Combination of Preoperative Ultrasonographic Mapping and Radio-Guided Occult Lesion Localization in Patients with Locally Recurrent/Persistent Papillary Thyroid Cancer a Pilot Study

Background: Better follow-up of patients with thyroid cancer and more sensitive detection leads to detection of recurrences in the neck. Our aim is to explore the feasibility of (ROLL) for radio-iodine negative cervical recurrences from thyroid cancer in patients with previously operated neck compartments to improve the surgical success and reduce the complication rates. Method(s): Pre and postoperative thyroglobulin levels and neck US were performed. The results of fine needle aspiration (FNA) cytopathology were available. In the morning of surgery, biopsy proven recurrent/persistent tumoral lesions were injected with Tc-99m labeled macro-aggregated albumin under US guidance. Thyroid bed exploration was carried out based on the location of lesions with the guidance of intra-operative gamma probe and neck map. The lesions showing high count rates were resected and labeled separately for histopathologic study and to ascertain removal of the radiolabeled lesions. Result(s): Total of 13 patients (8 females and 5 males) were included. Technical success rate was achieved in all patients with successful surgical removal of the lesions. All the lesions removed were positive on histopathologic assessment. Significant drop of the TG levels was achieved in all patients. Conclusion(s): The ROLL technique is feasible in patients with loco-regional recurrence particularly useful in patients already submitted to cervical dissections and/or with small lesions located in surgically difficult sites. It can therefore have clinical role in the management of cervical recurrences.

Publication History

Article published online:
11 May 2021