Verde G, Papini E, Pacella C M, Gallotti C, Delpiano S, Strada S, Fabbrini R, Bizzarri G, Rinaldi R, Panunzi C
Divison of Endocrinology, Ospedale Niguarda Ca' Granda, Milano, Italy.
Clin Endocrinol (Oxf). 1994 Dec;41(6):719-24. doi: 10.1111/j.1365-2265.1994.tb02785.x.
The management of cystic lesions in the thyroid remains controversial. We examined the efficacy and safety of ultrasound guided percutaneous ethanol injection for the treatment of benign cystic thyroid nodules in euthyroid patients.
(A) Preliminary randomized trial: 20 patients with predominantly cystic thyroid nodules were randomized in two groups and followed up for 1 month. Group 1 underwent fine needle aspiration of the fluid component of the nodules; Group 2 underwent percutaneous ethanol injection at the end of fine needle aspiration of the cyst fluid. (B) Prospective study: 32 patients with the same clinical characteristics (Group 3) were treated by fine needle aspiration and percutaneous ethanol injection, and followed up for 12 months.
Groups 1 and 2: clinical evaluation, thyroid ultrasonography, thyroid scintiscan and serum thyroid hormone profile were performed before treatment and one month later. Group 3: clinical evaluation, thyroid ultrasonography and serum thyroid hormone profile were performed in basal conditions and 1, 3, 6, 9, 12 months after treatment. Thyroid scintiscan was performed before treatment and 3-6 months later.
(A) Randomized study: one month after treatment, nodule volume decrease in Group 2 was significantly higher than in Group 1 (Group 2: median 14.75 range 6-29.9 ml; Group 1: median 3.65 range 0.2-18.5 ml; P < 0.01). Nodule volume reduction was greater than 50% versus baseline in 8 (80%) patients in Group 2 and in 3 (30%) patients in Group 1 (P < 0.01). (B) Prospective study (Group 3): a significant nodule volume reduction (P < 0.01 vs pretreatment) was observed 1 and 12 months after percutaneous ethanol injection (pretreatment: median 14.5, range 1.5-65.8 ml; 1 month: median 3.5, range 0.4-38.9 ml; 12 months: median 2.5, range 0.4-34.5 ml). Nodule volume reduction greater than 50% was recorded in 24 (80%) patients. Groups 1-3: recurrence of cyst fluid was demonstrated by ultrasonography in 8 patients of Group 1, in 3 patients of Group 2 and in 1 patient of Group 3. No relevant adverse effects or significant biochemical changes were observed.
Ultrasound guided percutaneous ethanol injection of cystic thyroid nodules is a safe, low-cost and effective therapeutic procedure in patients with benign thyroid cystic nodules. Indeed, nodule volume reduction was significantly greater and more frequent in patients treated by percutaneous ethanol injection than in those patients who underwent fluid aspiration alone. These results were confirmed in a long-term prospective trial and only one fluid recurrence was observed during 12 months of follow-up.
甲状腺囊性病变的管理仍存在争议。我们研究了超声引导下经皮乙醇注射治疗甲状腺功能正常患者的良性甲状腺囊性结节的有效性和安全性。
（A）初步随机试验：20例以甲状腺囊性结节为主的患者被随机分为两组，并随访1个月。第1组对结节的液体成分进行细针穿刺抽吸；第2组在对囊液进行细针穿刺抽吸后进行经皮乙醇注射。（B）前瞻性研究：32例具有相同临床特征的患者（第3组）接受细针穿刺抽吸和经皮乙醇注射治疗，并随访12个月。
第1组和第2组：在治疗前和治疗1个月后进行临床评估、甲状腺超声检查、甲状腺闪烁扫描和血清甲状腺激素谱检查。第3组：在基础状态以及治疗后1、3、6、9、12个月进行临床评估、甲状腺超声检查和血清甲状腺激素谱检查。在治疗前和治疗3 - 6个月后进行甲状腺闪烁扫描。
（A）随机研究：治疗1个月后，第2组结节体积减小明显高于第1组（第2组：中位数14.75，范围6 - 29.9 ml；第1组：中位数3.65，范围0.2 - 18.5 ml；P < 0.01）。第2组8例（80%）患者的结节体积较基线减少大于50%，第1组3例（30%）患者如此（P < 0.01）。（B）前瞻性研究（第3组）：经皮乙醇注射后1个月和12个月观察到结节体积显著减小（与治疗前相比，P < 0.01）（治疗前：中位数14.5，范围1.5 - 65.8 ml；1个月：中位数3.5，范围0.4 - 38.9 ml；12个月：中位数2.5，范围0.4 - 34.5 ml）。24例（80%）患者的结节体积减少大于50%。第1 - 3组：超声检查显示第1组8例、第2组3例和第3组1例患者出现囊液复发。未观察到相关不良反应或显著的生化变化。
超声引导下经皮乙醇注射治疗甲状腺囊性结节对良性甲状腺囊性结节患者是一种安全、低成本且有效的治疗方法。实际上，经皮乙醇注射治疗的患者结节体积减小明显更大且更频繁，比仅接受液体抽吸的患者效果更好。这些结果在长期前瞻性试验中得到证实，并且在12个月的随访期间仅观察到1例囊液复发。
