Ultrasound-guided percutaneous polidocanol ablation for symptomatic benign cystic and predominantly cystic thyroid nodules: a prospective evaluation of safety and efficacy

Abstract Aim of the study This study aimed to evaluate the safety and efficacy of ultrasound-guided percutaneous polidocanol ablation for the treatment of symptomatic benign cystic and predominantly cystic thyroid nodules. Methods This six-month prospective single-arm interventional trial was carried out at Ain Shams University Hospitals between March 2025 and August 2025. A sample of 30 patients of mean age (37.70 ± 9.92 years) with cystic or primarily cystic thyroid nodules (fluid percentage >50%) and benign cytology results were enrolled. Under ultrasound guidance, cystic content was aspirated and the cavity irrigated with saline before slowly injecting Polidocanol foam (30–50% of aspirated volume). The volume reduction rate (VRR), a visual analog scale for pressure symptoms, and a four-point cosmetic assessment were used to evaluate clinical results at 1, 3, and 6 months following the treatment. Results The study population was predominantly female (70%). The average mean initial nodule volume was 20.93 ± 13.70 cc. At the six-month check-in, the average VRR was 62.92 ± 23.69%, with 70% of patients achieving a successful outcome (VRR >50%). Pure cystic nodules showed a 75% success rate, while a lower success rate of 67% for those with a solid component. Despite the fact that this difference was not statistically significant ( P > 0.05), over the course of the follow-up period, there were notable changes in the median compression score ( P < 0.0001) and cosmetic score ( P < 0.001). Only temporary mild-to-moderate local pain was noted in 20% of cases; there were no significant consequences. Conclusion Ultrasound-guided percutaneous polidocanol ablation is a safe and efficient outpatient treatment option for benign cystic thyroid nodules that cause symptoms instead of surgery. The existence of a solid component can restrict therapeutic efficiency and may require many treatment sessions, even though it is quite effective for pure cysts.