title: Use of surgical gamma probe for the detection of lymph node metastases in differentiated thyroid cancer.
abstract: BACKGROUND
  Patients with differentiated thyroid cancer (DTC) after total or near-total thyroidectomy require 131I therapy. After surgery the persistence of lymph node metastases in our series of patients was frequent (30%). Such patients are preferentially treated with radioiodine and shifted to surgical reintervention when the nodal lesions persist after two 131I treatments.
  
  
  OBJECTIVE
  Use of an intraoperative radioactive probe (C-TraK) to allow a more radical surgical approach in thyroid cancer patients submitted to surgery for lymph node metastases.
  
  
  RESULTS
  After adequate withdrawal of L-thyroxine suppressive therapy six patients were given high 131I doses followed by post-therapy WBS which demonstrated cervical activity in 5 patients and peri-jugular activity in 1. Surgery with the help of a gamma probe allowed to detect and remove all metastatic nodes. After excision all surgical specimens showed higher radioactive counts with respect to the background. The post-surgical scan showed the disappearance of all areas of 131I uptake. Histology confirmed the presence of metastatic lesions from papillary thyroid cancer.
  
  
  CONCLUSIONS
  We conclude that the use of a gamma probe can be successful in patients with metastatic neck lesions resistant to 131I treatment, particularly in patients with nonpalpable lesions.
authors.affiliation: Dipartimento di Endocrinologia e Metabolismo, Pisa, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Lippi
authors.forename: M
authors.initials: M
authors.lastname: Capezzone
authors.forename: P
authors.initials: P
authors.lastname: Miccoli
authors.forename: C
authors.initials: C
authors.lastname: Traino
authors.forename: F
authors.initials: F
authors.lastname: Di Martino
authors.forename: F
authors.initials: F
authors.lastname: Angelini
authors.forename: C
authors.initials: C
authors.lastname: Spinelli
authors.forename: P
authors.initials: P
authors.lastname: Iacconi
authors.forename: A
authors.initials: A
authors.lastname: Pinchera
authors.forename: F
authors.initials: F
authors.lastname: Pacini
mesh_terms: D000328:Adult; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D015902:Gamma Cameras; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D011859:Radiography; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*