Radio‐guided nonpalpable metastatic lymph node localization in patients with recurrent thyroid cancer

Tükenmez, Mustafa; Erbil, Yeşim; Barbaros, Umut; Dural, Ahmet Cem; Salmaslıoğlu, Artür; Aksoy, Deniz; Mudun, Ayşe; Özarmağan, Selçuk

doi:10.1002/jso.20873

Cited by 42 publications

(42 citation statements)

References 9 publications

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“…As the dose of radioactivity used is low, the safety for the patient and physician is higher (15). The localisation by direct injection of radioactive substance into the lesion is advantageous, but not all lesions are suitable for this procedure due to their anatomic localisations.…”

Section: Discussionmentioning

confidence: 99%

Radioguided Occult Lesion Localization in Patients With Locally Recurrent Papillary Thyroid Carcinoma: How We Do It?

Gülçelik¹,

Doğan²,

Şahiner³

et al. 2017

Acta Oncol Tur.

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ÖZET Amaç:Papiller tiroid kanseri (PTK) tiroid bezinin en sık karşılaşılan kanseridir. Primer tedavi sonrası lateral boyunda %50'nin üzerinde, santral bölgede ise %25'in üzerinde bölgesel rekürrens ile karşılaşılır. Bu yazıda, preoperatif ultrason haritalama (PUH) ve Radioguided Occult Lesion Localization (ROLL) yöntemini kombine kullandığımız PTK rekürrensi nedeniyle reopere olmuş hastalardaki deneyimimizi sunmak amaçlanmıştır. Yöntem: Daha önce PTK ve lokal bölgesel metastaz nedeni ile total tiroidektomi (TT) ve santral/lateral boyun diseksiyonu uygulanmış 8 hasta lokal bölgesel rekürrens nedeni ile reopere edildiler. Nükslerin araştırılmasında yüksek çözünürlüklü ultrasonografi, ince iğne aspirasyon sitolojisi ve kan Tg düzeyleri kullanıldı. Nüksleri ispatlanmış ve sitopatolojik incelemede yüksek Tg seviyeleri saptanan olgular opere edildiler. Her hastanın yaşı, cinsiyeti, primer tümör boyutu, ilk ameliyatın şekli, adjuvan tedavileri, nükse kadar geçen süresi, ameliyatın yeri ve süresi, işaretli ve işaretsiz lezyonların sayısı ve haritada işaretli/ işaretsiz lezyonlardaki ve haritada bahsedilmeyen lezyonlardaki metastatik ve çıkarılan lezyonların sayısı kaydedildi. Bulgular: Lokalizasyon çalışması sonrası çıkarılan 20 lezyondan 16'sının malign olduğu görüldü. Haritalama sırasında işaretli lezyonlar dışında 36 ek lezyon da şüpheli olarak tanımlanmıştı. Bu lezyonların 34'ü tanımlanan anatomik yerleşimlerinde ve bölgelerde bulunarak çıkarıldı. İki lezyon ise haritalamada tanımlanan alanlarda bulunamadı. Bu 34 lezyondan 27'sinin malign olduğu gösterildi. Postoperatif takiplerde, bir hastada 7 günde kendiliğinden gerileyen şilöz kaçak ve seroma gelişti. Sonuç: Santral ve boyun bölgesine reoperasyon planlanan PTK li hastalarda ROLL ve preoperatif haritalama tekniğinin ameliyat güvenliği ve konforuna katkı sağlar. Anahtar Kelimeler: Tiroid kanseri, ROLL, papiller tiroid kanseri ABSTRACT Introduction: Papillary thyroid carcinoma (PTC) is the most-frequent type of thyroid cancer. Following primary treatment, regional metastasis in the cervical region can be seen in more than 50 percent of cases and in the central region in more than 25 percent of cases. Our aim is to present our experiences with patients operated on for the recurrence of papillary thyroid cancer with the combined use of pre-operative ultrasonographic mapping and radio-guided occult lesion localisation. Methods: Eight patients who had already undergone total thyroidectomy and central/lateral neck dissection for papillary thyroid carcinoma were re-operated on due to locoregional metastasis. High-resolution ultrasonography, fine needle aspiration cytology and blood Tg levels were used to search for recurrences. The patients with proven recurrences and high Tg wash-out levels in cytopathologic aspirates were operated on. For each patient, age, gender, size of the primary tumor, type of previous surgery, adjuvant treatments, time to recurrence, site and duration of surgery, numbers of marked and non-marked lesions, and the metastatic and total numbers of m...

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Section: Discussionmentioning

confidence: 99%

Radioguided Occult Lesion Localization in Patients With Locally Recurrent Papillary Thyroid Carcinoma: How We Do It?

Gülçelik¹,

Doğan²,

Şahiner³

et al. 2017

Acta Oncol Tur.

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“…Previously described operative localizing techniques for targeted lymph node excisions in this setting include: Hookwire-guided excisions, 4 blue-dye 15 or charcoal guided localizations 16 and radio-guided excision. [5][6][7] Alternative forms of management include radiofrequency ablation or the use of alcohol. 18 Advantages and disadvantages of these various methods continue to be debated.…”

Section: Discussionmentioning

confidence: 99%

“…15 The technique of radio-guided surgery is also suboptimal, as the radioisotope injection requires careful timing and, in some techniques, repeated scans up to 12 hours apart. [5][6][7] Ironically, the injection itself is usually ultrasound-guided, therefore a seemingly unnecessary additional step is added in the identification process. 5 In addition, the procedure may be hindered by a variable degree of uptake in the metastatic focus depending on its size and ability to take up radioiosotope, and by the fact that parathyroid glands may also take up the same radioisotope and can therefore be inadvertently removed.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of previous reports have used invasive techniques, such as hookwire placement or radioisotope injections, to mark the position of the lymph nodes preoperatively which can add significantly to patient morbidity. [4][5][6][7] In this report, we describe the technique of surgeonperformed ultrasound-guided excision of impalpable cervical lymph node metastases. The metastatic or suspicious lymph nodes identified during the course of preoperative workup obviously need to be visible sonographically.…”

Section: 5005/jp-journals-10002-1125mentioning

confidence: 99%

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Intraoperative Ultrasound-guided Excision of Cervical Lymph Nodes for Recurrent Differentiated Thyroid Cancer

Bennett¹,

Biggar²,

Wong³

et al. 2013

World Journal of Endocrine Surgery

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As a result of sensitive thyroglobulin assays and widespread use of cervical ultrasound, endocrine surgeons are encountering patients with impalpable suspicious or frankly metastatic cervical lymph nodes in the follow-up phase after treatment for welldifferentiated thyroid cancer. The surgical excision of impalpable disease of recurrent or persistent thyroid cancer can represent a significant challenge which may require some means of intraoperative localization to ensure that affected nodes are removed. Surgeon-performed intraoperative ultrasound (IOUS) can be used for guiding excision of suspicious but impalpable cervical nodes. The IOUS-guided excision technique is described. The successful application of IOUS to localize and guide resection of impalpable nodal recurrences of papillary thyroid carcinoma in two patients is reported. The utilization of IOUS to guide resection of impalpable pathological nodes in the context of thyroid carcinoma is a safe and practical technique which avoids the need for additional localization procedures and unnecessary potential morbidity for the patient.

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“…Localization of the abnormal parathyroid gland(s), particularly in previously operated areas, can be challenging to perform in an accurate, efficient, and safe manner. Preoperative imaging with ultrasonography, sestamibi scintigraphy, computed tomography, magnetic resonance, and/or ultrasound-guided fine-needle aspiration biopsy and parathormone (PTH) determination in aspirate (US-G-FNABx) are typical tools used to identify a hyperfunctioning parathyroid tumor and if it needs excision or not [2]. Ultrasound (US) provides the surgeon with direct and dynamic information about the location of the targeted tumor in relation to other identifiable anatomic landmarks as coordinates.…”

Section: Introductionmentioning

confidence: 99%

Successful Localization of Abnormal Parathyroid Gland Using Ultrasound-Guided Methylene Blue Dye Injection in the Reoperative Neck

et al. 2014

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Persistent or recurrent hyperparathyroidism is a challenging problem for endocrine surgeons. The aim of this study was to review our experience using ultrasound-guided (US-G) methylene blue dye injection for the localization and removal of abnormal parathyroid glands in patients having primary hyperparathyroidism and previous neck surgery. Between January 2012 and May 2013, six consecutive patients with primary hyperparathyroidism (PHPT) and previous neck surgery underwent focused parathyroidectomy with the use of US-G methylene blue dye injections to localize the presumed parathyroid adenoma were included in the study. We analyzed the data of six patients who underwent reoperative parathyroid surgery using US-G methylene blue dye injection retrospectively. The dye injection was performed just prior to surgery. All patients were successfully treated for their hyperparathyroidism which was confirmed by at least 50 % drop in intraoperative parathormone level 10 min after resection. There were no complications related with US-G dye injection or with surgery. US-G methylene blue dye injection is a cheap, safe, and effective method for localization of diseased parathyroid glands and guiding surgery in the reoperative neck.

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Radio‐guided nonpalpable metastatic lymph node localization in patients with recurrent thyroid cancer

Cited by 42 publications

References 9 publications

Radioguided Occult Lesion Localization in Patients With Locally Recurrent Papillary Thyroid Carcinoma: How We Do It?

Radioguided Occult Lesion Localization in Patients With Locally Recurrent Papillary Thyroid Carcinoma: How We Do It?

Intraoperative Ultrasound-guided Excision of Cervical Lymph Nodes for Recurrent Differentiated Thyroid Cancer

Successful Localization of Abnormal Parathyroid Gland Using Ultrasound-Guided Methylene Blue Dye Injection in the Reoperative Neck

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