Radioguided Occult Lesion Localization in Patients With Locally Recurrent Papillary Thyroid Carcinoma: How We Do It?

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.

Lokal ve bölgesel olarak nüksetmiþ papiller tiroid kanserinde nüks lezyonlarýn radyoaktif madde yardýmlý (ROLL) saptanmasý ve tedavisi

GÝRÝÞ ve AMAÇ: Papiller tiroid kanseri (PTK) tiroid bezinin en sýk karþýlaþýlan kanseridir. Primer tedavi sonrasý lateral boyunda %50’nin üzerinde, santral bölgede ise %25’in üzerinde bölgesel rekürrens ile karþýlaþýlýr. Bu yazýda, preoperatif ultrason haritalama (PUH) ve Radioguided Occult Lesion Localization (ROLL) yöntemini kombine kullandýðýmýz PTK rekürrensi nedeniyle reopere olmuþ hastalardaki deneyimimizi sunmak amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Daha önce PTK ve lokal bölgesel metastaz nedeni ile total tiroidektomi (TT) ve santral/lateral boyun diseksiyonu uygulanmýþ 8 hasta lokal bölgesel rekürrens nedeni ile reopere edildiler. Nükslerin araþtýrýlmasýnda yüksek çözünürlüklü ultrasonografi, ince iðne aspirasyon sitolojisi ve kan Tg düzeyleri kullanýldý. Nüksleri ispatlanmýþ ve sitopatolojik incelemede yüksek Tg seviyeleri saptanan olgular opere edildiler. Her hastanýn yaþý, cinsiyeti, primer tümör boyutu, ilk ameliyatýn þekli, adjuvan tedavileri, nükse kadar geçen süresi, ameliyatýn yeri ve süresi, iþaretli ve iþaretsiz lezyonlarýn sayýsý ve haritada iþaretli/ iþaretsiz lezyonlardaki ve haritada bahsedilmeyen lezyonlardaki metastatik ve çýkarýlan lezyonlarýn sayýsý kaydedildi.
BULGULAR: Lokalizasyon çalýþmasý sonrasý çýkarýlan 20 lezyondan 16’sýnýn malign olduðu görüldü. Haritalama sýrasýnda iþaretli lezyonlar dýþýnda 36 ek lezyon da þüpheli olarak tanýmlanmýþtý. Bu lezyonlarýn 34’ü tanýmlanan anatomik yerleþimlerinde ve bölgelerde bulunarak çýkarýldý. Ýki lezyon ise haritalamada tanýmlanan alanlarda bulunamadý. Bu 34 lezyondan 27’sinin malign olduðu gösterildi. Postoperatif takiplerde, bir hastada 7 günde kendiliðinden gerileyen þilöz kaçak ve seroma geliþti.
TARTIÞMA ve SONUÇ: Santral ve boyun bölgesine reoperasyon planlanan PTK li hastalarda ROLL ve preoperatif haritalama tekniðinin ameliyat güvenliði ve konforuna katký saðlar.