Surgical and pathological changes after percutaneous ethanol injection therapy of thyroid nodules

Few data exist on the operative and pathological findings in patients havin g undergone previous percutaneous ethanol injection (PEI) therapy of thyroi d nodules. We report here our experience with 13 patients operated on by th e same surgical team. Two pathologists, both blinded to the previous PEI tr eatment, carried out histological evaluation. Reasons for surgery included PEI failure, suspicion of malignancy, and tracheal compression. The operati ons did not pose any special problem from the technical point of view, and the postoperative courses were uneventful. One patient who had a second ope ration developed hypoparathyroidism, and laryngeal nerve palsy was never ob served. The histological diagnosis was hyperplastic or adenomatous nodule i n 12 cases and papillary thyroid cancer in 1. No difficulty was found in ev aluating the nodule capsule and surrounding vessels. In two lesions, nuclea r enlargement and clearing were identified in thyroid follicles immediately adjacent to necrotic or scarred areas. These changes were considered react ive. Ln conclusion, patients previously treated by PEI were operated on wit hout special technical problems. Histological diagnosis was not hindered, a nd there was no difficulty in ruling out malignant lesions. PEI, however, s hould be performed only by skilled operators, and incidental ethanol seepag e throughout the nodule capsule must be carefully avoided.