Localization of recurrent thyroid cancer using intraoperative ultrasound-guided dye injection.
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.
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ABSTRACT: Surgical excision is the definitive treatment for localized recurrence of papillary thyroid carcinoma. Reoperation for recurrence, however, is challenging and associated with increased operative times and complication rates. For safe and effective reoperation, ultrasound-guided charcoal tattooing localization can be used. The aim of this study was to investigate the feasibility and safety of the ultrasound-guided charcoal tattooing localization. Between November 2012 and August 2013, ten patients underwent preoperative charcoal tattooing localization for twelve recurrent lesions. Patient demographics, pathologic features, and operation results were reviewed. The technical success rate of charcoal tattooing was 100%. Eight patients had one recurrent lesion, and two patients had double lesions. Among these 12 recurrent lesions, three (25%) were found in level II, four (33%) in level IV, four (33%) in level VI, and one (8%) was found in the thyroidectomy bed site. The mean size of lesions was 0.87 ± 0.35 cm. Of these 10 patients, eight patients underwent selective lymph node dissection, one patient underwent modified radical neck dissection, and one patient underwent recurrent mass excision. Transient hypocalcemia developed in one patient, and no recurrent laryngeal nerve palsy occurred. There were no major complications related to the injection of the charcoal. The mean follow-up period after reoperation was 8.6 ± 2.7 months; in the follow-up ultrasound, there were no remnant lesions in all patients. Preoperative ultrasound-guided charcoal tattooing localization for recurrent thyroid cancer appears to be a feasible and safe procedure for reoperation. Further evaluation is warranted in larger patients' cohorts.
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ABSTRACT: Background: The primary goals of this interdisciplinary consensus statement are to define the eligibility criteria for management of recurrent and persistent cervical nodal disease in patients with differentiated thyroid cancer (DTC) and to review the risks and benefits of surgical intervention versus active surveillance. Methods: A writing group was convened by the Surgical Affairs Committee of the American Thyroid Association and was tasked with identifying the important clinical elements to consider when managing recurrent/persistent nodal disease in patients with DTC based on the available evidence in the literature and the group's collective experience. Summary: The decision on how to best manage individual patients with suspected recurrent/persistent nodal disease is challenging and requires the consideration of a significant number of variables outlined by the members of the interdisciplinary team. Here we report on the consensus opinions that were reached by the writing group regarding the technical and clinical issues encountered in this patient population. Conclusions: Identification of recurrent/persistent disease requires a team decision-making process that includes the patient and physicians as to what, if any, intervention should be performed to best control the disease while minimizing morbidity. Several management principles and variables involved in the decision making for surgery versus active surveillance were developed that should be taken into account when deciding how to best manage a patient with DTC and suspected recurrent or persistent cervical nodal disease.Thyroid: official journal of the American Thyroid Association 09/2014; DOI:10.1089/thy.2014.0098 · 2.60 Impact Factor
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ABSTRACT: Background: Reoperation for thyroid cancer recurrence is a surgical challenge in previously dissected necks and there is a need in a reliable procedure for surgeon guidance. In this study, we evaluated the usefulness of preoperative charcoal tattooing for surgical guidance. Methods: From July 2007 to May 2010, 53 patients (40 females and 13 males; mean age 44 years, range 19-76) have been prospectively included for preoperative localization of neck recurrences from differentiated (n=46) or medullary thyroid cancer (n=7). Preoperative cytological assessment was performed at least for one lesion in each patient. US imaging was performed with high frequency probes (8 - 14 Mhz) (Aplio, Toshiba, Japan). 0.5 to 3 ml of micronized peat charcoal ("Sterile Pigment Cender's", Derm Tech, France) was injected under US guidance using a 25 Gauges needle, 0-15 days preoperatively. Results: 106 lesions were selected for charcoal tattooing, 101 had been tattooed and 102 were removed (85 metastases, 17 benign at pathology). Tolerance of charcoal injection was good in all but 3 patients. A mean volume of 1 ml of charcoal was injected with a mean of 2 targets per patient. Charcoal labelling facilitated intraoperative detection in 56 "difficult" lesions (i.e small size, dense fibrosis, anatomical pitfalls) and charcoal trace facilitated intraoperative guidance in 17 lesions. Feasibility and usefulness rates were 83% and 70,7%, respectively. Conclusion: These findings suggest that charcoal tattooing under ultrasound guidance is an easy to implement, safe and useful procedure for surgeon guidance in neck reoperation for thyroid cancer.Thyroid: official journal of the American Thyroid Association 01/2015; DOI:10.1089/thy.2014.0329 · 2.60 Impact Factor