Combining high-intensity focused ultrasound (HIFU) ablation with percutaneous ethanol injection (PEI) in the treatment o
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Combining high-intensity focused ultrasound (HIFU) ablation with percutaneous ethanol injection (PEI) in the treatment of benign thyroid nodules Brian H. H. Lang 1,2
&
Yu-Cho Woo 3 & Keith Wan-Hang Chiu 4
Received: 7 April 2020 / Revised: 17 August 2020 / Accepted: 17 September 2020 # European Society of Radiology 2020
Abstract Objective Assessing the 6-month efficacy of combined high-intensity focused ultrasound (HIFU) ablation with percutaneous ethanol injection (PEI) in benign thyroid nodules by comparing it with HIFU ablation alone. Methods One hundred and eighty-one (55.2%) patients underwent HIFU alone (group I) while 147 (44.8%) underwent concomitant HIFU and PEI treatment for solid or predominantly solid nodules (group II). Intravenous sedation and analgesia were given before the start of treatment. Extent of nodule shrinkage (by volume reduction ratio (VRR)), pain scores (by 0–10 visual analogue scale) during and after ablation, and rate of vocal cord palsy (VCP), skin burn, and nausea/vomiting were compared between the two groups. Results The mean amount of ethanol injected in group II was 1.3 ± 0.7 ml. The 3- and 6-month VRR were significantly greater in group II (60.41 ± 20.49% vs. 50.13 ± 21.06%, p = 0.001; and 71.08 ± 21.25% vs. 61.37 ± 22.76%, p = 0.001, respectively), and “on-beam” treatment time was significantly shorter in group II (26.55 min vs. 30.26 min, p = 0.001). Group II patients reported significantly lower pain score during treatment (2.24 ± 3.07 vs. 4.97 ± 3.21, p < 0.001) and 2 h after treatment (2.23 ± 2.50 vs. 2.97 ± 4.39, p = 0.044). Rates of VCP, skin burn, and nausea or vomiting were not significantly different (p > 0.05). Conclusions The combined HIFU and PEI approach with improved administration of intravenous sedation and analgesia was associated with a significantly better 6-month efficacy than HIFU alone in benign thyroid nodules without compromising the safety and comfort of patients. Key Points • Concomitant HIFU and PEI have a better treatment efficacy than HIFU alone. • Concomitant HIFU and PEI have a comparable safety profile as HIFU alone. Keywords Interventional ultrasonography . High-intensity focused ultrasound ablation . Nodular goiter . Ultrasonic imaging . Ablation techniques
* Brian H. H. Lang [email protected] 1
Department of Surgery, The University of Hong Kong, Hong Kong SAR, China
2
Department of Surgery, Queen Mary Hospital, 02 Pokfulam Road, Hong Kong SAR, China
3
Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
4
Department of Radiology, The University of Hong Kong, Hong Kong SAR, China
Abbreviations HIFU High-intensity focused ultrasound PEI Percutaneous ethanol injection Tg Thyroglobulin TSH Thyroid-stimulating hormone US Ultrasonography VCP Vocal cord palsy VRR Volume reduction ratio
Introduction Benign thyroid nodules are present in over 70% of the general population. Although most remain relatively static over time, some can grow and cause symptoms necessitating surgery
Eur Radiol
[1–3]. However, surgery
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