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

Ultrasound-guided percutaneous ethanol ablation (UPEA) of neck nodal metastases (NNM) has rarely been reported in papillary thyroid carcinoma (PTC) patients with advanced localized disease. We ablated 25 PTC patients with stage III or IVA disease (mean age 58 years) who had “recurrent” NNM after sur...

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Bibliographic Details
Published in:Surgery 2013-12, Vol.154 (6), p.1448-1455
Main Authors: Hay, Ian D., Lee, Robert A., Davidge-Pitts, Caroline, Reading, Carl C., Charboneau, J. William
Format: Article
Language:English
Subjects:
Adult
Aged
Carcinoma - pathology
Carcinoma - secondary
Carcinoma - therapy
Carcinoma, Papillary - pathology
Carcinoma, Papillary - secondary
Carcinoma, Papillary - therapy
Ethanol - administration & dosage
Female
Humans
Iodine Radioisotopes - therapeutic use
Lymphatic Metastasis
Male
Middle Aged
Neck
Neoplasm Staging
Thyroid Cancer, Papillary
Thyroid Neoplasms - pathology
Thyroid Neoplasms - secondary
Thyroid Neoplasms - therapy
Thyroidectomy
Treatment Outcome
Ultrasonography, Interventional
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Summary:Ultrasound-guided percutaneous ethanol ablation (UPEA) of neck nodal metastases (NNM) has rarely been reported in papillary thyroid carcinoma (PTC) patients with advanced localized disease. We ablated 25 PTC patients with stage III or IVA disease (mean age 58 years) who had “recurrent” NNM after surgery and 131I therapy. Diagnosis of 37 selected NNM was proven by ultrasound-guided biopsy. UPEA was usually performed in 2 outpatient sessions. After UPEA, 35 of 37 NNM (95%) decreased in size. None had significant Doppler flow. Seventeen (46%) disappeared on rescanning. Serum thyroglobulin fell in 19 of 22 (86%) without thyroglobulin autoantibodies. None of the UPEA-treated NNM, followed on average for 5.4 years, required further intervention. Six patients (24%) subsequently developed 18 “new” recurrences. Of the 18, 15 (83%) were managed successfully by UPEA rather than operation. None of the 25 patients developed permanent hoarseness or have died from PTC. At our institution, where patients undergoing nodal dissections are charged $35–45,000, each outpatient UPEA procedure saves health providers approximately $38,400. Our 25 ablated patients, by avoiding 40 further neck reexplorations, on average, saved $61,440 in charges. UPEA for NNM in advanced localized PTC has proved safe and effective. It is also considerably less expensive than the conventional operative alternative of nodal dissection.
ISSN:0039-6060
1532-7361
DOI:10.1016/j.surg.2013.07.007