LAUSR

Childhood papillary thyroid carcinoma (CPTC), despite bilateral thyroidectomy (BT), nodal dissection and radioiodine remnant ablation (RRA), recurs within neck nodal metastases (NNM) in 33% within 20 postoperative years. These NNM are usually treated with re-operation or further radioiodine. Ethanol ablation (EA) may be considered when numbers of NNM are limited. We studied long-term results of EA in 14 patients presenting with CPTC during 1978-2013 and having EA for NNM during 2000-18. Cytologic diagnoses of 20 NNM (median diameter 9mm; median volume 203 mm3) were biopsy-proven. EA was performed during two outpatient sessions under local anesthesia; total volume injected ranged from 0.1-2.8cc (median 0.7). All were followed regularly by sonography and underwent volume recalculation and intra-nodal Doppler flow measurements. Successful ablation required reduction in both NNM volume and vascularity. Post-EA, patients were followed for 5-20 years (median 16). There were no complications, including post-procedure hoarseness. All 20 NNM shrank (mean by 87%) and Doppler flow eliminated in 19/20. After EA, 11 NNM (55%) disappeared on sonography; 8/11 before 20 months. Nine ablated foci were still identifiable after median of 147 months; only one identifiable 5mm NNM retained flow. Median serum Tg post-EA was 0.6 ng/ml. Only one patient had a rise in Tg attributed to lung metastases. EA of NNM in CPTC is effective and safe. Our results suggest that for CPTC patients, who do not wish further surgery and are uncomfortable with active surveillance of NNM, EA represents a minimally invasive outpatient management option.