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: 2.64).
11/2008; 33(3):434-9. DOI: 10.1007/s00268-008-9797-0
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.
Available from: Gioacchino Giugliano
- "Preoperative imaging, which may include ultrasound mapping or another type of imaging, is essential for marking the location of abnormal tissue and for planning the approach to second interventions. However, once an incision is made and tissues are dissected, the clear orientation seen preoperatively is usually lost in the scar tissue 1. Our group has developed a technique previously described by Sippel 1 that aims to facilitate diagnosis of patients with questions on cervical follow-up, which also allows treatment of these lesions with a lower complication rate and morbidity. "
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ABSTRACT: The evolution of new techniques for cancer surgery has led to important changes in cancer care in recent years. The endpoint of cancer treatment is now to treat the patient with minimum discomfort while respecting quality of life. New techniques, such as mini-invasive surgery, must respect the correct oncological indications, when technically feasible. The surgery for nodal spread or recurrence of disease, after previous surgery on T or T and N for neck cancer, can represent a diagnostic and therapeutic challenge, especially in the neck, which is characterized by small spaces and noble structures. Often lesions become enveloped in scar tissue and can be difficult to visualize during surgery, representing a genuine problem for the surgeon. Ultrasound dye-assisted surgery is a procedure that combines ultra-sound localization of pathological nodes with the use of methylene blue to mark diseased structures to simplify their visualization (and thus removal) in the surgical field. The technique is simple and can be used in surgically and oncologically experienced hands, even in hospitals that do not have sophisticated technology.
Available from: diss.kib.ki.se
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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.
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