Elsevier

Endocrine Practice

Volume 26, Issue 5, May 2020, Pages 492-498
Endocrine Practice

Original Articles
Ablation of Cystic Thyroid Nodules With N-Butyl Cyanoacrylate: A Preliminary Study

https://doi.org/10.4158/EP-2019-0497Get rights and content

ABSTRACT

Objective: Generally recommended treatment options for cystic nodules with compressive symptoms are simple aspiration, percutaneous ethanol injection, or surgery. N-butyl cyanoacrylate (NBCA) is a glue-like substance widely used in neurointerventions, mainly for treating arteriovenous malformations. It obstructs and attaches to the vessel walls, preventing recanalization. Our purpose was to investigate the efficacy and safety of NBCA in volume reduction of benign cystic thyroid nodules with compressive symptoms.

Methods: Twenty patients with 21 benign pure or partially cystic nodules were enrolled. After simple cyst aspiration, NBCA/lipiodol mixture was injected within the cyst cavity. Success was defined as at least 50% volume reduction after the intervention. Pre- and postintervention longest diameter and volume (calculated with ultrasonography after measuring three dimensions) of the nodules were compared. Posttreatment measurements were made at the 9-month final visit.

Results: Median largest diameter of the nodules measured before and after NBCA treatment was 4.8 cm (min-max, 3.1 and 6.3 cm) and 3.4 cm (min-max, 2.4 and 5.6 cm), respectively. Pre-NBCA treatment median volume was 24.8 mL (min-max, 10.9 and 46.1 mL), whereas post-treatment median volume was 5.5 mL (min-max, 2.1 and 29.6 mL). Median volume reduction was 72.6% (min-max, 21.0 and 95.4%). Intervention was successful in 20 of 21 nodules according to the predefined criteria. The changes in pre- and postintervention median longest diameter and volume were statistically significant.

Conclusion: For large cystic thyroid nodules, ablation with NBCA may be an effective treatment choice, as it significantly reduces the cyst volume and prevents fluid re-accumulation. There is need for further studies with a larger number of patients and longer follow-up.

Abbreviations: NBCA = N-butyl cyanoacrylate; PEI = percutaneous ethanol injection; US = ultrasonography

Section snippets

INTRODUCTION

Thyroid nodules are very common in daily clinical practice, and the incidence continues to increase due to the more frequent use of high-resolution ultrasonography (US) (1,2). The management of the thyroid nodules depends on the size, ultrasonographic features, and presence of compressive symptoms. The priority is always ruling out malignancy, and fine-needle aspiration biopsy (FNAB) is useful for that purpose. Pure cystic nodules have negligible risk of malignancy according to American Thyroid

METHODS

Our prospective study was performed in the Interventional Radiology Department of Ataturk Education and Research Hospital, Ankara, Turkey. Twenty patients with 21 pure or partially cystic nodules who were admitted to our tertiary medical center between January 2017 and January 2018 were enrolled. Informed written consent was obtained from all subjects prior to their enrollment, and our local ethics committee approved the study protocol in accordance with principles of the Declaration of

RESULTS

Twenty patients with 21 pure or predominantly cystic nodules were enrolled in the present study, including 12 females and 8 males. The mean age was 48.3 ± 13.3 years. Family history of thyroid disease was present in 14 patients. None of them had family history of thyroid cancer or previous exposure to ionized radiation. Seventeen of the nodules were palpated during the neck examination, whereas 3 nodules were incidentally discovered during carotid Doppler US, and 1 nodule was detected in neck

DISCUSSION

Thyroid nodules are very common in clinical practice; they are discovered by palpation in 3 to 7% and by US in approximately 50% of the general population (11). Most thyroid nodules are benign and do not cause any symptoms; benign thyroid nodules are therefore usually followed by only observation. However, a small portion of nodules (10 to 15%) increase in size over time and may induce symptoms or cosmetic concerns (12).

Surgery is established as a treatment choice for symptomatic benign thyroid

CONCLUSION

In conclusion, benign cystic thyroid nodules are common in clinical practice, and they can cause compressive symptoms. In such cases, cyst ablation with NBCA may be an effective treatment choice, as it significantly reduces the cyst volume and prevents fluid re-accumulation. There is a need for further studies with larger numbers of patients and longer follow-up, however.

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    • Cited by (3)

    • American Association of Clinical Endocrinology Disease State Clinical Review: The Clinical Utility of Minimally Invasive Interventional Procedures in the Management of Benign and Malignant Thyroid Lesions

      2022, Endocrine Practice
      Citation Excerpt :

      The major limitations of HIFU are its limited availability and prolonged treatment time relative to other ablative techniques.140 Percutaneous NBCA/lipiodol mixture has been injected in cystic thyroid nodules after aspiration in a small study of 21 nodules with 72.6% median volume reduction; NBCA is a glue-like substance used in vascular embolization.144 Larger studies are needed to establish safety and efficacy in this context.

    • Nonsurgical treatment of thyroid cysts - "seal them up"

      2020, Endocrine Practice

    • Efficacy of ethanol ablation for benign thyroid cysts and predominantly cystic nodules: A systematic review and meta-analysis

      2021, Endocrinology and Metabolism

    DISCLOSURE

    The authors have no multiplicity of interest to disclose.

    See accompanying article on p. 573.

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