Localization of recurrent thyroid cancer using intraoperative ultrasound-guided dye injection.

Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA.
World Journal of Surgery (Impact Factor: 2.35). 11/2008; 33(3):434-9. DOI: 10.1007/s00268-008-9797-0
Source: PubMed

ABSTRACT Small, nonpalpable lymph node recurrences are frequently identified in the follow-up of patients with thyroid cancer, and finding and removing these lesions in a reoperative field can be very challenging. The goal of this study was to evaluate the utility of preincision ultrasound-guided injection of blue dye into the abnormal lymph nodes to facilitate their safe and efficient removal.
We performed a prospective study between January and June 2007 at a single academic institution. Ten patients with isolated, nonpalpable nodal recurrences of papillary thyroid cancer underwent an operation for a neck recurrence (8 central, 2 lateral). A preincision ultrasound was performed in the operating room to localize the lesions, and 0.1 ml of blue dye was injected under ultrasound guidance into each abnormal lymph node. We examined the feasibility of the injection procedure, the accuracy of identifying pathologic lymph nodes, and the complications of injection.
The pathologic lymph nodes averaged 11 mm in size (range = 6-16 mm) and were detectable by ultrasound in all cases. Ultrasound-guided blue dye injection was successful in all cases. There were no complications related to dye injection. The blue node was easily identified and removed in all cases. The mean operative time was 80.4 min (range = 37-157 min).
Blue dye injection was feasible and was very useful for the identification of lymph node recurrences, especially in the reoperative neck. There were no complications related to the injection in this series. Further study is needed to determine the widespread safety and efficacy of this technique.

  • Source
  • [Show abstract] [Hide abstract]
    ABSTRACT: This work aims at analyzing three different techniques for synchronizing RF oscillators. These techniques are Injection Locking (ILO), Phase Locked Loop (PLL) and Injection Locked Phase Locked Loop (ILPLL). ILPLL, which is a combination of PLL and ILO, has superior noise performance -compared to all the rest- at medium frequency offsets and the same noise performance at low and high offsets. Furthermore, the ILPLL has better locking range and lower phase noise than the ILO for phase-shifts close to ±90°. In this work we present two different approaches for the study of the performance of the ILPLL, which as we show, produce equivalent results concerning the noise. A common gate VCO was used and the injected signal was the same for comparison reasons.
    Electronics, Circuits and Systems, 2003. ICECS 2003. Proceedings of the 2003 10th IEEE International Conference on; 01/2004
  • [Show abstract] [Hide abstract]
    ABSTRACT: The incidence of nonpalpable recurrence detected on follow-up ultrasound (US) after thyroidectomy has increased. However, surgical approach for nonpalpable lesions can be difficult. We assessed the safety and effectiveness of ultrasound-guided tattooing (US-tattoo) with a charcoal suspension for localizing nonpalpable cervical recurrences after thyroidectomy for thyroid cancer. Between March 2004 and February 2008, we retrospectively assessed 55 consecutive patients with 83 lesions who underwent US-tattoo with injection of a charcoal suspension for nonpalpable lesions. All patients underwent the surgical dissection after US-tattoo. The complications and effectiveness of US-tattoo were evaluated using ultrasonographic, surgical, and pathologic records. Among 83 lesions, 72 recurrences and 11 benign lesions were confirmed by final pathology. The average size of the localized lesions was 0.7 cm (range 0.4-1.4 cm). The most common site of tattooing was cervical lymph nodes at level IV. The technical success rate of US-tattoo for suspicious lesions was 96% (80/83). Failure of US-tattoo occurred in lesions located posterior to major vessels. During surgery, all but two successful tattooed lesions were detected by surgeons. No residual lesion was detected at follow-up US. With regard to complications, two patients (4%) had a dot-like marking at the skin puncture site after US-tattoo. Preoperative US-tattoo is a safe and effective method for successful reoperation of nonpalpable recurrences after thyroidectomy.
    Annals of Surgical Oncology 04/2009; 16(6):1655-9. DOI:10.1245/s10434-009-0431-7 · 3.94 Impact Factor