Excision efficiency of radioguided occult lesion localization in reoperative thyroid and parathyroid surgery.
BACKGROUND
The purpose of this study was to investigate the efficiency of a radioguided occult lesion localization technique in reoperative thyroid and parathyroid procedures in patients who had undergone previous neck exploration for thyroid or parathyroid disease.


METHODS
Twenty-one consecutive patients who were scheduled for reoperative thyroid or parathyroid surgery were studied. The indication for reoperation was recurrent papillary thyroid cancer (PTC) in eight patients, completion thyroidectomy for PTC in eight patients who had previously undergone a bilateral subtotal thyroidectomy, recurrent goiter in two patients, primary hyperparathyroidism in two patients, and recurrent parathyroid cancer in one patient. Ninety minutes before surgery, 0.1 mL of Technetium-99m (0.2 mCi)-labeled macroaggregated albumin was injected directly into the lesion under ultrasonographic guidance. During surgery, a handheld gamma probe was used to localize and excise the lesions. The background and postexcisional site radioactivities were compared to confirm the completeness of each procedure. The radiation dose in the operating room environment, duration of surgery, and postoperative complication rates were evaluated in all patients. In patients with PTC, the change in serum thyroglobulin (Tg) following surgery was noted.


RESULTS
Thirty lesions were marked and excised. The postexcisional bed gamma counts (610 ± 141) were markedly decreased compared with the pre-excisional site counts (21,415.8 ± 4993.4; p = 0.0001). The ratio of the postexcisional and background counts (4.6 ± 4.3) was significantly lower than the ratio of the pre-excisional and background counts (173.7 ± 156.4; p = 0.0001). The mean operation duration was 53.3 ± 7.5 minutes. The dose absorbed by the hands of the surgeon was estimated as 0.07 ± 0.02 and 0.15 ± 0.05 millisievert/h when one or three lesions were marked, respectively. One patient developed postoperative transient hypoparathyroidism. After surgery, serum Tg levels dropped to <2 ng/mL in 86% (6/7) of the patients with PTC whose preoperative serum Tg was elevated.


CONCLUSIONS
The radioguided occult lesion localization technique was efficient in the perioperative identification of thyroid and parathyroid tumors in patients who were undergoing reoperation for PTC and hyperparathyroidism.
Department of General Surgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Tarık
T
Terzioğlu
Yasemin Giles
YG
Senyurek
Fatih
F
Tunca
Cüneyt
C
Türkmen
Ayşe
A
Mudun
Artur
A
Salmaslıoglu
Sükrü
S
Sanlı
Hüseyin
H
Bircan
Onur
O
Demirkol
Serdar
S
Tezelman
D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006042:Goiter / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging / Q000601:surgery*; D007011:Hypoparathyroidism / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016105:Parathyroidectomy; D011446:Prospective Studies; D011829:Radiation Dosage; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012086:Reoperation; D013668:Technetium Tc 99m Aggregated Albumin; D013954:Thyroglobulin / Q000097:blood; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D013965:Thyroidectomy
D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D013954:Thyroglobulin