Valcavi Roberto, Frasoldati Andrea
Endocrine Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
Endocr Pract. 2004 May-Jun;10(3):269-75. doi: 10.4158/EP.10.3.269.
To provide an overview of ultrasound (US)-guided percutaneous ethanol injection (PEI) therapy for thyroid cystic nodules and discuss the practical and technical details.
We present preliminary data of a controlled randomized study involving 281 patients (221 women and 60 men; 18 to 85 years old) with benign thyroid cystic nodules. Study inclusion criteria were local discomfort or cosmetic damage, cystic volume more than 2 mL, 50% or more fluid component, benignity as confirmed by cytologic specimen obtained by US-guided fine-needle aspiration biopsy (FNAB), and euthyroidism. Exclusion criteria were inadequate, suspicious, or positive FNAB cytology, high serum calcitonin, and contralateral laryngeal cord palsy. By random assignment, 138 patients underwent simple cyst evacuation, and 143 underwent cyst evacuation plus PEI by a skilled operator using a US-guided technique. The amount of ethanol injected was 50 to 70% of the cystic fluid extracted.
Before treatment, the mean (+/-SD) nodule volume was 19.0 +/- 19.0 mL versus 20.0 +/- 13.4 mL in the PEI versus the simple evacuation group (no significant difference). After 1 year, volumes were 5.5 +/- 11.7 mL versus 16.4 +/- 13.7 mL (P<0.001), with a median 85.6% versus 7.3% reduction, respectively (P<0.001), of the initial volume. The median nodule volume reduction after PEI was 88.8% and 65.8% in empty body and mixed thyroid cysts, respectively. Compressive and cosmetic symptoms disappeared in 74.8% and 80.0% of patients treated with PEI versus 24.4% and 37.4% of patients treated with simple evacuation, respectively (P<0.001). Side effects were minor.
These data provide definitive evidence that PEI is a safe and effective treatment for thyroid cystic nodules. Unicameral thyroid cysts are the most suitable candidate nodules for PEI.
概述超声（US）引导下经皮乙醇注射（PEI）治疗甲状腺囊性结节的情况，并讨论实际操作和技术细节。
我们展示了一项对照随机研究的初步数据，该研究涉及281例患有良性甲状腺囊性结节的患者（221名女性和60名男性；年龄18至85岁）。研究纳入标准为局部不适或外观受损、囊肿体积超过2 mL、液体成分占50%或更多、经超声引导下细针穿刺活检（FNAB）获得的细胞学标本证实为良性以及甲状腺功能正常。排除标准为FNAB细胞学检查结果不充分、可疑或阳性、血清降钙素水平高以及对侧喉返神经麻痹。通过随机分配，138例患者接受单纯囊肿抽液，143例患者由熟练操作人员采用超声引导技术进行囊肿抽液加PEI。注入的乙醇量为抽出囊液的50%至70%。
治疗前，PEI组与单纯抽液组的平均（±标准差）结节体积分别为19.0±19.0 mL和20.0±13.4 mL（无显著差异）。1年后，体积分别为5.5±11.7 mL和16.4±13.7 mL（P<0.001），初始体积分别减少了中位数85.6%和7.3%（P<0.001）。PEI后，单纯甲状腺囊肿和混合性甲状腺囊肿的结节体积中位数减少分别为88.8%和65.8%。接受PEI治疗的患者中，压迫症状和外观症状消失的比例分别为74.8%和80.0%，而接受单纯抽液治疗的患者分别为24.4%和37.4%（P<0.001）。副作用较小。
这些数据提供了确凿证据，表明PEI是治疗甲状腺囊性结节的一种安全有效的方法。单纯性甲状腺囊肿是最适合PEI治疗的候选结节。
