ABSTRACT
Objective:
Results of
ethanol ablation (EA) for controlling
neck nodal
metastases (NNM) in
adult patients with
papillary thyroid carcinoma (APTC) beyond 6 months have rarely been reported. We now describe outcome results in controlling 71 NNM in 40 node-positive stage I APTC
patients followed for 66 to 269 months.
Methods:
All 40
patients were managed with bilateral
thyroidectomy and radioiodine
therapy and followed with
neck ultrasound (US) for >48 months after EA. Cumulative radioiodine doses ranged from 30 to 550â
mCi; pre-EA 27
patients (67%) had 36 additional
neck surgeries. Cytologic
diagnosis of PTC in 71 NNM selected for EA was confirmed by US-guided
biopsy. EA
technique and follow-up protocol were as previously described.
Results:
The 40
patients had 1 to 4 NNM; 67/71 NNM (94%) received 2 to 4
ethanol injections (total median volume 0.8â
cc). All ablated 71 NNM shrank (mean
volume reduction of 93%); nodal hypervascularity was eliminated. Thirty-eight NNM (54%) with initial volumes of 12-1404â
mm3 (median 164) disappeared on
neck sonography. Thirty-three hypovascular foci from ablated NNM (pre-EA volume range 31-636â
mm3; median 147) were still identifiable with volume reductions of 45% to 97% observed (median 81%). There were no
complications and no postprocedure
hoarseness. Final results were considered to be ideal or near ideal in 55% and satisfactory in 45%. There was no evidence of
tumor regrowth after EA.
Conclusion:
Our results demonstrate that for
patients with American
Joint Committee on
Cancer stage I APTC,
who do not wish further
surgery or radioiodine, and are uncomfortable with
active surveillance, EA can achieve durable control of recurrent NNM.