Optimum First-Line Treatment Technique for Benign Cystic Thyroid Nodules: Ethanol Ablation or Radiofrequency Ablation?

OBJECTIVE: The purpose of this article is to compare the efficacy and safety of ethanol ablation and radiofrequency ablation (RFA) used as treatment of benign cystic thyroid nodules. MATERIALS AND METHODS: Fifty-seven patients (44 women and 13 men) with benign cystic nodules (cystic portions > 90%) inducing pressure symptoms or cosmetic problems were treated with ethanol ablation (n = 36) or RFA (n = 21). Ethanol ablation was performed using 16- or 18-gauge needles with 95-99% ethanol, and RFA used a cooled-electrode RFA system and 17- or 18-gauge internally cooled electrodes. Of nine viscous nodules, five were treated with ethanol ablation and four with RFA, with all except for one nodule in the RFA group being treated only after evacuation of internal colloid material. Nodule volume, symptom score (0-10), cosmetic score (1-4), and complications were evaluated before and after treatment. RESULTS: Both ethanol ablation and RFA resulted in significant decreases in nodule volume (p < 0.001), symptom score (p < 0.001), and cosmetic score (p < 0.001). There were no between-group differences in mean volume reduction (p = 0.15), decreases in symptoms (p = 0.53), cosmetic scores (p = 0.69), or therapeutic success rate (p = 0.61). However, the mean number of treatment sessions was significantly lower in the ethanol ablation than in the RFA group (p = 0.026). No serious complications were encountered in either group. CONCLUSION: Ethanol ablation yielded similar results with fewer treatment sessions compared with RFA. Because ethanol ablation is also less expensive and simpler to perform than RFA, our findings suggest that ethanol ablation, rather than RFA, should be the first-line treatment technique for benign predominantly cystic thyroid nodules.