Ultrasound-guided injections control recurrent papillary thyroid carcinoma

Ultrasound-guided percutaneous ethanol injections hold up as a treatment for controlling neck recurrence of papillary thyroid carcinoma. They could be effective for patients who are poor candidates for surgery.

Standard treatment for the recurrence of papillary thyroid carcinoma in the neck requires surgery, and early surgical treatment improves prognosis for a recurring neck papillary thyroid carcinoma. But not all patients can tolerate surgery or radioactive iodine therapy when the recurrence of their cancer is found.

Dr. Byung Moon Kim in the radiology department at Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital and colleagues at other hospitals in Seoul published their study in European Radiology, which made it available online Nov. 27.

They studied 47 recurring neck papillary thyroid carcinomas in 27 patients between 19 and 80 years old, with a mean age of 53.2. All patients received treatments consisting of repeated ultrasound-guided percutaneous injections of 99% ethanol, with the needle position adjusted until the entire volume of papillary thyroid carcinoma was ablated. Follow-up ultrasound exams at three to six month intervals measured the percent volume decrease.

Treatment was considered effective when the papillary carcinoma decreased in volume and a power Doppler ultrasound exam showed no tumor vascularity. Failed treatments were those in which the carcinoma volume increased, remained stable, or showed tumor vascularity. Those treatments were repeated in additional sessions.

The researchers tracked the number of sessions and the total volume of ethanol per carcinoma. By the end of the study, all tumors had decreased significantly in volume. Decreases ranged from 30% to 100%, with a mean of 93.6%. The mean number of sessions per carcinoma was 2.1, ranging from one to six. The mean volume of ethanol used was 1.1 mL/session, ranging from 0.3 to 3 mL per session, and the mean total volume of ethanol per carcinoma was 2.4 mL, ranging from 0.3 to 10.1 mL.

The researchers concluded that ultrasound-guided percutaneous ethanol injection could be used as a treatment for neck recurring papillary thyroid carcinomas. This option would open up another treatment for those patients who couldn't tolerate surgery.