Role of charcoal tattooing in localization of recurred papillary thyroid carcinoma: initial experiences.
OBJECTIVE
Surgical excision is the definitive treatment for localized recurrence of papillary thyroid carcinoma. Reoperation for recurrence, however, is challenging and associated with increased operative times and complication rates. For safe and effective reoperation, ultrasound-guided charcoal tattooing localization can be used. The aim of this study was to investigate the feasibility and safety of the ultrasound-guided charcoal tattooing localization.


METHODS
Between November 2012 and August 2013, ten patients underwent preoperative charcoal tattooing localization for twelve recurrent lesions. Patient demographics, pathologic features, and operation results were reviewed.


RESULTS
The technical success rate of charcoal tattooing was 100%. Eight patients had one recurrent lesion, and two patients had double lesions. Among these 12 recurrent lesions, three (25%) were found in level II, four (33%) in level IV, four (33%) in level VI, and one (8%) was found in the thyroidectomy bed site. The mean size of lesions was 0.87 ± 0.35 cm. Of these 10 patients, eight patients underwent selective lymph node dissection, one patient underwent modified radical neck dissection, and one patient underwent recurrent mass excision. Transient hypocalcemia developed in one patient, and no recurrent laryngeal nerve palsy occurred. There were no major complications related to the injection of the charcoal. The mean follow-up period after reoperation was 8.6 ± 2.7 months; in the follow-up ultrasound, there were no remnant lesions in all patients.


CONCLUSIONS
Preoperative ultrasound-guided charcoal tattooing localization for recurrent thyroid cancer appears to be a feasible and safe procedure for reoperation. Further evaluation is warranted in larger patients' cohorts.
Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Hyungju
H
Kwon
Department of Surgery, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea.
Soon Young
SY
Tae
Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Su-Jin
SJ
Kim
Department of Pathology, Seoul National University Hospital, Seoul National College of Medicine, Seoul, Korea.
Kyeong Cheon
KC
Jung
Department of Radiology, Seoul National University Hospital, Seoul National College of Medicine, Seoul, Korea.
Ji-Hoon
JH
Kim
Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Kyu Eun
KE
Lee
Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. ; Department of Surgery, National Medical Center, Seoul, Korea.
Yeo-Kyu
YK
Youn
Charcoal; Recurrence; Reoperation; Tattooing; Thyroid neoplasms