Department of Nuclear Medicine, Gülhane Military Medical Academy, Ankara, Turkey.
Clin Nucl Med. 2010 Nov;35(11):847-52. doi: 10.1097/RLU.0b013e3181f48403.
To improve the surgical success and reduce the complication rates, we combine our routine preoperative ultrasound (US) mapping technique with radioguided occult lesion localization (ROLL) in patients with papillary thyroid cancer recurrences in central compartment.
In the morning of surgery, biopsy proven recurrent/persistent tumoral lesions were plotted on a sketch and injected with Tc-99m labeled macroaggregated albumin under US guidance. Thyroid bed exploration was carried out based on the location of biopsy proven lesion with the guidance of intraoperative gamma probe and neck map. The lymphoadipose tissues showing high count rates were resected and labeled separately for histopathologic study.
Despite extensive scarring in some patients probe safely guided to lesions. Noninjected tumor foci were searched and successfully resected in the light of neck map that showing topographic relation of injected and noninjected lesions. Among total of 41 excised lesions, 28 metastatic foci ranging from 3 to 38 mm in largest diameter were recognized at final histologic examination. Combination of preoperative mapping with ROLL was found helpful by the operating surgeons in all patients, respectively. Except 2 patients with known distant metastases, undetectable thyroglobulin levels were reached 6 weeks after surgery.
The use of preoperative US-mapping with ROLL in patients with nonpalpable recurrent/persistent papillary thyroid cancer in central compartment is technically safe and effective method. Combination of techniques provides better information about topographical relations of recurrent/persistent lesions during surgery.
为了提高手术成功率并降低并发症发生率，我们将常规术前超声（US）定位技术与放射性隐匿性病变定位（ROLL）相结合，应用于中央区复发性甲状腺乳头状癌患者。
手术当天早晨，对经活检证实的复发性/持续性肿瘤病变进行绘图，并在超声引导下注射 Tc-99m 标记的巨聚合白蛋白。根据活检证实的病变位置，在术中伽马探针和颈部图的引导下进行甲状腺床探查。切除显示高计数率的淋巴脂肪组织，并分别标记进行组织病理学研究。
尽管部分患者存在广泛的疤痕，但探针仍能安全地引导至病变部位。根据颈部图寻找未注射的肿瘤病灶，并成功切除，颈部图显示了注射和未注射病变的解剖关系。在总共切除的 41 个病变中，最终组织学检查发现 28 个转移灶，最大直径为 3 至 38 毫米。所有患者的手术医生均认为术前定位与 ROLL 相结合具有帮助。除 2 例已知远处转移的患者外，所有患者术后 6 周均达到无法检测到甲状腺球蛋白的水平。
在中央区触诊不到的复发性/持续性甲状腺乳头状癌患者中，使用术前 US 定位联合 ROLL 是一种安全有效的方法。两种技术的结合可以在手术中提供关于复发性/持续性病变的更好的解剖关系信息。
