The First 100 Patients to Undergo Elective Ethanol Ablation of Thyroid Cysts in the East of Scotland.

Introduction: Thyroid cysts are a common cause of neck lump presentation. Historically, treatment options were aspiration or surgery. Percutaneous ethanol ablation (PEA) offers a minimally invasive, low cost and effective alternative, although UK experience is limited.

Methods: Hundred consecutive patients to receive elective PEA for a benign thyroid cyst between May 2017 and October 2024 in NHS Lothian were reviewed. Cyst volume reduction (CVR) and patient outcomes over a median follow-up period of 33 months were reviewed.

Results: Median CVR was 79.16%. Follow-up data was available for 88 patients. 68 (77.3%) were discharged without further intervention following their first PEA. 14 (15.9%) had repeat PEA, 1 (1.1%) underwent fine needle aspiration and 5 (5.7%) were referred for consideration of surgery, of which 3 underwent a procedure. Regarding cyst characteristics, the presence of septations had the strongest influence on CVR (p = 0.003). Solid components were also significantly associated with decreased CVR (p = 0.019). Viscous cyst fluid showed a trend toward decreased CVR (p = 0.161). Further analysis demonstrated that septations (p = 0.056), solid components (p = 0.013) and viscosity (p = 0.013) were predictive of incomplete cyst resolution necessitating repeat interventions such as PEA, aspiration or surgery.

Conclusion: In conclusion, we found USS-guided PEA to be an effective treatment for benign thyroid cysts, resulting in significant cyst volume reduction. It was found to be most effective in simple cysts and can avoid the need for surgical intervention in over 95% of such cases. This service should be routinely offered to patients as part of the shared decision-making process.