title: Hook needle-guided excision of recurrent differentiated thyroid cancer in previously operated neck compartments: a safe technique for small, nonpalpable recurrent disease.
abstract: BACKGROUND
  As a result of more sensitive techniques to detect recurrent thyroid cancer, the number of patients presenting with small, nonpalpable recurrent thyroid cancer in cervical lymph nodes is increasing. Surgical excision of nonpalpable recurrent thyroid cancer can be difficult, particularly in a previously operated area.
  
  
  OBJECTIVE
  The objective of this study was to investigate whether preoperative insertion of a hook needle under ultrasound guidance is useful in neck reoperations for recurrent thyroid cancer.
  
  
  METHODS
  Ten consecutive patients presenting over a 4-month period with nonpalpable, ultrasound-visible, fine needle biopsy-proven recurrent thyroid cancer in previously operated neck compartment(s) were studied.
  
  
  METHODS
  We measured whether it was technically possible to insert a hook needle preoperatively, rate of negative neck exploration, and complication rate.
  
  
  RESULTS
  The hook needle was inserted in seven patients. In three patients, the hook needle was not inserted; one patient had palpable disease 4 months after the preoperative clinic visit, one patient had a tumor too close to the carotid artery, and one patient had multiple bilateral foci of recurrent disease in the central neck. One patient had bleeding after insertion of the needle due to a penetration of an anterior jugular vein that was easily managed at neck reexploration. No other complication occurred during the hook needle insertion, and the only surgical complication was a transient recurrent nerve palsy. All pathology reports showed malignant disease.
  
  
  CONCLUSIONS
  Hook needle-guided excision of recurrent thyroid cancer is feasible and appears to be a promising tool for safe and successful reoperation of patients with small recurrent thyroid cancer in cervical lymph nodes.
authors.affiliation: Endocrine Surgical Oncology, University of California/Mount Zion Medical Center, CA 94143-1674,USA. frederic.triponez@hcuge.ch
authors.forename: Frederic
authors.initials: F
authors.lastname: Triponez
authors.forename: Liina
authors.initials: L
authors.lastname: Poder
authors.forename: Rasa
authors.initials: R
authors.lastname: Zarnegar
authors.forename: Ruth
authors.initials: R
authors.lastname: Goldstein
authors.forename: Kayvan
authors.initials: K
authors.lastname: Roayaie
authors.forename: Vickie
authors.initials: V
authors.lastname: Feldstein
authors.forename: James
authors.initials: J
authors.lastname: Lee
authors.forename: Electron
authors.initials: E
authors.lastname: Kebebew
authors.forename: Quan-Yang
authors.initials: QY
authors.lastname: Duh
authors.forename: Orlo H
authors.initials: OH
authors.lastname: Clark
mesh_terms: D000293:Adolescent; D000328:Adult; D044963:Biopsy, Fine-Needle / Q000295:instrumentation / Q000379:methods*; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000601:surgery*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009333:Neck; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000601:surgery*; D009367:Neoplasm Staging; D010173:Palpation / Q000379:methods; D012449:Safety; D025321:Surgery, Computer-Assisted / Q000379:methods; D013525:Surgical Instruments; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014463:Ultrasonography