PSAT323 Ultrasound-guided Percutaneous Ethanol Ablation for the treatment of Benign Cystic Thyroid Nodules: Report of Three Cases on The Initial Ecuadorian Experience

INTRODUCTION: Ultrasound-guided Percutaneous Ethanol Ablation (UPEA) is one of the first-line treatments for benign pure cysts and predominantly cystic thyroid nodules (TN). This non-surgical procedure has been used for years worldwide, however, in Latin America, this was recently adopted. Therefore, the aim of this report is to characterize our initial experience with UPEA in Ecuador. Clinical cases description: We report on the cases of a woman (F1: 49 y) and two men (M1: 38 y, M2: 69 y) that underwent UPEA for three predominantly cystic TN at ITECC (Instituto de la Tiroides y Enfermedades de Cabeza y Cuello) in Ecuador. All nodules were non-functioning and graded as Bethesda II. Our approach in regards to the total ethanol volume injected was approximately calculated at 1/3 of the TN volume, using 75% ethanol. 10 ml of 2% lidocaine was used for anesthetic purposes. Initial volume and change in TN volume were calculated with the ATA calculator. Patient F1 had a 40 mm (23.5 ml) right lobe TN and underwent needle extraction of 5 ml of cystic fluid before the injection of 6 ml of ethanol. At 1-month follow-up, the nodule reduced 78.1% in volume (28 mm, 5.1 ml). Similarly, patient M1 had a 59 mm (44.8 ml) right lobe TN treated with 6 ml of ethanol after 20 ml of cystic fluid was extracted from the TN. At 3-month follow-up, the nodule reduced 99% in volume (7 mm, 0.1 ml). Finally, patient M2 had a 36 mm (14.5 ml) right lobe TN treated with 5 ml of ethanol. At 6-moth follow-up, the nodule reduced 99% in volume (0.5 mm, 0.04 ml). No patients developed complications and only needed one session. CONCLUSIONS: To the best of our knowledge, we are the pioneers in Ecuador and the fourth country in Latin America that implemented UPEA in the management of cystic TN. In this small report, UPEA seems to be an effective and safe treatment option for cystic TN. Patients had >75% reduction in cyst volume along with symptomatic relief and no complications. Our results are consistent with other series. Data on a longer follow-up are needed to confirm long-term efficacy. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.