Non-surgical management of benign thyroid cysts: use of ultrasound-guided ethanol ablation

Purpose: To determine the efficacy and safety of ultrasound-guided percutaneous ethanol ablation for the management of benign thyroid cysts. Study design: In this prospective study, 40 patients with fine-needle aspiration cytology-proven benign thyroid cysts underwent alcohol ablation. Sonographically, 24 nodules were predominantly cystic (simple cysts), and 16 showed both solid and cystic elements (complex cysts). The cyst fluid was aspirated, and an amount of sterile 95% ethanol equivalent to, 50% of the aspirated fluid was injected. Initially, a 20-gauge needle on a 20 ml syringe was used. Later, a three-way cannula was used in which one port was used for aspiration of the cyst fluid and the other for injection of the alcohol. Results: The pretreatment volume of the cysts was 5.8-18.5 ml (mean (SD) 12.26 (3.6)). Cyst volume after treatment was 0-8 ml (mean (SD) 3.73 (2.8)). Ten cysts had disappeared completely after treatment. Cosmetic symptoms disappeared in 90% of the patients. Twenty-four patients complained of a local burning sensation at the injection site. The use of the three-way cannula helped to decrease the procedure time by decreasing the chances of needle displacement. Conclusion: Ultrasound-guided ethanol ablation is a safe, highly effective, relatively rapid treatment modality that is both patient and surgeon friendly and should be considered as the treatment of choice for benign cystic thyroid nodules.