title: Radioguided surgery with combined use of gamma probe and hand-held gamma camera for treatment of papillary thyroid cancer locoregional recurrences: a preliminary study.
abstract: BACKGROUND
  Persistent differentiated papillary thyroid cancer (PTC) with metastasis followed by radical locoregional surgery is an indication for limited reoperation. Despite excellent prognosis the major challenge is controlling locoregional recurrences.
  
  
  OBJECTIVE
  To evaluate the efficacy of radioguided excision with combined use of gamma probe and an hand-held gamma camera.
  
  
  METHODS
  From June 2009 to January 2012, we enrolled twenty-two patients with locoregional PTC recurrences, previously undergone to central and/or lateral neck dissection for PTC. The diagnosis of recurrent PTC was based on thyroglobulin (TG) evaluation [basal and after thyroid stimulating hormone (TSH) stimulation], ultrasound (US), iodine-131 (131I) whole body scan (WBS) and fine needle aspiration cytology (FNAC). In the morning of surgery, radiotracer was injected directly into the lesions by US guide. Careful dissection was carried out using gamma probe and hand held gamma camera. Metastatic lymph nodes were identified and excised.
  
  
  RESULTS
  In all the patients recruited, 39 pathologic nodes were injected and 61 nodes were removed. Among the removed nodes, 22 (36.1%) were additional nodes (not injected by radiotracer). Of the additional lymph nodes, 7 (31.8%) were metastatic. Mean radioactive count of the lesion (28.633±9.218 counts/s) was higher than tumor bed (385.73±192.23 counts/s) (p < 0.0001). No complications were observed during radioguided excision, neither on post-operative period.
  
  
  CONCLUSIONS
  The use of hand-held gamma camera in addition to gamma probe in our preliminary study allows a minimally invasive procedure and safer identifications of the lesions and ensures the completeness of the excision in a difficult surgical field.
authors.affiliation: Operative Unit Surgery of Thyroid and Parathyroid, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy. carlo_bellotti@hotmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Bellotti
authors.forename: G
authors.initials: G
authors.lastname: Castagnola
authors.forename: S M
authors.initials: SM
authors.lastname: Tierno
authors.forename: F
authors.initials: F
authors.lastname: Centanini
authors.forename: A
authors.initials: A
authors.lastname: Sparagna
authors.forename: I
authors.initials: I
authors.lastname: Vetrone
authors.forename: G
authors.initials: G
authors.lastname: Mezzetti
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002291:Carcinoma, Papillary; D004867:Equipment Design; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000295:instrumentation*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D019275:Radiopharmaceuticals; D016634:Radiosurgery / Q000295:instrumentation*; D012086:Reoperation; D013668:Technetium Tc 99m Aggregated Albumin; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin