title: On-site ultrasound-guided localization for impalpable nodal recurrences in papillary thyroid carcinoma patients.
abstract: OBJECTIVE
  The cervical lymph nodes are the most common sites of locoregional recurrence in patients with papillary thyroid carcinoma (PTC). Accurate tumor localization is important for the successful removal of impalpable recurrences in the cervical lymph nodes. We evaluated the benefits of ultrasound-guided localization (UGL) performed by a single surgeon on site.
  
  
  METHODS
  Of 53 PTC patients who underwent reoperation for impalpable nodal recurrences, 32 (group 1) were assessed only using preoperative imaging, while 21 (group 2) were additionally evaluated by on-site UGL performed by the operating surgeon. Postoperative outcomes were compared between the two groups.
  
  
  RESULTS
  Operation times were significantly shorter (P < 0.001) and the mean size of the resected lymph nodes were smaller (P = 0.013) for group 2 patients. More lymph nodes were identified and resected in group 1 (3.56 vs. 3.19), but the rate of positive lymph nodes was significantly higher in group 2 (P < 0.001). There were no differences between the two groups in terms of resection success rate, complication rate, and postoperative hospital stay. During a mean follow-up period of 27.6 months, 52 patients (98.1%) showed no evidence of recurrence on routine ultrasound, and serum thyroglobulin concentrations remained < 1 ng/mL in 49 patients (92.5%).
  
  
  CONCLUSIONS
  On-site UGL performed by the operating surgeon is useful for accurate resection of impalpable nodal recurrences in PTC patients.
authors.affiliation: Department of Surgery, The Armed Forces Capital Hospital, Seongnam, Korea.
authors.forename: Kuk-Jin
authors.initials: KJ
authors.lastname: Kim
authors.forename: Bup-Woo
authors.initials: BW
authors.lastname: Kim
authors.forename: Yong Sang
authors.initials: YS
authors.lastname: Lee
authors.forename: Hang-Seok
authors.initials: HS
authors.lastname: Chang
authors.forename: Cheong Soo
authors.initials: CS
authors.lastname: Park
keywords: Impalpable nodal recurrences; Localization; On-site ultrasound; Papillary thyroid carcinoma
references.citation: Br J Surg. 2012 Oct;99(10):1345-51
references.pmid: 22961511
references.citation: Eur J Clin Pharmacol. 2000 Jun;56(3):247-50
references.pmid: 10952480
references.citation: Br J Surg. 1993 Aug;80(8):1009-12
references.pmid: 8402050
references.citation: J Clin Endocrinol Metab. 2001 Apr;86(4):1447-63
references.pmid: 11297567
references.citation: J Clin Endocrinol Metab. 2003 Aug;88(8):3668-73
references.pmid: 12915653
references.citation: Am J Surg. 2012 Nov;204(5):798-9
references.pmid: 22575397
references.citation: Endocr Pract. 2001 May-Jun;7(3):202-20
references.pmid: 11430305
references.citation: Eur J Endocrinol. 2004 Nov;151(5):539-48
references.pmid: 15538930
references.citation: J Surg Oncol. 2006 Dec 15;94(8):678-82
references.pmid: 17131414
references.citation: Surgery. 2004 Dec;136(6):1310-22
references.pmid: 15657592
references.citation: World J Surg. 1997 Jul-Aug;21(6):644-7
references.pmid: 9230664
references.citation: Cancer. 2001 Dec 1;92(11):2868-74
references.pmid: 11753960
references.citation: N Engl J Med. 1998 Jan 29;338(5):297-306
references.pmid: 9445411
references.citation: Surgery. 2002 Dec;132(6):924-8; discussion 928-9
references.pmid: 12490837
references.citation: Surgery. 2007 Dec;142(6):965-72
references.pmid: 18063083
references.citation: World J Surg. 2003 Jul;27(7):770-5
references.pmid: 14509503
references.citation: J Am Coll Surg. 2003 Aug;197(2):182-90
references.pmid: 12892795
references.citation: J Psychopharmacol. 2011 Mar;25(3):429-36
references.pmid: 20142303
references.citation: J Clin Endocrinol Metab. 2003 Apr;88(4):1433-41
references.pmid: 12679418
references.citation: Thyroid. 2006 Feb;16(2):109-42
references.pmid: 16420177
references.citation: Am Surg. 2004 May;70(5):407-13
references.pmid: 15156948
references.citation: J Endocrinol Invest. 2002 Jun;25(6):526-31
references.pmid: 12109624
references.citation: Scand J Surg. 2004;93(4):261-71
references.pmid: 15658666
references.citation: J Clin Endocrinol Metab. 2006 Dec;91(12):4943-7
references.pmid: 16968803
references.citation: Ann Surg Oncol. 2009 Jun;16(6):1655-9
references.pmid: 19319605
references.citation: Cancer. 2003 Jan 1;97(1):90-6
references.pmid: 12491509