Endocrinology, Diabetes and Metabolism Department and Center for Thyroid Diseases, A.O. Ordine Mauriziano, Turin, Italy.
Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
Eur J Endocrinol. 2020 Nov;183(5):489-495. doi: 10.1530/EJE-20-0213.
Cystic thyroid nodules (CNs), although generally benign, can cause compressive or aesthetic problems. Percutaneous ethanol injection (PEI) can represent an alternative to surgery. The present retrospective study evaluates: (i) the long-term outcome of CNs after PEI; (ii) the differences between two different PEI protocols; (iii) the CNs response according to the liquid component.
The study comprises 358 nodules post-PEI followed for at least 2 years. PEI was performed according to two different treatment protocols with a single (Foggia) or double (Turin) alcohol injection. CNs were divided according to their composition: cystic (CYS) >90%, mainly cystic (M-CYS) 75-90%, mixed (MIX) 50-75%, solid-mixed (S-MIX) 35-50%. The volume reduction rate (VRR) was defined as nodule volume (mL) after PEI/nodule volume (mL) before PEI x 100.
The 1-year VRR was significantly higher than that at 6 months (89.5% vs 72.9%, P = 0.0005), no differences were observed after 1 year. A significant difference between Turin and Foggia was observed only in VRR at early visit (79% vs 86%, respectively, P = 0.002) and recurrence rate (14% vs 24%, respectively, P = 0.001). Minor side-effects were infrequent. In 192 nodules with a 10-year follow-up CYS showed higher VRR than MIX and S-MIX nodules (P < 0.001).
Our study reported that the long-term outcome of CNs treated with PEI is excellent regardless of the PEI technique utilized; the larger the cystic amount, the higher the VRR. Based on present results, PEI can be considered as the first-line choice for treating thyroid CNs.
尽管甲状腺囊性结节（CN）通常为良性，但仍可能导致压迫或美观问题。经皮乙醇注射（PEI）可作为手术的替代方法。本回顾性研究评估了：（i）PEI 后 CN 的长期结果；（ii）两种不同 PEI 方案之间的差异；（iii）根据液体成分的 CN 反应。
该研究纳入了至少随访 2 年的 358 例经 PEI 治疗的结节。PEI 采用两种不同的治疗方案进行，包括单次（福贾）或双次（都灵）酒精注射。根据其组成，将 CN 分为：囊性（CYS）＞90%，主要为囊性（M-CYS）75-90%，混合性（MIX）50-75%，实性-混合性（S-MIX）35-50%。体积减少率（VRR）定义为 PEI 后结节体积（mL）/PEI 前结节体积（mL）×100。
1 年时的 VRR 明显高于 6 个月时（89.5% vs 72.9%，P = 0.0005），1 年后无差异。仅在早期就诊时观察到都灵和福贾之间的 VRR 存在显著差异（分别为 79% vs 86%，P = 0.002）和复发率（分别为 14% vs 24%，P = 0.001）。轻微的副作用并不常见。在 192 例随访 10 年的结节中，CYS 组的 VRR 高于 MIX 组和 S-MIX 组（P < 0.001）。
我们的研究报告称，无论使用何种 PEI 技术，CN 经 PEI 治疗的长期结果均非常出色；囊性成分越多，VRR 越高。基于目前的结果，PEI 可被视为治疗甲状腺 CN 的首选方法。
