Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Ethanol Ablation of the Thyroid Nodules: 2018 Consensus Statement by the Korean Society of Thyroid Radiology

  • Soo Yeon Hahn (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jung Hee Shin (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Dong Gyu Na (Department of Radiology, Gangneung Asan Hospital) ;
  • Eun Joo Ha (Department of Radiology, Ajou University School of Medicine) ;
  • Hye Shin Ahn (Department of Radiology and Thyroid Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Hyun Kyung Lim (Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine) ;
  • Jeong Hyun Lee (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jeong Seon Park (Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital) ;
  • Ji-hoon Kim (Department of Radiology, Seoul National University College of Medicine) ;
  • Jin Yong Sung (Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital ) ;
  • Joon Hyung Lee (Department of Radiology, Haeundae Paik Hospital, Inje University School of Medicine) ;
  • Jung Hwan Baek (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jung Hyun Yoon (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Jung Suk Sim (Department of Radiology, Withsim Clinic) ;
  • Kwang Hwi Lee (Department of Radiology, Sheikh Khalifa Specialty Hospital) ;
  • Seon Mi Baek (Department of Radiology, Haeundae Sharing and Happiness Hospital) ;
  • So Lyung Jung (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Yeo Koon Kim (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Yoon Jung Choi (Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University)
  • Received : 2018.10.08
  • Accepted : 2018.11.05
  • Published : 2019.04.01
Download PDF
⟨ Previous Next ⟩

Abstract

Minimally invasive treatment of symptomatic thyroid nodules is now commonplace. Ethanol ablation (EA) of thyroid cystic nodules has been performed since the 1990s, but there is no global consensus or guideline. Although various limitations of EA have been described, recommendations for practical application are necessary. Therefore, the Task Force Committee of the Korean Society of Thyroid Radiology initiated the present consensus statement and here we provide recommendations for the role of EA in the management of symptomatic thyroid nodules. These recommendations are based on evidence to date from the literature and expert opinion.

Keywords

Acknowledgement

This study was supported by a grant by 2017 Clinical Practice Guideline Research Fund by Korean Society of Radiology & Korean Society of Thyroid Radiology.

References

  1. Gharib H, Papini E. Thyroid nodules: clinical importance, assessment, and treatment. Endocrinol Metab Clin North Am 2007;36:707-735,
  2. Durante C, Costante G, Lucisano G, Bruno R, Meringolo D, Paciaroni A, et al. The natural history of benign thyroid nodules. JAMA 2015;313:926-935 
  3. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016;26:1-133 
  4. Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedus L, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules--2016 update. Endocr Pract 2016;22:622-639 
  5. Zelmanovitz F, Genro S, Gross JL. Suppressive therapy with levothyroxine for solitary thyroid nodules: a double-blind controlled clinical study and cumulative meta-analyses. J Clin Endocrinol Metab 1998;83:3881-3885 
  6. Wemeau JL, Caron P, Schvartz C, Schlienger JL, Orgiazzi J, Cousty C, et al. Effects of thyroid-stimulating hormone suppression with levothyroxine in reducing the volume of solitary thyroid nodules and improving extranodular nonpalpable changes: a randomized, double-blind, placebo-controlled trial by the French Thyroid Research Group. J Clin Endocrinol Metab 2002;87:4928-4934 
  7. Castro MR, Caraballo PJ, Morris JC. Effectiveness of thyroid hormone suppressive therapy in benign solitary thyroid nodules: a meta-analysis. J Clin Endocrinol Metab 2002;87:4154-4159 
  8. Bergenfelz A, Jansson S, Kristoffersson A, Martensson H, Reihner E, Wallin G, et al. Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg 2008;393:667-673 
  9. Kandil E, Krishnan B, Noureldine SI, Yao L, Tufano RP. Hemithyroidectomy: a meta-analysis of postoperative need for hormone replacement and complications. ORL J Otorhinolaryngol Relat Spec 2013;75:6-17 
  10. Hegedus L. Therapy: a new nonsurgical therapy option for benign thyroid nodules? Nat Rev Endocrinol 2009;5:476-478 
  11. Shin JH, Baek JH, Chung J, Ha EJ, Kim JH, Lee YH, et al. Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean Society of Thyroid Radiology consensus statement and recommendations. Korean J Radiol 2016;17:370-395 
  12. Crile G Jr. Treatment of thyroid cysts by aspiration. Surgery 1966;59:210-212 
  13. Miller JM, Zafar SU, Karo JJ. The cystic thyroid nodule. Recognition and management. Radiology 1974;110:257-261 
  14. Sykes D. The solitary thyroid nodule. Br J Surg 1981;68:510-512 
  15. Hegedus L, Hansen JM, Karstrup S, Torp-Pedersen S, Juul N. Tetracycline for sclerosis of thyroid cysts. A randomized study. Arch Intern Med 1988;148:1116-1118 
  16. Ryan WG, Dwarakanathan A. Minor complication of thyroid cyst sclerosis with tetracycline. Arch Intern Med 1986;146:201-202 
  17. Rozman B, Bencezigman Z, Tomicbrzac H, Skreb F, Pavlinovic Z, Simonovic I. Sclerosation of thyroid cysts by ethanol. Periodicum Biologorum 1990;91:453 
  18. Livraghi T, Paracchi A, Ferrari C, Reschini E, Macchi RM, Bonifacino A. Treatment of autonomous thyroid nodules with percutaneous ethanol injection: 4-year experience. Radiology 1994;190:529-533 
  19. Yasuda K, Ozaki O, Sugino K, Yamashita T, Toshima K, Ito K, et al. Treatment of cystic lesions of the thyroid by ethanol instillation. World J Surg 1992;16:958-961 
  20. Martino E, Murtas ML, Loviselli A, Piga M, Petrini L, Miccoli P, et al. Percutaneous intranodular ethanol injection for treatment of autonomously functioning thyroid nodules. Surgery 1992;112:1161-1164; discussion 1164-1165 
  21. Papini E, Panunzi C, Pacella CM, Bizzarri G, Fabbrini R, Petrucci L, et al. Percutaneous ultrasound-guided ethanol injection: a new treatment of toxic autonomously functioning thyroid nodules? J Clin Endocrinol Metab 1993;76:411-416 
  22. Goletti O, Monzani F, Lenziardi M, Lippolis PV, De Negri F, Caraccio N, et al. Cold thyroid nodules: a new application of percutaneous ethanol injection treatment. J Clin Ultrasound 1994;22:175-178 
  23. Bennedbaek FN, Hegedus L. Alcohol sclerotherapy for benign solitary solid cold thyroid nodules. Lancet 1995;346:1227 
  24. Bennedbaek FN, Karstrup S, Hegedus, L. Percutaneous ethanol injection therapy in the treatment of thyroid and parathyroid diseases. Eur J Endocrinol 1997;136:240-250 
  25. Lippi F, Ferrari C, Manetti L, Rago T, Santini F, Monzani F, et al. Treatment of solitary autonomous thyroid nodules by percutaneous ethanol injection: results of an Italian multicenter study. The multicenter study group. J Clin Endocrinol Metab 1996;81:3261-3264 
  26. Papini E, Pacella CM, Verde G. Percutaneous ethanol injection (PEI): what is its role in the treatment of benign thyroid nodules? Thyroid 1995;5:147-150 
  27. Zingrillo M, Collura D, Ghiggi MR, Nirchio V, Trischitta V. Treatment of large cold benign thyroid nodules not eligible for surgery with percutaneous ethanol injection. J Clin Endocrinol Metab 1998;83:3905-3907 
  28. Bennedbaek FN, Hegedus L. Treatment of recurrent thyroid cysts with ethanol: a randomized double-blind controlled trial. J Clin Endocrinol Metab 2003;88:5773-5777 
  29. Kim BM, Kim MJ, Kim EK, Park SI, Park CS, Chung WY. Controlling recurrent papillary thyroid carcinoma in the neck by ultrasonography-guided percutaneous ethanol injection. Eur Radiol 2008;18:835-842 
  30. Lewis BD, Hay ID, Charboneau JW, McIver B, Reading CC, Goellner JR. Percutaneous ethanol injection for treatment of cervical lymph node metastases in patients with papillary thyroid carcinoma. AJR Am J Roentgenol 2002;178:699-704 
  31. Monchik JM, Donatini G, Iannuccilli J, Dupuy DE. Radiofrequency ablation and percutaneous ethanol injection treatment for recurrent local and distant well-differentiated thyroid carcinoma. Ann Surg 2006;244:296-304 
  32. Lim CY, Yun JS, Lee J, Nam KH, Chung WY, Park CS. Percutaneous ethanol injection therapy for locally recurrent papillary thyroid carcinoma. Thyroid 2007;17:347-350 
  33. Heilo A, Sigstad E, Fagerlid KH, Haskjold OI, Groholt KK, Berner A, et al. Efficacy of ultrasound-guided percutaneous ethanol injection treatment in patients with a limited number of metastatic cervical lymph nodes from papillary thyroid carcinoma. J Clin Endocrinol Metab 2011;96:2750-2755 
  34. Hay ID, Lee RA, Davidge-Pitts C, Reading CC, Charboneau JW. Long-term outcome of ultrasound-guided percutaneous ethanol ablation of selected "recurrent" neck nodal metastases in 25 patients with TNM stages III or IVA papillary thyroid carcinoma previously treated by surgery and 131I therapy. Surgery 2013;154:1448-1454; discussion 1454-1455 
  35. Guenette JP, Monchik JM, Dupuy DE. Image-guided ablation of postsurgical locoregional recurrence of biopsy-proven well-differentiated thyroid carcinoma. J Vasc Interv Radiol 2013;24:672-679 
  36. Lee N, Tuttle M. The role of external beam radiotherapy in the treatment of papillary thyroid cancer. Endocr Relat Cancer 2006;13:971-977 
  37. Shaha AR. Implications of prognostic factors and risk groups in the management of differentiated thyroid cancer. Laryngoscope 2004;114:393-402 
  38. Dupuy DE, Monchik JM, Decrea C, Pisharodi L. Radiofrequency ablation of regional recurrence from well-differentiated thyroid malignancy. Surgery 2001;130:971-977 
  39. Baek JH, Kim YS, Sung JY, Choi H, Lee JH. Locoregional control of metastatic well-differentiated thyroid cancer by ultrasound-guided radiofrequency ablation. AJR Am J Roentgenol 2011;197:W331-W336 
  40. Long B, Li L, Yao L, Chen S, Yi H, Ye X, et al. Combined use of radioiodine therapy and radiofrequency ablation in treating postsurgical thyroid remnant of differentiated thyroid carcinoma. J Cancer Res Ther 2015;11 Suppl:C244-C247 
  41. Park KW, Shin JH, Han BK, Ko EY, Chung JH. Inoperable symptomatic recurrent thyroid cancers: preliminary result of radiofrequency ablation. Ann Surg Oncol 2011;18:2564-2568 
  42. Zhao Q, Tian G, Kong D, Jiang T. Meta-analysis of radiofrequency ablation for treating the local recurrence of thyroid cancers. J Endocrinol Invest 2016;39:909-916 
  43. Wang L, Ge M, Xu D, Chen L, Qian C, Shi K, et al. Ultrasonography-guided percutaneous radiofrequency ablation for cervical lymph node metastasis from thyroid carcinoma. J Cancer Res Ther 2014;10 Suppl:C144-C149 
  44. Lee SJ, Jung SL, Kim BS, Ahn KJ, Choi HS, Lim DJ, et al. Radiofrequency ablation to treat loco-regional recurrence of well-differentiated thyroid carcinoma. Korean J Radiol 2014;15:817-826 
  45. Lim HK, Baek JH, Lee JH, Kim WB, Kim TY, Shong YK, et al. Efficacy and safety of radiofrequency ablation for treating locoregional recurrence from papillary thyroid cancer. Eur Radiol 2015;25:163-170 
  46. Kim JH, Yoo WS, Park YJ, Park DJ, Yun TJ, Choi SH, et al. Efficacy and safety of radiofrequency ablation for treatment of locally recurrent thyroid cancers smaller than 2 cm. Radiology 2015;276:909-918 
  47. Sung JY, Baek JH, Kim KS, Lee D, Yoo H, Kim JK, et al. Single-session treatment of benign cystic thyroid nodules with ethanol versus radiofrequency ablation: a prospective randomized study. Radiology 2013;269:293-300 
  48. Baek JH, Ha EJ, Choi YJ, Sung JY, Kim JK, Shong YK. Radiofrequency versus Ethanol Ablation for Treating Predominantly cystic thyroid nodules: a randomized clinical trial. Korean J Radiol 2015;16:1332-1340 
  49. Suh CH, Baek JH, Ha EJ, Choi YJ, Lee JH, Kim JK, et al. Ethanol ablation of predominantly cystic thyroid nodules: evaluation of recurrence rate and factors related to recurrence. Clin Radiol 2015;70:42-47 
  50. Monzani F, Caraccio N, Goletti O, Lippolis PV, Casolaro A, Del Guerra P, et al. Five-year follow-up of percutaneous ethanol injection for the treatment of hyperfunctioning thyroid nodules: a study of 117 patients. Clin Endocrinol (Oxf) 1997;46:9-15 
  51. Verde G, Papini E, Pacella CM, Gallotti C, Delpiano S, Strada S, et al. Ultrasound guided percutaneous ethanol injection in the treatment of cystic thyroid nodules. Clin Endocrinol (Oxf) 1994;41:719-724 
  52. Kim JH, Lee HK, Lee JH, Ahn IM, Choi CG. Efficacy of sonographically guided percutaneous ethanol injection for treatment of thyroid cysts versus solid thyroid nodules. AJR Am J Roentgenol 2003;180:1723-1726 
  53. Kim DW, Rho MH, Kim HJ, Kwon JS, Sung YS, Lee SW. Percutaneous ethanol injection for benign cystic thyroid nodules: is aspiration of ethanol-mixed fluid advantageous? AJNR Am J Neuroradiol 2005;26:2122-2127 
  54. Valcavi R, Frasoldati A. Ultrasound-guided percutaneous ethanol injection therapy in thyroid cystic nodules. Endocr Pract 2004;10:269-275 
  55. Jang SW, Baek JH, Kim JK, Sung JY, Choi H, Lim HK, et al. How to manage the patients with unsatisfactory results after ethanol ablation for thyroid nodules: role of radiofrequency ablation. Eur J Radiol 2012;81:905-910 
  56. Monzani F, Lippi F, Goletti O, Del Guerra P, Caraccio N, Lippolis PV, et al. Percutaneous aspiration and ethanol sclerotherapy for thyroid cysts. J Clin Endocrinol Metab 1994;78:800-802 
  57. Guglielmi R, Pacella CM, Bianchini A, Bizzarri G, Rinaldi R, Graziano FM, et al. Percutaneous ethanol injection treatment in benign thyroid lesions: role and efficacy. Thyroid 2004;14:125-131 
  58. Monzani F, Goletti O, Caraccio N, Del Guerra P, Ferdeghini M, Pucci E, et al. Percutaneous ethanol injection treatment of autonomous thyroid adenoma: hormonal and clinical evaluation. Clin Endocrinol (Oxf) 1992;36:491-497 
  59. Mazzeo S, Toni MG, De Gaudio C, Caramella D, Pinto F, Lencioni R, et al. Percutaneous injection of ethanol to treat autonomous thyroid nodules. AJR Am J Roentgenol 1993;161:871-876 
  60. Di Lelio A, Rivolta M, Casati M, Capra M. Treatment of autonomous thyroid nodules: value of percutaneous ethanol injection. AJR Am J Roentgenol 1995;164:207-213 
  61. Tarantino L, Francica G, Sordelli I, Sperlongano P, Parmeggiani D, Ripa C, et al. Percutaneous ethanol injection of hyperfunctioning thyroid nodules: long-term follow-up in 125 patients. AJR Am J Roentgenol 2008;190:800-808 
  62. Kim DW, Rho MH, Park HJ, Kwag HJ. Ultrasonography-guided ethanol ablation of predominantly solid thyroid nodules: a preliminary study for factors that predict the outcome. Br J Radiol 2012;85:930-936 
  63. Livraghi T, Paracchi A, Ferrari C, Bergonzi M, Garavaglia G, Raineri P, et al. Treatment of autonomous thyroid nodules with percutaneous ethanol injection: preliminary results. Work in progress. Radiology 1990;175:827-829 
  64. Tarantino L, Giorgio A, Mariniello N, de Stefano G, Perrotta A, Aloisio V, et al. Percutaneous ethanol injection of large autonomous hyperfunctioning thyroid nodules. Radiology 2000;214:143-148 
  65. Del Prete S, Russo D, Caraglia M, Giuberti G, Marra M, Vitale G, et al. Percutaneous ethanol injection of autonomous thyroid nodules with a volume larger than 40 ml: three years of follow-up. Clin Radiol 2001;56:895-901 
  66. Gharib H, Hegedus L, Pacella CM, Baek JH, Papini E. Clinical review: nonsurgical, image-guided, minimally invasive therapy for thyroid nodules. J Clin Endocrinol Metab 2013;98:3949-3957 
  67. Shin JE, Baek JH, Lee JH. Radiofrequency and ethanol ablation for the treatment of recurrent thyroid cancers: current status and challenges. Curr Opin Oncol 2013;25:14-19 
  68. Sung JY, Baek JH, Jung SL, Kim JH, Kim KS, Lee D, et al. Radiofrequency ablation for autonomously functioning thyroid nodules: a multicenter study. Thyroid 2015;25:112-117 
  69. Paschke R, Hegedus L, Alexander E, Valcavi R, Papini E, Gharib H. Thyroid nodule guidelines: agreement, disagreement and need for future research. Nat Rev Endocrinol 2011;7:354-361 
  70. Papini E, Pacella CM, Hegedus L. Diagnosis of endocrine disease: thyroid ultrasound (US) and US-assisted procedures: from the shadows into an array of applications. Eur J Endocrinol 2014;170:R133-R146 
  71. Che Y, Jin S, Shi C, Wang L, Zhang X, Li Y, et al. Treatment of benign thyroid nodules: comparison of surgery with radiofrequency ablation. AJNR Am J Neuroradiol 2015;36:1321-1325 
  72. Seo SH, Kim TH, Kim SH, Lee SH, Kim JT, Park DW, et al. Predicting the size of benign thyroid nodules and analysis of associated factors that affect nodule size. Chonnam Med J 2015;51:97-101 
  73. Bernardi S, Stacul F, Michelli A, Giudici F, Zuolo G, de Manzini N, et al. 12-month efficacy of a single radiofrequency ablation on autonomously functioning thyroid nodules. Endocrine 2017;57:402-408 
  74. Sohn YM, Hong SW, Kim EK, Kim MJ, Moon HJ, Kim SJ, et al. Complete eradication of metastatic lymph node after percutaneous ethanol injection therapy: pathologic correlation. Thyroid 2009;19:317-319 
  75. Vannucchi G, Covelli D, Perrino M, De Leo S, Fugazzola L. Ultrasound-guided percutaneous ethanol injection in papillary thyroid cancer metastatic lymph-nodes. Endocrine 2014;47:648-651 
  76. Suh CH, Baek JH, Choi YJ, Lee JH. Efficacy and safety of radiofrequency and ethanol ablation for treating locally recurrent thyroid cancer: a systematic review and meta-analysis. Thyroid 2016;26:420-428 
  77. Kim SY, Kim SM, Chang H, Kim BW, Lim CY, Lee YS, et al. Long-term outcomes of ethanol injection therapy for locally recurrent papillary thyroid cancer. Eur Arch Otorhinolaryngol 2017;274:3497-3501 
  78. Hay ID, Charboneau JW. The coming of age of ultrasound-guided percutaneous ethanol ablation of selected neck nodal metastases in well-differentiated thyroid carcinoma. J Clin Endocrinol Metab 2011;96:2717-2720 
  79. Goyal RM, Jonklaas J, Burman KD. Management of recurrent cervical papillary thyroid cancer. Endocrinol Metab Clin North Am 2014;43:565-572 
  80. Fontenot TE, Deniwar A, Bhatia P, Al-Qurayshi Z, Randolph GW, Kandil E. Percutaneous ethanol injection vs reoperation for locally recurrent papillary thyroid cancer: a systematic review and pooled analysis. JAMA Otolaryngol Head Neck Surg 2015;141:512-518 
  81. Jeong SY, Baek JH, Choi YJ, Lee JH. Ethanol and thermal ablation for malignant thyroid tumours. Int J Hyperthermia 2017;33:938-945 
  82. Goletti O, Lenziardi M, De Negri F, Fiorini I, Lippolis PV, Cristofani E, et al. Inoperable thyroid carcinoma: palliation with percutaneous injection of ethanol. Eur J Surg 1993;159:639-641 
  83. Isozaki T, Kiba T, Numata K, Saito S, Shimamura T, Kitamura T, et al. Medullary thyroid carcinoma with multiple hepatic metastases: treatment with transcatheter arterial embolization and percutaneous ethanol injection. Intern Med 1999;38:17-21 
  84. Akasu H, Shimizu K, Kitagawa W, Naito Z, Kawanami O, Tanaka S. Histological study of papillary thyroid carcinoma treated with percutaneous ethanol injection therapy. Pathol Int 2002;52:406-409 
  85. Albanese G, Kondo KL. Pharmacology of sclerotherapy. Semin Intervent Radiol 2010;27:391-399 
  86. Ahmed M, Brace CL, Lee FT Jr, Goldberg SN. Principles of and advances in percutaneous ablation. Radiology 2011;258:351-369 
  87. Baek JH, Kim YS, Lee D, Huh JY, Lee JH. Benign predominantly solid thyroid nodules: prospective study of efficacy of sonographically guided radiofrequency ablation versus control condition. AJR Am J Roentgenol 2010;194:1137-1142 
  88. Ahn HS, Kim SJ, Park SH, Seo M. Radiofrequency ablation of benign thyroid nodules: evaluation of the treatment efficacy using ultrasonography. Ultrasonography 2016;35:244-252 
  89. Ko ES, Sung JY, Shin JH. Intralesional saline injection for effective ultrasound-guided aspiration of benign viscous cystic thyroid nodules. Ultrasonography 2014;33:122-127 
  90. Sung JY, Baek JH, Kim YS, Jeong HJ, Kwak MS, Lee D, et al. One-step ethanol ablation of viscous cystic thyroid nodules. AJR Am J Roentgenol 2008;191:1730-1733 
  91. Kim SM, Baek JH, Kim YS, Sung JY, Lim HK, Choi H, et al. Efficacy and safety of ethanol ablation for thyroglossal duct cysts. AJNR Am J Neuroradiol 2011;32:306-309 
  92. Cho YS, Lee HK, Ahn IM, Lim SM, Kim DH, Choi CG, et al. Sonographically guided ethanol sclerotherapy for benign thyroid cysts: results in 22 patients. AJR Am J Roentgenol 2000;174:213-216 
  93. Zingrillo M, Torlontano M, Ghiggi MR, D'Aloiso L, Nirchio V, Bisceglia M, et al. Percutaneous ethanol injection of large thyroid cystic nodules. Thyroid 1996;6:403-408 
  94. Zingrillo M, Torlontano M, Chiarella R, Ghiggi MR, Nirchio V, Bisceglia M, et al. Percutaneous ethanol injection may be a definitive treatment for symptomatic thyroid cystic nodules not treatable by surgery: five-year follow-up study. Thyroid 1999;9:763-767 
  95. Kim YJ, Baek JH, Ha EJ, Lim HK, Lee JH, Sung JY, et al. Cystic versus predominantly cystic thyroid nodules: efficacy of ethanol ablation and analysis of related factors. Eur Radiol 2012;22:1573-1578 
  96. Sung JY, Kim YS, Choi H, Lee JH, Baek JH. Optimum first-line treatment technique for benign cystic thyroid nodules: ethanol ablation or radiofrequency ablation? AJR Am J Roentgenol 2011;196:W210-W214 
  97. Del Prete S, Caraglia M, Russo D, Vitale G, Giuberti G, Marra M, et al. Percutaneous ethanol injection efficacy in the treatment of large symptomatic thyroid cystic nodules: ten-year follow-up of a large series. Thyroid 2002;12:815-821 
  98. Park NH, Kim DW, Park HJ, Lee EJ, Park JS, Park SI, et al. Thyroid cysts treated with ethanol ablation can mimic malignancy during sonographic follow-up. J Clin Ultrasound 2011;39:441-446 
  99. Zingrillo M, Ghiggi MR, Liuzzi A. A large, nonfunctioning parathyroid cyst recurring after aspiration and subsequently cured by percutaneous ethanol injection. J Clin Ultrasound 1996;24:378-382 
  100. Lee SJ, Ahn IM. Effectiveness of percutaneous ethanol injection therapy in benign nodular and cystic thyroid diseases: long-term follow-up experience. Endocr J 2005;52:455-462 
  101. Bennedbaek FN, Nielsen LK, Hegedus L. Effect of percutaneous ethanol injection therapy versus suppressive doses of L-thyroxine on benign solitary solid cold thyroid nodules: a randomized trial. J Clin Endocrinol Metab 1998;83:830-835 
  102. Caraccio N, Goletti O, Lippolis PV, Casolaro A, Cavina E, Miccoli P, et al. Is percutaneous ethanol injection a useful alternative for the treatment of the cold benign thyroid nodule? Five years' experience. Thyroid 1997;7:699-704 
  103. Lee JH, Kim YS, Lee D, Choi H, Yoo H, Baek JH. Radiofrequency ablation (RFA) of benign thyroid nodules in patients with incompletely resolved clinical problems after ethanol ablation (EA). World J Surg 2010;34:1488-1493 
  104. Rodriguez-Lomba E, Molina-Lopez I, Parra-Blanco V, Suarez-Fernandez R, Ciudad-Blanco C. Cutaneous implantation of papillary thyroid carcinoma secondary to percutaneous ethanol injection into nodal metastasis. J Eur Acad Dermatol Venereol 2018;32:e11-e13