9):2750-2755.
  7. Complete eradication of metastatic lymph node after percutaneous ethanol injection therapy: pathologic correlation. Thyroid 2009 Mar;19(3):317-319.
  8. Long-term outcome of ultrasound-guided percutaneous ethanol ablation 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. Surgery 2013 Dec;154(6):1448-1454.
  9. Ultrasound-guided percutaneous ethanol injection in papillary thyroid cancer metastatic lymph-nodes. Endocrine 2014 Nov;47(2):648-651.
  10. Fluorodeoxyglucose-positron emission tomography scanpositive recurrent papillary thyroid cancer and the prognosis and implications for surgical management. World J Surg Oncol 2012 Sep;10:192.
  11. Real-time prognosis for metastatic thyroid carcinoma based on 2-[18F]fluoro- 2-deoxy-D-glucose-positron emission tomography scanning. J Clin Endocrinol Metab 2006 Feb;91(2):498-505.
  12. Integrated PET/CT in differentiated thyroid cancer: diagnostic accuracy and impact on patient management. J Nucl Med 2006 Apr;47(4):616-624.
  13. 18F-FDG PET in the diagnosis and follow-up of thyroid malignancy. In vivo 2008 Jan-Feb;22(1):109-114.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.