Erbil Yeşim, Sari Serkan, Ağcaoğlu Orhan, Ersöz Feyzullah, Bayraktar Adem, Salmaslioğlu Artür, Gozkun Osman, Adalet Işik, Ozarmağan Selçuk
Department of General Surgery, Istanbul University, Istanbul Medical Faculty, Çapa, İstanbul, Turkey.
World J Surg. 2010 Nov;34(11):2581-8. doi: 10.1007/s00268-010-0714-y.
Better follow-up of patients with papillary thyroid cancer (PTC) and more sensitive detection leads to detection of recurrences in the neck. Despite excellent outcomes, the major challenge is controlling locoregional recurrence. We aimed to investigate whether the radio-guided excision of metastatic lymph nodes makes it possible to find the affected lymph nodes in patients with previously operated neck compartments.
This prospective study included 46 patients with recurrent/persistent PTC who had previously undergone operation of the neck compartment. Prior to operation, the pathologic node was localized by ultrasound (US) and radiotracer ((99m)Tc-labeled rhenium colloid) was injected directly into the pathologic node. Careful dissection was carried out following the area of maximum radioactivity until the metastatic lymph node(s) were identified and excised.
One affected lymph node was removed in 17 patients, and more than one lymph node (affected or additional nodes) was removed in 29 patients. The median count from the lesion was significantly higher than values from the lesion bed (background activity) (16,886 counts/20 s versus 52 counts/20 s; p < 0.001). During follow-up, four patients were lost to follow-up and 27 patients had negative US and basal thyroglobulin (Tg). Five patients had suspicious lymph nodes on the operated side. Although the basal Tg level remained above the normal limit, moderately high in 8 patients, no metastases were detected in the neck.
Radio-guided excision of metastatic lymph nodes can be performed safely for the detection and excision of recurrent thyroid cancer in the central and lateral neck.
对甲状腺乳头状癌（PTC）患者进行更好的随访以及更灵敏的检测可发现颈部复发情况。尽管治疗效果良好，但主要挑战在于控制局部区域复发。我们旨在研究放射性引导下切除转移性淋巴结是否能在先前已进行颈部区域手术的患者中找到受累淋巴结。
这项前瞻性研究纳入了46例先前接受过颈部区域手术的复发性/持续性PTC患者。手术前，通过超声（US）定位病理淋巴结，并将放射性示踪剂（（99m）Tc标记的铼胶体）直接注入病理淋巴结。沿着最大放射性区域进行仔细解剖，直至识别并切除转移性淋巴结。
17例患者切除了1个受累淋巴结，29例患者切除了1个以上淋巴结（受累或额外的淋巴结）。病变部位的计数中位数显著高于病变床部位（本底活性）（16,886计数/20秒对52计数/20秒；p < 0.001）。随访期间，4例患者失访，27例患者超声及基础甲状腺球蛋白（Tg）检查结果为阴性。5例患者手术侧有可疑淋巴结。尽管基础Tg水平仍高于正常范围，8例患者中处于中度高位，但颈部未检测到转移灶。
放射性引导下切除转移性淋巴结可安全地用于检测和切除颈部中央和外侧复发性甲状腺癌。
