title: Long-term outcome of ultrasound-guided percutaneous ethanol ablation of selected "recurrent" neck nodal metastases in 25 patients with TNM stages III or IVA papillary thyroid carcinoma previously treated by surgery and 131I therapy.
abstract: BACKGROUND
  Ultrasound-guided percutaneous ethanol ablation (UPEA) of neck nodal metastases (NNM) has rarely been reported in papillary thyroid carcinoma (PTC) patients with advanced localized disease.
  
  
  METHODS
  We ablated 25 PTC patients with stage III or IVA disease (mean age 58 years) who had "recurrent" NNM after surgery and 131I therapy. Diagnosis of 37 selected NNM was proven by ultrasound-guided biopsy. UPEA was usually performed in 2 outpatient sessions.
  
  
  RESULTS
  After UPEA, 35 of 37 NNM (95%) decreased in size. None had significant Doppler flow. Seventeen (46%) disappeared on rescanning. Serum thyroglobulin fell in 19 of 22 (86%) without thyroglobulin autoantibodies. None of the UPEA-treated NNM, followed on average for 5.4 years, required further intervention. Six patients (24%) subsequently developed 18 "new" recurrences. Of the 18, 15 (83%) were managed successfully by UPEA rather than operation. None of the 25 patients developed permanent hoarseness or have died from PTC. At our institution, where patients undergoing nodal dissections are charged $35-45,000, each outpatient UPEA procedure saves health providers approximately $38,400. Our 25 ablated patients, by avoiding 40 further neck reexplorations, on average, saved $61,440 in charges.
  
  
  CONCLUSIONS
  UPEA for NNM in advanced localized PTC has proved safe and effective. It is also considerably less expensive than the conventional operative alternative of nodal dissection.
authors.affiliation: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, MN. Electronic address: hay.ian@mayo.edu.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Hay
authors.forename: Robert A
authors.initials: RA
authors.lastname: Lee
authors.forename: Caroline
authors.initials: C
authors.lastname: Davidge-Pitts
authors.forename: Carl C
authors.initials: CC
authors.lastname: Reading
authors.forename: J William
authors.initials: JW
authors.lastname: Charboneau
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000556:secondary* / Q000628:therapy*; D002291:Carcinoma, Papillary / Q000473:pathology / Q000556:secondary* / Q000628:therapy*; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D009367:Neoplasm Staging; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000473:pathology / Q000556:secondary* / Q000628:therapy*; D013965:Thyroidectomy; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D007457:Iodine Radioisotopes; D000431:Ethanol