Gamma Probe–Guided Resection and Scanning with Tc-99m MIBI of a Local Recurrence of Follicular Thyroid Carcinoma

Abstract

A 30-year-old woman underwent two operations for multinodular goiter and follicular thyroid carcinoma. The residual thyroid tissue was ablated by I-131 therapy. After 7 years of follow-up, Tc-99m MIBI and I-131 scintigraphy were performed, because her serum thyroglobulin level was much higher compared with the control analysis performed in the sixth year. Tc-99m MIBI showed pathologic accumulation, which could be consistent with a local recurrence, whereas the results of I-131 scintigraphy were negative. The locally recurring follicular thyroid carcinoma was resected using a gamma probe and Tc-99m MIBI. The thyroglobulin level decreased to a normal level after surgery. This case shows that the intraoperative use of a gamma probe with Tc-99m MIBI allows localization of recurrent thyroid tissue in the scarred area in patients with increased radionuclide accumulation, and scanning of the affected area using the gamma probe may be helpful in determining whether resection is complete.

Tc-99m radio-guided completion thyroidectomy for differentiated thyroid carcinoma

“…proposed radio-guided surgery for the intraoperative localization and resection of locoregional, non-functioning (I-131-negative) DTC recurrences with Tc-99m MIBI. [142225] Rubello et al . reported a lesion to background ratio higher than 2.0 in all cases (mean ± SD = 3.2 ± 0.8) at operation.…”

I‐123‐guided excision of metastatic papillary thyroid cancer

“…Negele et al more recently presented a series of four patients and literature review, in which a similar technique was utilized [2]. Boz et al described the localization and excision of a local recurrence of follicular thyroid cancer using Tc-99m methoxyisobutyl isonitrile (MIBI) [3]. These authors demonstrated both the utility of Tc-99m MIBI for intraoperative localization and the possibility that recurrent thyroid cancer may elude detection by diagnostic I-131 whole body scanning.…”

Gamma probe-assisted brain tumor microsurgical resection: a new technique

“…The gamma-probe is resistant, portable, not too expensive and easy to use, presenting a high sensitivity and specificity, as demonstrated by the GPAS performed to remove a wide variety of tumors [3][4][5]9,10,[20][21][22][23][24][25] and sentinel-nodes [13][14][15][16][17][18][19] . In fact, its sensitivity se- ems to be greater than that of CT (Bell et al 3 : 11 of 13 patients harboring ovarian cancer underwent preoperative CT-scan, which was normal in all of them), MRI (Martinez et al 23 : one out of three patients with parathyroid disease underwent preoperative MRI and CT, being both normal) and external scintigraphy (Martin et al 4 : this procedure was normal in 11 out of 23 patients with colorectal tumor).…”

“…This technique, named by others as radioguided surgery (RGS) and by the present authors as gamma probe-assisted surgery (GPAS), was introduced into clinical practice in 1985 by Martin et al 3,4 , allowing them to promptly recognize the lesion in 28 patients harboring colorectal tumors. Using a variety of radiolabeled substances [1][2][3][4][5][6][7][8][9][10] , many authors have performed GPAS to map sentinelnodes of melanomas 13 , of breast 14 , vulvar 15 , cervical 16 , prostate 17 , penile 18 and thyroid 19 cancer, and to identify breast (the radiolabeled substance may be injected intravenously 20 and within 21 or around 22 the tumor), ovarian 3 , colorectal 4,5 , gastroenteropancreatic 10 , parathyroid 23 and thyroid 24,25 tumors and neuroblastomas 9 , with a significant successful rate.…”