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.
Keywords: Papillary thyroid cancer, Recurrent thyroid cancer, Surgeon performed ultrasound, Ultrasound-guided ethanol ablation.
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.
Source of support: Nil
Conflict of interest: None