Interventional Oncology

Session: Educational Exhibit Presentations - Station 6: Interventional Oncology

Ethanol Ablation of Cervical Node Metastases from Differentiated Thyroid Carcinoma

Monday, March 6, 2023

5:35 PM – 5:40 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

Emiliano Garza Frias, MD

Post Doctoral Research Fellow
Massachusetts General Hospital

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Cynthia De La Garza Ramos, MD

Interventional Radiology Resident
Department of Radiology, Division of Interventional Radiology, Mayo Clinic, Jacksonville, FL 32224, United States
Beau B. Toskich, MD, FSIR

Professor
Department of Radiology, Division of Interventional Radiology, Mayo Clinic, Jacksonville, FL 32224, United States
RP

Ricardo Paz-Fumagalli, MD

Interventional Radiologist
Mayo Clinic Florida

Disclosure(s):

Emiliano Garza Frias, MD: No financial relationships to disclose

Cynthia De La Garza Ramos, MD: No financial relationships to disclose

Beau B. Toskich, MD, FSIR: No relevant disclosure to display

Learning Objectives: 1) Review clinical indications of percutaneous ethanol ablation (EA) of cervical lymph nodes metastases from thyroid carcinoma. 2) Describe the technical approach of EA. 3) Discuss current literature evidence of EA clinical outcomes.

Background: Differentiated thyroid cancer often metastasizes to cervical lymph nodes. Resection is the treatment of choice, but recurrent surgeries can be challenging due to adhesions, fibrosis, or scar tissue. Ultrasound-guided ethanol injection has been used to ablate cervical node metastases for patients with < 4 metastatic lymph nodes, unresponsive to radioiodine therapy, or considered unsuitable candidates for surgery or general anesthesia. {1-2} EA has been shown to be efficacious and safe, with minimal procedural morbidity. A long-term efficacy study recently demonstrated that approximately 80% (n=35/44) of patients that underwent EA achieved permanent local control at a median follow-up of 11.3 years. {3}

Clinical Findings/Procedure Details:

According to the largest published patient group treated with EA, 13 recurrent lesions (in 10 out of 44 patients) were detected at the site of previous ablation, resulting in 19% recurrence rate. The most common location was the lateral neck (10 lesions), followed by central neck (3 lesions). A total of 6 out of 10 lesions had a diameter of >10mm (median 13.5 mm, range 10-18). {3}

Preliminary sonography is used to plan the approach. After preparation of the skin, local anesthetic is administered only along the expected needle path. A 25-gauge needle is mounted on a 1-mL syringe loaded with absolute ethanol. Using real-time sonographic visualization, the needle is advanced into the target lesion and the ethanol is slowly injected. Diffusion of ethanol produces hyperechogenicity. Ethanol leak identification is based on the sonographic observation of extravasation from the target lesion or the patient reporting a sudden change in pain sensation. Ethanol leak must be identified to minimize the risk of nerve injury. The volume of ethanol injected generally is proportional to node size. No recovery time is required after the intervention and patients can be discharged immediately. {1}

Conclusion and/or Teaching Points: In patients with cervical node metastases from differentiated thyroid cancer who are unresponsive to radioiodine and poor surgical candidates, sonographically-guided EA is safe, low-cost, effective, and can be implemented with widely available equipment.