Feasibility of Charcoal Tattooing for Localization of Metastatic Lymph Nodes in Robotic Selective Neck Dissection for Papillary Thyroid Carcinoma.
BACKGROUND
This study aimed to evaluate the feasibility and effectiveness of ultrasound-guided charcoal tattooing in locating metastatic lymph nodes in robotic selective neck dissection (SND) for papillary thyroid carcinoma (PTC).


METHODS
The overall study group comprised 21 patients with PTC who underwent robotic SND via a unilateral transaxillary approach for treatment of suspicious lymph node metastasis in the lateral compartment. Charcoal suspension was injected into 10 of the patients (total of 23 lesions) 1 day before robotic SND. The authors evaluated the location of the tattoos, the success rate of localization, the intraoperative detection rate, and the complications associated with the procedure. The perioperative results were compared with those in the control group of 11 patients who did not receive charcoal tattooing.


RESULTS
Charcoal suspension was successfully injected into 22 of the 23 suspicious lymph nodes (95.7 %). The remaining lesion was located posterior to the internal jugular vein. Therefore, the charcoal was injected into the soft tissue around the lymph node. Ultrasound-guided injections were well tolerated in all the patients, and no major complications occurred. All the charcoal-tattooed lesions were identified intraoperatively by the surgeon. The number of harvested and metastatic lymph nodes in the lateral compartment was greater in the patients with charcoal tattoo localization than in the control group. The two groups did not differ in terms of perioperative complications, operation time, or volume of drainage.


CONCLUSIONS
Ultrasound-guided charcoal tattooing for localization of metastatic lymph nodes is feasible and effective in robotic SND for the treatment of PTC with lateral compartment lymph node metastasis.
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea.
Chang Myeon
CM
Song
Department of Radiology, College of Medicine, Hanyang University, Seoul, Korea.
Jeong Seon
JS
Park
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea.
Woosung
W
Park
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea.
Yong Bae
YB
Ji
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea.
Seok Hyun
SH
Cho
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea. kytae@hanyang.ac.kr.
Kyung
K
Tae
D000328:Adult; D002291:Carcinoma, Papillary / Q000556:secondary* / Q000601:surgery; D016022:Case-Control Studies; D002606:Charcoal / Q000737:chemistry*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D037981:Neck Dissection; D009367:Neoplasm Staging; D061646:Operative Time; D011379:Prognosis; D011446:Prospective Studies; D012371:Robotics; D013653:Tattooing / Q000379:methods*; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy
D002606:Charcoal