Ultrasound-guided microwave ablation combined with ethanol injection is an effective and safer alternative to surgery for treating nodular retrosternal goiters, with comparable success rates of 98.7% but significantly lower complication rates of 2.2% compared to surgery's 34.8%.
- Treatment Success: MWA with ethanol injection achieved 98.7% success rate, comparable to surgery's 100%
- Safety Profile: Complication rate was only 2.2% for ablation versus 34.8% for surgery (p < 0.001)
- Faster Recovery: Ablation patients experienced shorter hospitalization, reduced blood loss, and smaller incisions compared to surgical patients
- Study Details: Retrospective analysis of 555 patients (224 per group) with median 48-month follow-up between 2016-2024
- Symptom Relief: Both approaches reduced symptom scores from baseline 3.8 to 0.4 post-treatment with sustained improvement
Ultrasound-guided microwave ablation (MWA) combined with ethanol injection is effective for treating nodular retrosternal goiters (RSG), suggest findings published November 3 in Radiology.
This approach proved to be as successful as surgery, but with lower complication rates, wrote researchers led by Ying-Ying Li, MD, PhD, from the Chinese PLA General Hospital in Beijing.
“These findings indicate that MWA combined with ethanol injection offers comparable efficacy with a more favorable safety profile, supporting its role as a valuable alternative for eligible patients,” Li and colleagues wrote.
While surgery is the standard treatment approach for symptomatic RSGs, several complications could arise. These cnlude recurrent laryngeal nerve (RLN) injury, hypoparathyroidism, and airway obstruction caused by hemorrhage. And while most RSGs can be treated via transcervical incision, some patients require riskier extracervical approaches.
Recent research suggests that ultrasound-guided thermal ablation can effectively treat thyroid nodules and that combining this approach with ethanol injection could improve overall efficiency. However, the researchers noted limited data on how this could improve RSG treatment.
Li and co-authors compared the long-term efficacy and safety of MWA combined with ethanol injection versus surgery for patients with nodular RSGs.
Representative images of the ablation procedure in a 35-year-old female patient with right grade 1 retrosternal goiter (RSG). (A) Illustration of a hydrodissection technique that consists of an injection of 40–80 mL of normal saline to form a distance of at least 1 cm between the thyroid nodule (TN) and the critical structure to reduce the chance of thermal injury (blue: veins; red: artery; yellow: nerve; yellow area: hydrodissection area [H]). (B) Image of the ablation procedure performed in a 35-year-old female patient with right grade 1 RSG. The needle was inserted into the thyroid nodule under the guidance of the stent. (C–E) Preoperative contrast-enhanced CT images (C, sagittal; D, coronal; and E, axial planes) in the same patient demonstrate that the inferior margin of the RSG lies (C) between the thoracic inlet and the aortic arch convexity, with the left deviation of the trachea caused by mass compression (D, E). (F–H) Contrast-enhanced CT images in the same patient in the same planes as C–E, respectively, at 1 year after ablation show the regression of the RSG to (F) the neck and the trachea return to (G, H) the midline, with a volume reduction rate of 86%. RLN = recurrent laryngeal nerve, T = trachea.RSNA
The retrospective study included 555 patients treated between 2016 and 2024. The researchers used propensity score matching to place 224 patients in the ablation group and 224 patients in the surgery group. They observed the patients for a median of 48 months.
The ablation approach led to treatment success comparable to that of surgery while also leading to lower complication rates.
Comparison between MWA with ethanol injection, surgery | |||
Measure | Surgery | MWA plus ethanol injection | P value |
Treatment success rate | 100% | 98.7% | 0.08 |
Complication rate | 34.8% | 2.2% | < 0.001 |
Transient RLN injury occurred in 1.3% of patients who underwent ablation and 5.8% of patients who underwent surgery (p = 0.01).
Both modalities lowered symptom scores from baseline from 3.8 at baseline to 0.4 post-treatment, respectively (both p < 0.001).
The team also reported other benefits for the ablation approach at one year follow-up, including the following: shorter posttreatment hospitalization (p < 0.001), shorter procedure time (p < 0.001), reduced estimated blood loss (p < 0.001), shorter incision length (p < 0.001), lower cost (p < 0.001), and lower cosmetic score (mean, 1.1 vs. 1.2; p = 0.03).
The study authors noted that using MWA for RSG treatment has its share of technical challenges due to the deep intrathoracic location, large nodule volume, rich vascularity, and proximity of these goiters to critical structures.
“To address these challenges, precise preoperative planning is essential,” they wrote. “In our practice, interventional sonologists with more than 20 years of experience perform the procedure, routinely using hydrodissection, pre-MWA ethanol injection, and real-time ultrasound monitoring, enabling safe and effective ablation.”
The authors called for prospective, multicenter studies with larger study samples to confirm their findings and establish long-term benefits.
Read the full study here.
