Borsò E, Grosso M, Boni G, Manca G, Bianchi P, Puccini M, Arganini M, Cabria M, Piccardo A, Arlandini A, Orlandini C, Mariani G
Regional Center of Nuclear Medicine University of Pisa, Pisa, Italy -
Q J Nucl Med Mol Imaging. 2013 Dec;57(4):401-11.
We explored the feasibility of radioguided occult lesion localization (ROLL) for radioiodine-negative cervical recurrences from differentiated thyroid cancer (DTC).
The procedure was performed in 32 patients (3 patients being operated twice); 15/32 patients had had multiple prior lymph node dissections ("hostile" anatomy). 99mTc-albumin macro-aggregates (99mTc-MAA) were injected intra-lesionally under ultrasound guidance; 2 to 18 hours later, a hand-held gamma-probe helped to localize the lesions intraoperatively and to ascertain removal of the radiolabeled lesions. Mini-invasive excision of the radiolabelled lesions was performed in 12 cases (m-ROLL), while a modified radical neck dissection was performed in 23 cases after radioguided lymphadenectomy (d-ROLL). Fifty-nine lesions were radiolabelled (mean size 11±4.5 mm).
Radioguidance allowed to identify/remove 56/59 lesions (95%). Some leakage of 99mTc-MAA in the surrounding tissues hampered detection of 3 lesions, which were removed anyway (100% overall localization). Histopathology confirmed metastatic involvement of the radiolabeled lesions and some additional metastases in other nodes. Neither nerve injury nor hypoparathyroidism occurred. After a median follow-up of 29 months, 19 patients were disease-free, 12 patients developed loco-regional recurrences, 1 patient had distant metastases and 1 patient had both loco-regional and distant metastases. Recurrences rates were 33% for m-ROLL and 40% for d-ROLL.
The ROLL technique is feasible in selected patients with loco-regional recurrence from DTC, proving to be particularly useful also in patients already submitted to cervical dissections and/or with small lesions located in surgically difficult sites. It can therefore have a clinical role in the management of cervical DTC recurrences.
我们探讨了放射性引导隐匿性病变定位（ROLL）用于分化型甲状腺癌（DTC）碘阴性颈部复发灶的可行性。
该手术在32例患者中进行（3例患者接受了两次手术）；32例患者中有15例曾接受过多次先前的淋巴结清扫术（“复杂”解剖结构）。在超声引导下将99m锝 - 白蛋白大聚合体（99mTc - MAA）注射到病变内；2至18小时后，手持γ探测器有助于在术中定位病变并确定放射性标记病变是否被切除。12例患者进行了放射性标记病变的微创切除（m - ROLL），而23例患者在放射性引导淋巴结清扫术后进行了改良根治性颈清扫术（d - ROLL）。59个病变被放射性标记（平均大小11±4.5毫米）。
放射性引导可识别/切除59个病变中的56个（95%）。99mTc - MAA在周围组织中的一些渗漏妨碍了3个病变的检测，但这些病变最终也被切除（总体定位率100%）。组织病理学证实放射性标记病变有转移累及，且其他淋巴结有一些额外转移。未发生神经损伤或甲状旁腺功能减退。中位随访29个月后，19例患者无疾病，12例患者出现局部区域复发，1例患者有远处转移，1例患者既有局部区域转移又有远处转移。m - ROLL的复发率为33%，d - ROLL的复发率为40%。
ROLL技术在选定的DTC局部区域复发患者中是可行的，在已经接受过颈部清扫术和/或病变较小且位于手术困难部位的患者中也证明特别有用。因此，它在颈部DTC复发的管理中可发挥临床作用。
