The rate of operative success achieved with radioguided occult lesion localization and intraoperative ultrasonography in patients with recurrent papillary thyroid cancer

• Published in: Surgery Vol. 156; no. 5; pp. 1116 - 1126
• Main Authors: Giles, Yasemin Şenyürek, MD, Sarıcı, İnanc Samil, MD, Tunca, Fatih, MD, Sormaz, İsmail Cem, MD, Salmaslıoğlu, Artur, MD, Adalet, Işık, MD, Özgür, İlker, MD, Tezelman, Serdar, MD, Terzioğlu, Tarık, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2014
• Subjects: Adult; Aged; Carcinoma - diagnostic imaging; Carcinoma - surgery; Carcinoma, Papillary; Female; Humans; Intraoperative Period; Lymph Nodes - surgery; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Recurrence, Local - surgery; Prospective Studies; Radionuclide Imaging; Surgery; Technetium; Thyroid Cancer, Papillary; Thyroid Neoplasms - diagnostic imaging; Thyroid Neoplasms - surgery; Ultrasonography, Interventional; Young Adult
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2014.04.012

Background To investigate the rate of operative success in excision of nonpalpable lymph nodes with metastatic disease achieved with radioguided occult lesion localization (ROLL) and intraoperative ultrasonography (IOUS) in patients with papillary thyroid cancer (PTC). Methods Twenty consecutive PTC patients with nonpalpable lymph nodes with metastastic disease localized in previously operated fields were randomized to receive ROLL ( n  = 11) or IOUS ( n  = 9). Nodes were excised along with adjacent soft tissue to accomplish a compartment-oriented dissection. The duration of operation, rate of postoperative complications, pre- and postoperative serum thyroglobulin (Tg) levels, and the findings of postoperative neck ultrasonography and postablation scan were recorded in all patients. Measures of operative success included a postoperative Tg level <50% of preoperative Tg level and no abnormal lesions on postoperative imaging. Results Histopathologic examination confirmed the excision of all preoperatively identified metastatic nodes. Additional nodes also were excised (2.3 ± 3.3 per specimen in the ROLL group and 1.6 ± 1.8 per specimen in the IOUS group), 23% of which were metastatic. No postoperative complications occurred in either group. The duration of operation was similar in the 2 groups ( P  = .4). Postoperative imaging confirmed the clearance of suspicious nodes in all patients. The rate of operative success in ROLL and IOUS group were 100% and 89%, respectively. Conclusion In patients with recurrent PTC, a high rate of operative success in excision of nonpalpable metastatic lymph nodes was achieved by both ROLL and IOUS. We recommend compartment-oriented dissection; this approach may maximize the removal of metastatic nodes not identified by preoperative imaging.