Department of Radiology and Nuclear Medicine, Oslo University Hospital HF, 0424Oslo, Norway.
J Clin Endocrinol Metab. 2011 Sep;96(9):2750-5. doi: 10.1210/jc.2010-2952. Epub 2011 Jun 29.
Repeated neck explorations can be a difficult task in patients with recurrent metastatic cervical lymph nodes from papillary thyroid carcinoma (PTC).
The aim of this retrospective study has been to assess the efficacy of ultrasound (US)-guided percutaneous ethanol injection (PEI) as treatment of metastatic cervical lymph nodes from PTC.
Sixty-nine patients who previously had undergone thyroidectomy for PTC were selected for inclusion. However, three patients were later excluded due to lack of follow-up. Lymph node status was determined by US-guided fine-needle aspiration biopsy and/or by raised levels of thyroglobulin in washouts from the cytological needle. Guided by US, 0.1-1.0 ml of 99.5% ethanol was injected into the metastatic lymph nodes.
Three patients (eight metastatic lymph nodes in total) were reassigned to surgery due to progression (multiple new metastases), leaving 63 patients and 109 neck lymph nodes to be included. Mean observation time was 38.4 months (range, 3-72). A total of 101 of the 109 (93%) metastatic lymph nodes responded to PEI treatment, 92 (84%) completely and nine incompletely. Two did not respond, and four progressed. Two lymph nodes previously considered successfully treated showed evidence of malignancy during follow-up. No significant side effects were reported.
US-guided PEI treatment of metastatic lymph nodes seems to be an excellent alternative to surgery in patients with a limited number of neck metastases from PTC. This procedure should replace "berry picking" surgery.
对于复发性甲状腺乳头状癌（PTC）颈部转移性淋巴结的患者，反复进行颈部探查可能是一项艰巨的任务。
本回顾性研究旨在评估超声（US）引导下经皮乙醇注射（PEI）治疗 PTC 颈部转移性淋巴结的疗效。
选择 69 例先前因 PTC 接受甲状腺切除术的患者纳入研究。然而，由于缺乏随访，有 3 例患者后来被排除在外。通过 US 引导下的细针抽吸活检和/或细胞学针冲洗中甲状腺球蛋白水平升高来确定淋巴结状态。在 US 引导下，将 0.1-1.0 ml 的 99.5%乙醇注入转移性淋巴结。
由于进展（多个新转移），有 3 例患者（共 8 个转移性淋巴结）重新分配至手术治疗，其余 63 例患者和 109 个颈部淋巴结纳入研究。平均观察时间为 38.4 个月（范围 3-72）。109 个转移性淋巴结中，共有 101 个（93%）对 PEI 治疗有反应，92 个（84%）完全反应，9 个不完全反应。2 个无反应，4 个进展。2 个先前被认为治疗成功的淋巴结在随访期间显示出恶性肿瘤的证据。未报告明显的不良反应。
对于 PTC 颈部转移性淋巴结数量有限的患者，US 引导下的 PEI 治疗似乎是手术的绝佳替代方案。该方法应替代“摘浆果”手术。
