Percutaneous Ethanol Injection for Treatment of Cervical Lymph Node Metastases in Patients with Papillary Thyroid Carcinoma
B. D. Lewis1,
I. D. Hay2,
J. W. Charboneau1,
B. McIver2,
C. C. Reading1 and
J. R. Goellner3
1
Department of Radiology, Mayo Clinic and Mayo Foundation, 200 First St., SW,
Rochester, MN 55905.
2
Division of Endocrinology and Internal Medicine, Mayo Clinic and Mayo
Foundation, Rochester, MN 55905.
3
Department of Surgical Pathology, Mayo Clinic and Mayo Foundation, Rochester,
MN 55905.
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Fig. 1A. —Transverse sonograms of metastatic adenopathy in 48-year-old
woman with papillary thyroid carcinoma. Sonogram reveals 8 x 9 mm lymph
node (arrow) with needle in place.
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Fig. 1B. —Transverse sonograms of metastatic adenopathy in 48-year-old
woman with papillary thyroid carcinoma. Image obtained at initial injection
with small volume of ethanol shows echogenic region in posterior aspect of
lymph node (arrowhead) due to microbubble formation.
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Fig. 1C. —Transverse sonograms of metastatic adenopathy in 48-year-old
woman with papillary thyroid carcinoma. Image obtained after repositioning of
needle shows another site in lymph node (arrow) being treated.
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Fig. 1D. —Transverse sonograms of metastatic adenopathy in 48-year-old
woman with papillary thyroid carcinoma. Image obtained 9 months after
percutaneous ethanol injection shows that size of treated lymph node
(cursors) has decreased markedly.
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Fig. 2A. —27-year-old woman with papillary thyroid carcinoma. Standard
diagram used to map location of each lymph node (to facilitate follow-up and
communication between sonographic examinations) shows several left internal
jugular nodes were identified, with one node (arrow) located between
internal jugular vein and common carotid artery. SMG = submandibular
gland.
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Fig. 2B. —27-year-old woman with papillary thyroid carcinoma.
Corresponding transverse sonogram reveals lymph node (cursors). CCA =
common carotid artery, JUG = internal jugular vein.
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Fig. 3A. —Favorable response to percutaneous ethanol injection in
55-year-old woman with papillary thyroid carcinoma. Longitudinal sonogram
shows 4 x 7 x 7 mm lymph node (cursors) that was positive
for metastatic papillary thyroid carcinoma at biopsy.
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Fig. 3B. —Favorable response to percutaneous ethanol injection in
55-year-old woman with papillary thyroid carcinoma. Power Doppler sonogram
shows marked nodal perfusion.
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Fig. 3C. —Favorable response to percutaneous ethanol injection in
55-year-old woman with papillary thyroid carcinoma. Longitudinal sonogram
obtained 9 months after percutaneous ethanol injection shows size of lymph
node (cursors) has decreased dramatically to 2 x 2 x 5
mm, and there is no color Doppler sonographic evidence of perfusion.
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Fig. 4. —Graph shows mean volume in cubic millimeters in metastatic
lymph nodes treated with percutaneous ethanol ablation over time.
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Fig. 5A. —Persistent perfusion after initial percutaneous ethanol
injection requiring retreatment in 36-year-old man with papillary thyroid
carcinoma. Longitudinal sonogram shows enlarged biopsy-confirmed metastatic
lymph node (cursors).
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Fig. 5B. —Persistent perfusion after initial percutaneous ethanol
injection requiring retreatment in 36-year-old man with papillary thyroid
carcinoma. Power Doppler sonogram reveals uniform perfusion before
percutaneous ethanol injection.
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Fig. 5C. —Persistent perfusion after initial percutaneous ethanol
injection requiring retreatment in 36-year-old man with papillary thyroid
carcinoma. Longitudinal sonogram obtained 9 weeks after percutaneous ethanol
injection shows size of lymph node is unchanged, and there is evidence of
slight residual perfusion. Because of these findings, percutaneous ethanol
injection treatment was repeated.
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Fig. 5D. —Persistent perfusion after initial percutaneous ethanol
injection requiring retreatment in 36-year-old man with papillary thyroid
carcinoma. Longitudinal sonogram obtained 14 weeks after C reveals that
size of lymph node (arrows) has decreased dramatically. No perfusion
on power Doppler sonography is shown.
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Copyright © 2002 by the American Roentgen Ray Society.
