Same-day ultrasound guidance in reoperation for locally recurrent papillary thyroid cancer.
BACKGROUND
Reoperation for locally recurrent papillary thyroid cancer (PTC) is technically difficult and associated with higher morbidity. This study evaluated the use of same-day ultrasound guidance (SDUS) as an adjunct.


METHODS
We compared 2 cohorts of consecutive patients with a single impalpable focus of recurrent PTC. Group I (August 2001-January 2004) was explored based on results of imaging. Group II (April 2004-January 2007) had an additional SDUS, performed before incision with indelible skin marking directly over the lesion. Outcome measures included failure to resect, lesion size, and postoperative change in thyroglobulin.


RESULTS
In group I, in 3 of 6 cases the surgeon was unable to find the preoperatively imaged focus. By contrast, all 19 group II patients had successful resection of the lesion facilitated by SDUS (P < .01). SDUS resection was more likely to succeed even though group II lesions were smaller (mean 17 vs 11 mm; P = .009). Mean operative times did not differ but morbidity was lower (P < .01) in group II. Postresection serum thyroglobulin levels dropped to undetectable in 50% of evaluable cases.


CONCLUSIONS
When focused resection of recurrent PTC is considered appropriate, SDUS guidance is an efficient and useful adjunct, allowing resection of lesions as small as 6 mm.
University of Pittsburgh, Department of Surgery, Pittsburgh, Pennsylvania, USA.
Kelly L
KL
McCoy
John H
JH
Yim
Mitchell E
ME
Tublin
Lynn A
LA
Burmeister
Jennifer B
JB
Ogilvie
Sally E
SE
Carty
D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000601:surgery*; D011300:Preoperative Care; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013954:Thyroglobulin / Q000097:blood; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography
D013954:Thyroglobulin