Advertisement

Percutaneous Ethanol Injection (PEI): Thyroid Cysts and Other Neck Lesions

  • Andrea Frasoldati
  • Roberto Valcavi

Ethanol injection causes irreversible tissue damage through cellular dehydration, protein denaturation, coagulative necrosis, and small vessel thrombosis leading to hemorrhagic infarct and reactive fibrosis. The sclerosing properties of ethanol have prompted its use in the treatment of various malignant or benign lesions such us hepatocellular carcinoma, adrenal adenoma, parathyroid adenoma, or hyperplasia.

Percutaneous ethanol injection (PEI) for the treatment of thyroid lesions was introduced into clinical practice in 1990. This technique was initially proposed as an alternative to surgery and radioiodine administration in the management of autonomous functioning nodules. While the use of PEI for this purpose has sensibly decreased, ethanol sclerosing properties have been successfully applied in the treatment of thyroid cystic lesions. The present chapter will deal with PEI applications to thyroid lesions, focusing on the treatment of thyroid cysts. PEI therapy of other neck lesions (e.g., parathyroid, lymph nodes) will also be briefly addressed.

Keywords

Papillary Thyroid Carcinoma Thyroid Nodule Parathyroid Adenoma Percutaneous Ethanol Injection Thyroid Lesion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bean WJ (1981) Renal cysts: treatment with alcohol. Radiology 138:329–331PubMedGoogle Scholar
  2. 2.
    Bean WJ, Rodan BA (1985) Hepatic cysts: treatment with alcohol. Am J Radiol 144:237–241Google Scholar
  3. 3.
    Solbiati L, Giangrande A, DePra L, et al (1985) Percutaneous ethanol injection of parathyroid tumors under US guidance: treatment for secondary hyperparathyroidism. Radiology 155:607–610PubMedGoogle Scholar
  4. 4.
    Livraghi T, Giorgio A, Mario G, et al (1985) Hepatocellular carcinoma and cirrhosis in 746 patients: long term results of percutaneous ethanol injection. Radiology 197:101–108Google Scholar
  5. 5.
    Rossi R, Savastano S, Tommasselli AP, et al (1995) Percutaneous computer tomography-guided ethanol injection in aldosterone-producing adrenal adrenocortical adenoma. Eur J Endocrinol 132:302–305PubMedCrossRefGoogle Scholar
  6. 6.
    Livraghi T, Paracchi A, Ferrari C, et al (1990) Treatment of autonomous thyroid nodule with percutaneous ethanol injection: preliminary results. Radiology 175:827–829PubMedGoogle Scholar
  7. 7.
    Martino E, Murtas MI, Liviselli A, et al (1992) Percutaneous intranodular ethanol injection for treatment of autonomously functioning thyroid nodules. Surgery 112:1161–1165PubMedGoogle Scholar
  8. 8.
    Papini E, Panunzi C, Pacella CM, et al (1993) Percutaneous ultrasound-guided ethanol injection: a new treatment of toxic autonomously functioning thyroid nodules? J Clin Endocrinol Metab 76:411–416PubMedCrossRefGoogle Scholar
  9. 9.
    Livraghi T, Paracchi MA, Ferrari C, et al (1994) Treatment of autonomous thyroid nodules with percutaneous ethanol injection–a 4 year experience. Radiology 190:529–533PubMedGoogle Scholar
  10. 10.
    Lippi F, Ferrari C, Manetti L, et al (1996) Treatment of solitary autonomous thyroid nodules by percutaneous ethanol injection. Results of an Italian multicenter study. J Clin Endocrinol Metab 81:3261–3264PubMedCrossRefGoogle Scholar
  11. 11.
    Monzani F, Caraccio N, Goletti O (1997) Five year follow-up of percutaneous ethanol injection for the treatment of hyperfunctioning thyroid nodules: a study of 117 patients. Clin Endocrinol 46:9–15CrossRefGoogle Scholar
  12. 12.
    Lee SJ, Ahn I-M (2005) Effectiveness of percutaneous ethanol injection therapy in benign nodular and cystic thyroid disease: long-term follow-up experience. Endocr J 52:455–462PubMedCrossRefGoogle Scholar
  13. 13.
    Pacini F (2003) Role of percutaneous ethanol injection in management of nodular lesions of the thyroid gland. J Nucl Med 44:211–212PubMedGoogle Scholar
  14. 14.
    Zingrillo M, Modoni S, Conte M, et al (2003) Percutaneous ethanol injection plus radioiodine versus radioiodine alone in the treatment of large toxic thyroid nodules. J Nucl Med 44:207–210PubMedGoogle Scholar
  15. 15.
    Bennedbaek FN, Nielsen LK, Hegedus L (1998) Effect of percutaneous ethanol injection therapy versus suppressive doses of l-thyroxine on benign solitary solid cold nodules: a randomized trial. J Clin Endocrinol Metab 83: 830–835PubMedCrossRefGoogle Scholar
  16. 16.
    Bennendbaek FN, Hegedus L (1999) Percutaneous ethanol injection therapy in benign solitary cold thyroid nodules: a randomized trial comparing one injection with three injections. Thyroid 9:225–233CrossRefGoogle Scholar
  17. 17.
    Kim JH, Lee HK, Lee JH et al (2003) Efficacy of sonographically guided percutaneous ethanol injection for treatment of thyroid cysts versus solid thyroid nodules. AJR 180: 1623–1726Google Scholar
  18. 18.
    Alexander EK, Heering JP, Benson CB, et al (2002) Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules. J Clin Endocrinol Metab 87:924–927Google Scholar
  19. 19.
    De Los Santos ET, Keyhani-Rofagha S, Cunningham JJ, et al (1990) Cystic thyroid nodules the dilemma of malignant lesions. Arch. Intern. Med 150:422–427CrossRefGoogle Scholar
  20. 20.
    Sheppard MC, Franklyn JA (1994) Management of the single thyroid nodule. Clin Endocrinol 41:719–724CrossRefGoogle Scholar
  21. 21.
    Clark OH, Okerlund MD, Cavalieri RR, et al (1979) Diagnosis and treatment of thyroid parathyroid and thyroglossal duct cysts. J Clin Endocrinol Metab 48:983–988PubMedCrossRefGoogle Scholar
  22. 22.
    Jensen F, Rasmussen SN (1976) The treatment of thyroid cysts by ultrasonographically-guided fine needle aspiration. Acta Chir Scand 142:209–211PubMedGoogle Scholar
  23. 23.
    Monzani F, Lippi F, Goletti O, et al (1994) Percutaneous aspiration and ethanol sclerotherapy for thyroid cysts. J Clin Endocrinol Metab 78:800–802PubMedCrossRefGoogle Scholar
  24. 24.
    Verde G, Papini E, Pacella CM, et al (1994) Ultrasound guided percutaneous ethanol injection in the treatment of cystic thyroid nodules. Clin Endocrinol 41:719–724CrossRefGoogle Scholar
  25. 25.
    Zingrillo M, Torlontano M, Chiarella R, et al (1999) Percutaneous ethanol injection may be a definitive treatment for symptomatic thyroid cystic nodules not treatable by surgery: five-year follow-up study. Thyroid 9:763–767PubMedCrossRefGoogle Scholar
  26. 26.
    Valcavi R, Frasoldati A (2004) Ultrasound-guided percutaneous ethanol injection therapy in thyroid cystic nodules. Endocr Pract 10:269–275PubMedGoogle Scholar
  27. 27.
    Bennedbaek FN, Hegedus L (2003) Treatment of recurrent thyroid cysts with ethanol: a randomized double blind controlled trial. J Clin Endocrinol Metab 88:5773–5777PubMedCrossRefGoogle Scholar
  28. 28.
    Kim DW, Rho MH, Kim HJ et al (2005) Percutaneous ethanol injection for benign cystic thyroid nodules: is aspiration of ethanol-mixed fluid advantageous? AJNR 26:2122–2127PubMedGoogle Scholar
  29. 29.
    Clark OH (1978) Parathyroid cysts. Am J Surg 35:395–402CrossRefGoogle Scholar
  30. 30.
    Ujiki MB, Nayar R, Sturgeon C, et al (2007) Parathyroid cyst: often mistaken for a thyroid cyst. World J Surg 31:60–64PubMedCrossRefGoogle Scholar
  31. 31.
    Ippolito G, Palazzo F, Sebag F, et al (2006) A single institution 25-year review of true parathyroid cysts. Lagenbecks Arch Surg 391:13–18CrossRefGoogle Scholar
  32. 32.
    Silverman JF, Khazanie PG, Norris HT, et al (1986) Parathyroid hormone (PTH) assay of parathyroid cysts examined by fine-needle aspiration biopsy. Am J Clin Pathol 86:776–780PubMedGoogle Scholar
  33. 33.
    Pacini F, Antonelli A, Lari R, et al (1985) Unsuspected parathyroid cysts diagnosed by measurement of thyroglobulin and parathyroid hormone concentration in fluid aspirates. Ann Intern Med 102:793–794PubMedGoogle Scholar
  34. 34.
    Akel M, Salti I, Azar ST (1999) Successful treatment of parathyroid cyst using Ethanol Sclerotherapy. Am J Med Sci 317:50–52PubMedCrossRefGoogle Scholar
  35. 35.
    Baskin HJ (2004) New applications of thyroid and parathyroid ultrasound. Min Endocrinol 29:195–206Google Scholar
  36. 36.
    Okamura K, Ikenoue H, Sato K, et al (1992) Sclerotherapy for benign parathyroid cysts. Am J Surg 163:344–345PubMedCrossRefGoogle Scholar
  37. 37.
    Sanchez A, Carretto H (1993) Treatment of a nonfunctioning parathyroid cysts with tetracycline injection. Head Neck 15:263–265PubMedCrossRefGoogle Scholar
  38. 38.
    Fukumoto K, Kojima T, Tomonari H, et al (1994) Ethanol injection sclerotherapy for Baker’s cysts, thyroglossal duct cysts, and branchial cleft cysts. Ann Plast Surg 33:615–619PubMedCrossRefGoogle Scholar
  39. 39.
    Baskin HJ (2006) Percutaneous ethanol injection of thyroglossal duct cysts. Endocr Pract 12:355–357PubMedGoogle Scholar
  40. 40.
    Harman CR, Grant CS, Hay ID, et al (1998) Indications, technique and efficacy of alcohol injection of enlarged parathyroid glands in patients with primary hyperparathyroidism. Surgery 124:1011–1020PubMedCrossRefGoogle Scholar
  41. 41.
    Cercueil JP, Jacob D, Verges B, et al (1998) Percutaneous ethanol injection into parathyroid adenomas: mid- and long-term results. Eur Radiol 8:1565–1569PubMedCrossRefGoogle Scholar
  42. 42.
    Solbiati L, Giangrande A, Pra LD, et al (1985) Ultrasound-guided percutaneous fine-needle ethanol injection into parathyroid glands in secondary hyperparathyroidism. Radiology 155:607–610PubMedGoogle Scholar
  43. 43.
    Fugakawa M Kitaoga M Tominaka Y, et al (2003) Guidelines for percutaneous ethanol injection therapy of the parathyroid glands in chronic dialysis patients. Nephrol Dial Transplant 18:(Suppl 3):31–33Google Scholar
  44. 44.
    Lewis BD, Hay ID, Charboneau JW, et al (2002) Percutaneous ethanol injection for treatment of cervical lymph node metastases in patients with papillary thyroid carcinoma. AJR 178:699–704.PubMedGoogle Scholar
  45. 45.
    Lim CY, Yum JS, Lee J, et al (2007) Percutaneous ethanol injection therapy for locally recurrent papillary thyroid carcinoma. Thyroid 17:347–350PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Andrea Frasoldati
    • 1
  • Roberto Valcavi
    • 1
  1. 1.Endocrinology UnitArcispedale Santa Maria NuovaItaly

Personalised recommendations