Ultrasound (US)-guided ethanol ablation for cystic thyroid nodules: a comparison of the ethanol retention and aspiration techniques

Abstract Purpose This study evaluates the efficacy and safety of ethanol ablation for cystic thyroid nodules by comparing the retention and aspiration techniques. Methods A prospective randomized trial was conducted from November 2021 to August 2022, involving 60 patients (mean age 38.83 ± 11.86 years) with thyroid cysts or predominantly cystic nodules. Patients were divided into two groups of 30 each: one treated using the retention technique and the other using the aspiration technique. Females constituted 73.3% of participants (44 patients). The study assessed nodules classified as purely cystic (43.3%) or predominantly cystic (56.7%). Results The median initial nodule volume was 29.5 cc (20.25–39.5). After 12 months, the median volume reduction ratio (VRR) was 79.5% (63–86), with an overall success rate of 83.33% (VRR ≥ 50%). Both techniques yielded comparable results for VRR ( P = 0.379), success rates ( P = 0.731), symptom scores ( P = 0.617), cosmetic outcomes ( P = 0.289), and procedural pain ( P = 0.526). Factors such as initial nodule volume and solid component percentage were inversely correlated with VRR ( P < 0.001 and P = 0.037, respectively). Lower success rates were observed in nodules with type 2 or 3 vascularity compared to those with type 0 or 1 vascularity ( P < 0.001). Conclusion Both retention and aspiration techniques are effective and safe for managing cystic and predominantly cystic thyroid nodules. The outcomes of ethanol ablation are influenced by factors such as initial volume, solid component percentage, and nodule vascularity.