Efficacy of Ultrasound-Guided Percutaneous Ethanol Ablation for Locally Recurrent Pediatric Thyroid Cancer

Tuesday, March 7, 2023

3:09 PM – 3:18 PM

Location: Phoenix Convention Center, 224AB

Presenting Author(s)

SS

Sean Schoeman, MBChB

Post-Doctoral Research Fellow
Children's Hospital of Philadelphia

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

MG

Marian Gaballah, DO

Attending Physician
Children's Hospital of Philadelphia
FW

Fikadu Worede, n/a

Resident
Mercy Hospital of Philadelphia
AC

Anne Marie Cahill, MBBch, BAO

Division Chief
Children's Hospital Of Philadelphia
AS

Abhay S. Srinivasan, MD

Assistant Professor
Children's Hospital of Philadelphia
GK

Ganesh Krishnamurthy, MD

Assistant Professor
Children's Hospital of Philadelphia
FE

Fernando Escobar, MD

Assistant Professor
Children's Hospital of Philadelphia
AB

Andrew Bauer, MD

Professor of Pediatrics
Children's Hospital of Philadelphia

Disclosure(s):

Sean Schoeman, MBChB: No financial relationships to disclose

Anne Marie Cahill, MBBch, BAO: Avanos Medical: Advisory Committee or Review Panel Member (Ongoing); Purespring: Advisory Committee or Review Panel Member (Ongoing); Siemens Healthineers: Consultant (Ongoing)

Abhay S. Srinivasan, MD: No financial relationships to disclose

Ganesh Krishnamurthy, MD: No financial relationships to disclose

Purpose: To assess the efficacy of ultrasound guided percutaneous ethanol ablation (UPEA) for locally recurrent thyroid cancer in pediatric patients and evaluate lesion response on imaging and associations between patient and lesion-level features and response.

Materials and Methods:

A retrospective study of clinical and imaging records of children referred for UPEA of locally recurrent thyroid cancer over a 12-year period was performed. All patients had confirmed metastases to the surgical bed (SB) or local lymph nodes; those with >5 local metastases did not undergo UPEA. Patients with no follow-up imaging were excluded.

17 patients (10 F, 7 M), all with a diagnosis of papillary thyroid cancer met criteria. Median age at diagnosis was 14 years (IQR 12.6-15.3 y). All were treated by initial thyroidectomy and nodal dissection, and 8 required additional nodal resection. All received radioactive iodine ablation post-resection, with 4 receiving >1 treatment. All UPEA were performed on an outpatient basis with general anesthesia. Sonographic and clinical follow-up after UPEA to evaluate Thyroglobulin (Tg) level, lesion size and perfusion with Doppler assessment occurred at approximately 6-month intervals. Lesion progression was assessed on a combination of no decrease in perfusion, volume reduction rate < 50% and increasing Tg levels.

Results:

Median time from diagnosis to first UPEA was 2.8 y (IQR 1.8-5.1 y). Patients underwent one (n=9) or two (n=8) UPEA procedures. Median change in Tg level after treatment (range 4-18 months) was a decrease of 0.45 ng/ml (IQR 0.10-3.13 ng/ml). Median ultrasound follow-up was 13 m (IQR 11-19 m).

There were 35 evaluable lesions, of which 26 were lymph nodes. Median initial lesion volume was 105 mm3 (IQR 55.0 – 285.9) with a median volume reduction rate (winsorized) of 71.4% (IQR 33.3-100). 8 lesions progressed despite UPEA, with subsequent surgical nodal resection required. Residual perfusion was absent in 64.5% and there was no association between lesion type (LN vs SB) and perfusion outcome (p=0.83). 10 lesions (28.6%) required repeat treatment. Median ethanol volume on 1st treatment was 0.3ml (IQR 0.2-0.4); there was no correlation between ethanol volume and volume reduction rate (Spearman’s r=0.03, p=0.89). Most UPEA were done with a 25 G needle (72%) and needle gauge, 25 G or 27 G, had no effect on volume reduction rate (51.7% vs 26.5% p=0.85). No procedure-related complications occurred.

Conclusion: Results indicate a response on imaging by a large proportion of lesions and support the use of ethanol ablation in the management of recurrent thyroid cancer in children.