Radio-guided surgery for non-131I-avid thyroid cancer.
OBJECTIVE
In this paper we report in a larger series the use of radio-probe-guided surgery (RGS) in nonradioiodine avid, well-differentiated thyroid cancer (DTC).


METHODS
Thirty-seven patients with locoregional recurrent, nonradioiodine avid DTC were studied with (99m)Tc-sestamibi directed RGS using a handheld gamma probe as an intraoperative detector.


RESULTS
Twenty-three women and 14 men were followed after RGS for 35.4 +/- 12.5 months (range 9-57). There were 33 papillary (one "tall" cell variant), 2 follicular, and 2 Hürthle cell cancers. In 7 patients, thyroid cancer recurred in the neck while cervical lymph node metastases were found in 31 patients (one patient had papillary cancer in both the thyroid bed and cervical lymph nodes). Sixty-six discrete nodules ranging from 6 to 45mm (mean tumor diameter, 18.4 +/- 8.5mm) were identified by both high-resolution ultrasound and (99m)Tc-sestamibi probe-guided RGS. After RGS, Tg (thyroglobulin) fell in 33 of 37 patients and mean target=nontarget sestamibi uptake ratios decreased in all 37 patients ( p < 0.0001).


CONCLUSIONS
These data confirm our earlier observations that a (99m)Tc-sestamibi intraoperative gamma probe can be used to identify and guide resection of recurrent tumor and involved lymph nodes in locoregional metastases of nonradioiodine-avid thyroid cancer.
Rubello
Domenico
D
Nuclear Medicine Service-PET Unit, S. Maria della Misericordia Rovigo Hospital, Istituto Oncologico Veneto (IOV), Rovigo, Italy.
Pelizzo
Maria Rosa
MR
Casara
Dario
D
Piotto
Andrea
A
Toniato
Antonio
A
Fig
Lorraine
L
Gross
Milton
M
D018263:Adenocarcinoma, Follicular / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery; D018249:Adenoma, Oxyphilic / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery*; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000601:surgery; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D016634:Radiosurgery / Q000379:methods*; D017256:Technetium Tc 99m Sestamibi; D013954:Thyroglobulin / Q000097:blood; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*
D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D013954:Thyroglobulin; D017256:Technetium Tc 99m Sestamibi