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 marked/non-marked and non-mentioned lesions in the maps were recorded.

RESULTS

Sixteen lesions of 20 lesions removed after localisation were found to be malignant. In addition to the marked lesions during mapping, 36 additional lesions had been defined as suspicious. Thirty-four of these lesions were found at exact anatomic sites and localisations described and removed. Two lesions could not be found at areas described during mapping. Of 34 lesions, 27 were found to be metastatic. During the postoperative follow-up, chylous leak with spontaneous regression in 7 days and seroma occurred in one patient.

DISCUSSION AND CONCLUSION

Radio-guided occult lesion localisation and pre-operative mapping contribute to the safety and comfort of patients in planned re-operations on lateral and central neck regions.