甲状腺嚢胞・充実性結節に対する修正超音波ガイド下ポリドカノール硬化療法：単一施設後ろ向き研究

To evaluate the efficacy and safety of a modified ultrasound-guided polidocanol sclerotherapy protocol in treating benign cystic-solid thyroid nodules, and to provide a reference for clinical treatment.

This retrospective study involved 125 patients with 126 pathologically confirmed benign cystic-solid thyroid nodules who underwent ultrasound-guided polidocanol sclerotherapy at our institution between January 2021 and December 2023. Before administering the sclerosant injection, cystic components were aspirated and irrigated with saline, and the nodules were classified on the basis of the proportion of cystic components and baseline volume, as well as patient sex and age and the color and consistency of the cystic fluid. Nodule volume was measured using ultrasonography before treatment and at 1, 3, 6, and 12 months after treatment. The volume reduction rate (VRR) at 12 months was calculated, and treatment efficacy and adverse events were compared among different nodule subgroups.

Among the 126 nodules in 125 patients, 115 nodules showed an effective outcome, corresponding to an overall effectiveness rate of 91.3% (115/126). The effective rates for nodules with cystic components ≤70%, 70%-90%, and > 90% were 80.0% (28/35), 94.2% (49/52), and 97.4% (38/39), respectively, and the differences among the three groups were statistically significant (P < 0.05). Overall efficacy did not differ significantly in relation to cyst fluid color, cyst fluid consistency, baseline nodule volume, patient age, or sex. Fourteen patients (11.2%) experienced minor adverse reactions, including mild local pain (n = 9), transient low-grade fever with nausea and vomiting (n = 2), intermittent swallowing discomfort (n = 2), and postoperative hemorrhage that was controllable by local compression (n = 1). All adverse reactions resolved spontaneously or with conservative management. The patients showed no significant complications, such as infection, severe pain, voice alterations, esophageal or tracheal injury, or sclerosant extravasation.

Modified ultrasound-guided polidocanol sclerotherapy for benign cystic-solid thyroid nodules is safe and effective, and the treatment efficacy is positively associated with the proportion of cystic components. This technique may represent a promising alternative to ethanol injection for the management of cystic-solid thyroid nodules.