Semin intervent Radiol 2019; 36(05): 381-385
DOI: 10.1055/s-0039-1696651
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ethanol Ablation of Neck Metastases from Differentiated Thyroid Carcinoma

Ricardo Paz-Fumagalli
1   Division of Interventional Radiology, Mayo Clinic, Jacksonville, Florida
,
Xi Li
1   Division of Interventional Radiology, Mayo Clinic, Jacksonville, Florida
2   Interventional Radiology Department, Changzheng Hospital, Shanghai, China
,
Robert C. Smallridge
3   Division of Endocrinology, Mayo Clinic, Jacksonville, Florida
› Author Affiliations
Further Information

Publication History

Publication Date:
02 December 2019 (online)

Abstract

Differentiated thyroid cancer often metastasizes to cervical lymph nodes, characteristically with slow growth rate and low-level aggressiveness. Cervical lymph node resection is the treatment of choice, but ethanol ablation offers a therapeutic option for patients with few nodes unresponsive to radioiodine therapy and who are poor surgical candidates. The ethanol ablation procedure is minimally invasive, guided sonographically, easily and safely repeated, and easily implemented with minimal technology and cost. Transient nerve injury is infrequent and virtually the only important complication. Current experience indicates that ethanol ablation has the safest therapeutic profile compared to surgery and thermal ablation, and the effectiveness is comparable to thermal ablation and approaches that of surgery. Well-designed clinical trials are lacking.

 
  • References

  • 1 Solbiati L, Giangrande A, De Pra L, Bellotti E, Cantù P, Ravetto C. Percutaneous ethanol injection of parathyroid tumors under US guidance: treatment for secondary hyperparathyroidism. Radiology 1985; 155 (03) 607-610
  • 2 Charboneau JW, Hay ID, van Heerden JA. Persistent primary hyperparathyroidism: successful ultrasound-guided percutaneous ethanol ablation of an occult adenoma. Mayo Clin Proc 1988; 63 (09) 913-917
  • 3 Lewis BD, Hay ID, Charboneau JW, McIver B, Reading CC, Goellner JR. Percutaneous ethanol injection for treatment of cervical lymph node metastases in patients with papillary thyroid carcinoma. AJR Am J Roentgenol 2002; 178 (03) 699-704
  • 4 Cooper DS, Doherty GM, Haugen BR. , et al; American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19 (11) 1167-1214
  • 5 Haugen BR, Alexander EK, Bible KC. , et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26 (01) 1-133
  • 6 National Comprehensive Cancer Network. NCCN Guidelines. Available at: https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf . Accessed July 25, 2019
  • 7 Valvo V, Nucera C. Coding molecular determinants of thyroid cancer development and progression. Endocrinol Metab Clin North Am 2019; 48 (01) 37-59
  • 8 Stulak JM, Grant CS, Farley DR. , et al. Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer. Arch Surg 2006; 141 (05) 489-494 , discussion 494–496
  • 9 Qubain SW, Nakano S, Baba M, Takao S, Aikou T. Distribution of lymph node micrometastasis in pN0 well-differentiated thyroid carcinoma. Surgery 2002; 131 (03) 249-256
  • 10 Ito Y, Uruno T, Nakano K. , et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid 2003; 13 (04) 381-387
  • 11 Smith VA, Sessions RB, Lentsch EJ. Cervical lymph node metastasis and papillary thyroid carcinoma: does the compartment involved affect survival? Experience from the SEER database. J Surg Oncol 2012; 106 (04) 357-362
  • 12 Randolph GW, Duh QY, Heller KS. , et al; American Thyroid Association Surgical Affairs Committee's Taskforce on Thyroid Cancer Nodal Surgery. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid 2012; 22 (11) 1144-1152
  • 13 Schneider DF, Mazeh H, Chen H, Sippel RS. Lymph node ratio predicts recurrence in papillary thyroid cancer. Oncologist 2013; 18 (02) 157-162
  • 14 Viola D, Materazzi G, Valerio L. , et al. Prophylactic central compartment lymph node dissection in papillary thyroid carcinoma: clinical implications derived from the first prospective randomized controlled single institution study. J Clin Endocrinol Metab 2015; 100 (04) 1316-1324
  • 15 Wada N, Suganuma N, Nakayama H. , et al. Microscopic regional lymph node status in papillary thyroid carcinoma with and without lymphadenopathy and its relation to outcomes. Langenbecks Arch Surg 2007; 392 (04) 417-422
  • 16 Hay ID, Lee RA, Davidge-Pitts C, Reading CC, Charboneau JW. Long-term outcome of ultrasound-guided percutaneous ethanol ablation of selected “recurrent” neck nodal metastases in 25 patients with TNM stages III or IVA papillary thyroid carcinoma previously treated by surgery and 131I therapy. Surgery 2013; 154 (06) 1448-1454 , discussion 1454–1455
  • 17 Fontenot TE, Deniwar A, Bhatia P, Al-Qurayshi Z, Randolph GW, Kandil E. Percutaneous ethanol injection vs reoperation for locally recurrent papillary thyroid cancer: a systematic review and pooled analysis. JAMA Otolaryngol Head Neck Surg 2015; 141 (06) 512-518
  • 18 Suh CH, Baek JH, Choi YJ, Lee JH. Efficacy and safety of radiofrequency and ethanol ablation for treating locally recurrent thyroid cancer: a systematic review and meta-analysis. Thyroid 2016; 26 (03) 420-428
  • 19 Vega-Figueroa L, Cheicky E, Abate E. , et al. Nerve injury after ethanol ablation of thyroid cancer metastases to the neck. J Endocr Soc 2019; 3 (01) MON-553