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Combining high-intensity focused ultrasound (HIFU) ablation with percutaneous ethanol injection (PEI) in the treatment of benign thyroid nodules

  • Ultrasound
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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.

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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

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Acknowledgments

We would like to thank Mr. Hill Yu for collecting all the clinical relevant data during the study period.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Surgery, The University of Hong Kong, Hong Kong SAR, China

    Brian H. H. Lang

  2. Department of Surgery, Queen Mary Hospital, 02 Pokfulam Road, Hong Kong SAR, China

    Brian H. H. Lang

  3. Department of Medicine, The University of Hong Kong, Hong Kong SAR, China

    Yu-Cho Woo

  4. Department of Radiology, The University of Hong Kong, Hong Kong SAR, China

    Keith Wan-Hang Chiu

Authors
  1. Brian H. H. Lang
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  2. Yu-Cho Woo
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  3. Keith Wan-Hang Chiu
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Contributions

BHH Lang, YC Woo, and KWH Chiu were involved in the review of literature, acquisition of data, and drafting and completing the manuscript. BHH Lang, YC Woo, and KWH Chiu were also involved in the review of literature and drafting the manuscript. BHH Lang, YC Woo, and KWH Chiu conceived the study, participated in the co-ordination and the acquisition of data, and helped to draft the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Brian H. H. Lang.

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Guarantor

The scientific guarantors of this publication are Professor Stephen Cheng (Head of Department) and Professor Brian Lang (first and corresponding author).

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Single institution

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Lang, B.H.H., Woo, YC. & Chiu, K.WH. Combining high-intensity focused ultrasound (HIFU) ablation with percutaneous ethanol injection (PEI) in the treatment of benign thyroid nodules. Eur Radiol 31, 2384–2391 (2021). https://doi.org/10.1007/s00330-020-07317-3

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  • DOI: https://doi.org/10.1007/s00330-020-07317-3

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