title: Efficacy of ultrasound-guided percutaneous ethanol injection treatment in patients with a limited number of metastatic cervical lymph nodes from papillary thyroid carcinoma.
abstract: BACKGROUND
  Repeated neck explorations can be a difficult task in patients with recurrent metastatic cervical lymph nodes from papillary thyroid carcinoma (PTC).
  
  
  OBJECTIVE
  The aim of this retrospective study has been to assess the efficacy of ultrasound (US)-guided percutaneous ethanol injection (PEI) as treatment of metastatic cervical lymph nodes from PTC.
  
  
  METHODS
  Sixty-nine patients who previously had undergone thyroidectomy for PTC were selected for inclusion. However, three patients were later excluded due to lack of follow-up. Lymph node status was determined by US-guided fine-needle aspiration biopsy and/or by raised levels of thyroglobulin in washouts from the cytological needle. Guided by US, 0.1-1.0 ml of 99.5% ethanol was injected into the metastatic lymph nodes.
  
  
  RESULTS
  Three patients (eight metastatic lymph nodes in total) were reassigned to surgery due to progression (multiple new metastases), leaving 63 patients and 109 neck lymph nodes to be included. Mean observation time was 38.4 months (range, 3-72). A total of 101 of the 109 (93%) metastatic lymph nodes responded to PEI treatment, 92 (84%) completely and nine incompletely. Two did not respond, and four progressed. Two lymph nodes previously considered successfully treated showed evidence of malignancy during follow-up. No significant side effects were reported.
  
  
  CONCLUSIONS
  US-guided PEI treatment of metastatic lymph nodes seems to be an excellent alternative to surgery in patients with a limited number of neck metastases from PTC. This procedure should replace "berry picking" surgery.
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital HF, 0424Oslo, Norway.
authors.forename: Arne
authors.initials: A
authors.lastname: Heilo
authors.forename: Eva
authors.initials: E
authors.lastname: Sigstad
authors.forename: Kristin Holgersen
authors.initials: KH
authors.lastname: Fagerlid
authors.forename: Olav Inge
authors.initials: OI
authors.lastname: Håskjold
authors.forename: Krystyna Kotanska
authors.initials: KK
authors.lastname: Grøholt
authors.forename: Aasmund
authors.initials: A
authors.lastname: Berner
authors.forename: Trine
authors.initials: T
authors.lastname: Bjøro
authors.forename: Lars H
authors.initials: LH
authors.lastname: Jørgensen
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D002277:Carcinoma; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D000431:Ethanol / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000431:Ethanol