Minimally invasive techniques for the management of benign thyroid nodules: Efficacy and impact on quality of life of percutaneous ethanol injection. Results from a high-resolution thyroid nodule unit

Abstract

Background and objective: The high incidence of thyroid nodular disease has raised concerns on the therapeutic management of benign thyroid nodules. The development of minimally invasive techniques is an alternative to surgery and has a low rate of complications. Our objective was to evaluate the safety and efficacy profile of percutaneous ethanol injections (PEI) with ethanol aspiration of symptomatic cystic and predominantly cystic thyroid nodules (cystic component > 50%) treated in the thyroid nodule high-resolution unit (TNHRU) of Hospital de Tortosa Verge de la Cinta Hospital, Tarragona, Spain.

Patients and methods: The present work is a prospective, observational and descriptive study of 32 patients (87.5% women, mean age of 43; SD, 12) evaluated at the TNHRU from August 2022 through December 2023. Demographic data such as age, sex, previous thyroid function, diagnostic method, initial nodular volume, nodular composition and nodular location were analyzed. Using ultrasounds, measurements of diameters and thyroid nodule volume were taken. We aspirated a total of 50% of the cystic content and injected between 2 mL and 5 mL of 99% ethanol (depending on cystic volume). After letting the ethanol act inside the nodule for 5 to 10 minutes, all the cystic content and the injected ethanol were aspirated. We performed an ultrasound follow-up at 1, 3 and 6 months, calculating the total volume and the volume reduction rate (VRR). The impact on health-related quality of life (HRQoL) was assessed using the ThyPRO-39es questionnaire, which was administered before and after the PEI treatment at the 6-month follow-up.

Results: The median volume reduction at the end of the 6-month follow-up was 0.23 mL (0.00-0.67), and the VRR, 98.57% (94.80-100.00). The difference between the initial volume and the mean volume at the 1-, 3-, and 6-month follow-ups was statistically significant, as was the VRR between the 1-month and the 3- and 6-month follow-ups. Six patients (18.80%) required 2 PEIs and only 2 patients (6.3%) required 3 PEIs. The overall quality of life, which was scored from 0 (good) to 4 (poor), significantly improved from 1.28; SD, 0.81 up to 0.19; SD, 0.40 (p < 0.001).

Conclusions: PEI is an effective alternative to treat cystic thyroid nodules resulting in an improved patients' HRQoL. It can be performed outpatiently with a low rate of complications, thus making it suitable for inclusion in the service portfolio of a HRTNU.

Keywords: Ecografía tiroidea; Minimally invasive techniques; Nódulo tiroideo; Thyroid nodule; Thyroid ultrasound; Técnicas mínimamente invasivas.