Chami Linda, Hartl Dana, Leboulleux Sophie, Baudin Eric, Lumbroso Jean, Schlumberger Martin, Travagli Jean Paul
1 Radiology Department, Hôpital Pitié Salpétrière, APHP, UPMC , Paris, France .
Thyroid. 2015 Mar;25(3):341-6. doi: 10.1089/thy.2014.0329. Epub 2015 Feb 26.
Reoperation for thyroid cancer recurrence is a surgical challenge in previously dissected necks, and there is a need for a reliable procedure for surgeon guidance. In this study, the usefulness of preoperative charcoal tattooing for surgical guidance was evaluated.
From July 2007 to May 2010, 53 patients (40 females; Mage=44 years, range 19-76 years) were prospectively included for preoperative localization of neck recurrences from differentiated (n=46) or medullary thyroid cancer (n=7). Preoperative cytological assessment was performed for at least one lesion in each patient. Ultrasound (US) imaging was performed with high-frequency probes (8-14 Mhz). Micronized peat charcoal (0.5-3 mL) was injected under US guidance using a 25 gauge needle, 0-15 days preoperatively.
A total of 106 lesions were selected for charcoal tattooing. Of these, 101 had been tattooed, and 102 were removed (85 metastases, 17 benign on pathology). The tolerance of charcoal injection was good in all but three patients. A mean volume of 1 mL of charcoal was injected with a mean of two targets per patient. Charcoal labeling facilitated intraoperative detection in 56 "difficult" lesions (i.e., small size, dense fibrosis, anatomical pitfalls), and charcoal trace facilitated intraoperative guidance in 17 lesions. Feasibility and usefulness rates were 83% and 70.7% respectively.
These findings suggest that charcoal tattooing under US guidance is an easy to implement, safe, and useful procedure for surgeon guidance in neck reoperation for thyroid cancer.
甲状腺癌复发后的再次手术是既往已行颈部手术患者面临的一项外科挑战，因此需要一种可靠的手术指导方法。在本研究中，评估了术前炭粉纹身用于手术指导的有效性。
2007年7月至2010年5月，前瞻性纳入53例患者（40例女性；平均年龄44岁，范围19 - 76岁），以对分化型甲状腺癌（n = 46）或髓样甲状腺癌（n = 7）颈部复发灶进行术前定位。对每位患者至少一个病灶进行术前细胞学评估。使用高频探头（8 - 14 Mhz）进行超声（US）成像。术前0 - 15天，在超声引导下使用25号针头注射微粉化泥炭炭（0.5 - 3 mL）。
共选择106个病灶进行炭粉纹身。其中，101个已纹身，102个被切除（85个为转移灶，17个病理检查为良性）。除3例患者外，其余患者对炭粉注射的耐受性良好。每位患者平均注射1 mL炭粉，平均注射两个靶点。炭粉标记有助于术中发现56个“困难”病灶（即体积小、纤维化致密、解剖结构复杂），炭粉痕迹有助于术中引导17个病灶。可行性和有效率分别为83%和70.7%。
这些结果表明，超声引导下的炭粉纹身是一种易于实施、安全且有用的方法，可为甲状腺癌颈部再次手术的外科医生提供指导。
