Percutaneous ethanol injection (PEI) for thyroid cysts and other neck lesions

Abstract

Percutaneous ethanol injection (PEI), also known as ethanol, or alcohol, ablation, is the first-line treatment for thyroid cystic nodules. Immediately after its instillation into the thyroid tissue, ethanol causes coagulative necrosis and fibrotic changes resulting in a stable and durable regression of the treated cystic lesion. Long-term effectiveness of PEI, along with its substantial safety, has been consistently documented by many studies published in the last decades: therefore this procedure has gained a worldwide diffusion. In parallel with the successful utilization of the sclerosing properties of ethanol in thyroid cystic nodules, PEI application for treatment of autonomously functioning thyroid nodules (AFTNs) or solid cold thyroid nodules has been progressively abandoned due to its poor efficacy, the not negligible risk of side effects, and the expanding use of other ultrasound-guided interventional techniques, namely, laser thermal ablation (LTA) and radio-frequency ablation (RFA). Ethanol ablation has also been used with good results for treating hyperplastic parathyroid (PT) glands in patients with chronic renal failure as well as large nonfunctioning PT cysts. In addition, in selected patients, metastatic lymph nodes from differentiated thyroid cancer can be treated with PEI as an alternative option to surgery.