Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA.
Am Surg. 2021 Apr;87(4):581-587. doi: 10.1177/0003134820951491. Epub 2020 Nov 1.
To evaluate the safety and efficacy of percutaneous ethanol ablation (PEA) on indeterminate thyroid nodules (Bethesda III and IV) based on ultrasound (US) elastography by assessing the volume reduction rate (VRR), relative reduction in size, resolution of compressive symptoms, and post-procedural complications.
This is a retrospective cohort study of all thyroid nodules treated with PEA by a single surgeon at a North American tertiary referral center. Study variables included demographics, nodule characteristics, Bethesda classification, US elastography, presence of compressive symptoms, thyroid function, and post-procedural complications. Relative volume reductions and VRR were calculated at 3- and 6-month follow-ups.
Thirty-four thyroid nodules were evaluated in 22 patients. All thyroid nodules underwent a fine needle aspiration prior to PEA. After 6 months, 45% of all thyroid nodules exhibited a VRR of ≥50%. A significant VRR was achieved in the soft thyroid nodules at 6 months (42.15% ± 31), compared to the stiff nodules with 30.92% ± 91.53, < .05. Post-PEA thyroid stimulating hormone levels did not significantly change after the procedure. Compressive symptoms resolved in all 5 patients who reported it. One patient developed transient vocal cord paresis that resolved in 3 months.
To the best of our knowledge, this is the largest series of PEA for thyroid nodules in North America. Ultrasound elastography is a useful adjunct in predicting the success of PEA for nonmalignant thyroid nodules. Percutaneous ethanol ablation is both a safe and effective alternative to surgery for relief of compressive symptoms in select patients.
通过评估体积减少率（VRR）、相对缩小率、压迫症状缓解情况和术后并发症，评估超声弹性成像引导下经皮乙醇消融（PEA）治疗不确定甲状腺结节（Bethesda III 和 IV 类）的安全性和有效性。
这是一项回顾性队列研究，纳入了在北美一家三级转诊中心由同一位外科医生进行 PEA 治疗的所有甲状腺结节患者。研究变量包括人口统计学特征、结节特征、Bethesda 分类、超声弹性成像、压迫症状、甲状腺功能和术后并发症。在 3 个月和 6 个月随访时计算相对体积减少率和 VRR。
在 22 名患者中评估了 34 个甲状腺结节。所有甲状腺结节均在 PEA 前进行了细针抽吸活检。6 个月后，45%的甲状腺结节 VRR≥50%。与硬结节（30.92%±91.53）相比，软结节在 6 个月时获得了显著的 VRR（42.15%±31），差异有统计学意义（<.05）。PEA 后促甲状腺激素水平在手术后没有显著变化。所有报告有压迫症状的患者的症状均得到缓解。1 例患者出现短暂性声带麻痹，3 个月后缓解。
据我们所知，这是北美最大的 PEA 治疗甲状腺结节系列研究。超声弹性成像有助于预测 PEA 治疗非恶性甲状腺结节的成功率。对于选择的患者，经皮乙醇消融是手术缓解压迫症状的一种安全有效的替代方法。
