Operative Unit Surgery of Thyroid and Parathyroid, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2013 Dec;17(24):3362-6.
Persistent differentiated papillary thyroid cancer (PTC) with metastasis followed by radical locoregional surgery is an indication for limited reoperation. Despite excellent prognosis the major challenge is controlling locoregional recurrences.
To evaluate the efficacy of radioguided excision with combined use of gamma probe and an hand-held gamma camera.
From June 2009 to January 2012, we enrolled twenty-two patients with locoregional PTC recurrences, previously undergone to central and/or lateral neck dissection for PTC. The diagnosis of recurrent PTC was based on thyroglobulin (TG) evaluation [basal and after thyroid stimulating hormone (TSH) stimulation], ultrasound (US), iodine-131 (131I) whole body scan (WBS) and fine needle aspiration cytology (FNAC). In the morning of surgery, radiotracer was injected directly into the lesions by US guide. Careful dissection was carried out using gamma probe and hand held gamma camera. Metastatic lymph nodes were identified and excised.
In all the patients recruited, 39 pathologic nodes were injected and 61 nodes were removed. Among the removed nodes, 22 (36.1%) were additional nodes (not injected by radiotracer). Of the additional lymph nodes, 7 (31.8%) were metastatic. Mean radioactive count of the lesion (28.633±9.218 counts/s) was higher than tumor bed (385.73±192.23 counts/s) (p < 0.0001). No complications were observed during radioguided excision, neither on post-operative period.
The use of hand-held gamma camera in addition to gamma probe in our preliminary study allows a minimally invasive procedure and safer identifications of the lesions and ensures the completeness of the excision in a difficult surgical field.
伴有转移的持续性分化型甲状腺癌（PTC）经根治性局部手术治疗后，是进行有限再手术的指征。尽管预后良好，但主要的挑战是控制局部复发。
评估伽马探针联合使用手持伽马相机引导切除的疗效。
从 2009 年 6 月至 2012 年 1 月，我们招募了 22 例局部复发性 PTC 患者，这些患者之前因 PTC 接受过中央和/或侧颈部清扫术。复发性 PTC 的诊断基于甲状腺球蛋白（Tg）评估[基础和促甲状腺激素（TSH）刺激后]、超声（US）、碘-131（131I）全身扫描（WBS）和细针抽吸细胞学（FNAC）。手术当天早上，通过 US 引导将放射性示踪剂直接注射到病变部位。使用伽马探针和手持伽马相机进行仔细解剖。识别并切除转移的淋巴结。
在所有招募的患者中，共注射了 39 个病理淋巴结，切除了 61 个淋巴结。在切除的淋巴结中，有 22 个（36.1%）为未注射放射性示踪剂的额外淋巴结。在这些额外的淋巴结中，有 7 个（31.8%）为转移性淋巴结。病变（28.633±9.218 计数/s）的放射性计数明显高于肿瘤床（385.73±192.23 计数/s）（p<0.0001）。在放射性引导切除过程中，无论是手术期间还是术后，均未观察到任何并发症。
在我们的初步研究中，手持伽马相机除了伽马探针之外，还可以进行微创操作，更安全地识别病变，并确保在困难的手术区域完成切除的完整性。
