Treatment of local and regional recurrences of differentiated thyroid cancer by radio-guided surgery with iodine-131.
BACKGROUND/MATERIAL AND METHODS: The aim of this study was to assess the reliability of radioiodine ((131)I) and a gamma probe for radio-guided surgery (RGS) to detect and radically dissect lymph node recurrence (LNR) in 15 patients with differentiated thyroid cancer (DTC). The major inclusion criterion was the presence of a radioiodine-positive LNR after previous total thyroidectomy and at least two ineffective (131)I treatments. The protocol was designed as follows: Day 0--all patients were hospitalized and received 3.7 GBq of (131) I while clinically hypothyroid. Day 3--pre-surgery whole-body scan with a therapeutic (131)I dose (TxWBS) was acquired. Day 5--neck surgery using a gamma probe (Navigator GPS, AutoSuture, Italy), recording the absolute counts and the lesion/background (L/B) counts ratio was performed. Day 7--post-surgery TxWBS was performed using the remaining radioactivity.


CONCLUSIONS
This protocol permitted us to identify neoplastic foci with high sensitivity and specificity, enabling us to remove lymph node metastases resistant to radioiodine therapy in a single session. The protocol also allowed detection of some additional tumoural foci in sclerotic areas or behind vascular structures that were not seen at the pre-surgery TxWBS evaluation.
Salvatori
Massimo
M
Institute of Nuclear Medicine, Policlinico Gemelli, Universita Cattolica del Sacro Cuore, Roma, Italy.
Ardito
Guglielmo
G
Pelizzo
Maria Rosa
MR
Mariani
Giuliano
G
Gross
Milton
M
Al-Nahhas
Adil
A
Rubello
Domenico
D
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000532:radiotherapy / Q000601:surgery*; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods; D016896:Treatment Outcome
D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals