Ultrasound-Guided Percutaneous Ethanol Ablation for the Management of Recurrent Thyroid Cancer: Evaluation of Efficacy and Impact on Disease Course

Abstract

[eng] Background and Objectives: Neck recurrences of thyroid cancer are frequently detected in routine ultrasound (US) follow-up. Broad management of these lesions may include active surveillance, surgery or local percutaneous techniques, but for the latter, little is known about impact on long-term follow-up and need of subsequent radioactive iodine (RAI) therapy. Materials and Methods: 42 patients underwent US-guided ethanol ablation (EA) over 71 thyroid bed or lymph node confirmed recurrences. All volume reduction ＞50%, absence of power Doppler signal and fine needle aspiration (FNA) washout thyroglobulin (Tg) value ＜1 ng/mL should be present to consider a complete ablation. Patients with TNM stage I-II, ≤2 lesions and/or baseline plasma TSH-suppressed Tg level ＜0.2 ng/mL did not undergo post-EA RAI therapy. Post-EA plasma Tg values were compared to baseline in patients with and without subsequent RAI therapy. Results: 62 lesions (87.32%) achieved a complete ablation after a mean follow-up of 40.5 months (range, 12-73). Four treated lesions (5.63%) recurred (3/39 and 1/32 in patients with and without subsequent RAI therapy), and 7 patients (16.66%) developed new recurrences throughout follow-up (5/19 and 2/23 with and without RAI therapy). Both plasma TSH-suppressed and TSH-stimulated Tg levels descended after EA in both groups, and 17/38 (44.73%) patients achieved a TSH-suppressed Tg ＜0.2 ng/mL, with no differences between both groups of patients. All EA procedures were conducted safely without serious or persistent side effects. Conclusion: Successful EA were achieved safely in 87.32% of patients with recurrent thyroid cancer, with a positive effect on systemic disease as reflected by plasma post-EA Tg levels. A subset of patients with TNM stage III, ≤2 lesions and/or low pre-EA plasma Tg levels may not need subsequent RAI therapy after successful ablation. Overall, EA is an effective and balanced therapy for selected patients with neck recurrent thyroid cancer as an alternative to surgery.