Operative bed recurrence of thyroid cancer: utility of a preoperative needle localization technique.
BACKGROUND
Surgical management of recurrent disease after total thyroidectomy and/or neck dissection for thyroid carcinoma remains a challenging clinical problem. Reoperation is associated with a significant increase in morbidity. Preoperative needle localization technique for non-palpable breast tumors has recently been extrapolated to head and neck surgery. We report on the use of preoperative ultrasound-guided needle localization for non-palpable recurrent operative bed disease as an intraoperative aid in resection.


METHODS
Patients with thyroid carcinoma were identified from a retrospective database at a tertiary care center from 2011-2014. Inclusion criteria were history of thyroidectomy and/or neck dissection, non-palpable recurrent disease in the resection bed on surveillance, and ultrasound-guided needle localization of recurrent disease before resection. Perioperative data and outcomes were analyzed.


RESULTS
Seventeen patients were identified using the inclusion criteria listed above. Median patient age was 46 years (53% male, 47% female). A total of 23 masses in the previous operative bed were needle-localized successfully with no major long-term sequelae from this technique. The recurrent laryngeal nerve was involved with tumor in six patients. Two patients, in whom the tumor surrounded the nerve circumferentially, experienced recurrent laryngeal nerve injuries. No patients experienced postoperative hypocalcemia. With a routine surveillance and a median follow-up of 558 days, sixteen of the patients remain with no evidence of disease.


CONCLUSIONS
Preoperative ultrasound-guided needle localization of non-palpable recurrent operative bed disease after thyroidectomy and/or neck dissection is a potentially safe method to aid in resection and cure.
Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA.
Oliver S
OS
Eng
Department of Surgery, University of Chicago Medical Center, Chicago, IL 60637, USA.
Scott B
SB
Grant
Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA.
Jason
J
Weissler
Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA.
Mitchell
M
Simon
Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA.
Sudipta
S
Roychowdhury
Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA.
Tomer
T
Davidov
Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA.
Stanley Z
SZ
Trooskin
Thyroid cancer; needle localization; recurrence; technique