Departamento de Medicina Nuclear, Hospital Universitario Virgen Macarena, Sevilla, España.
Departamento de Radiofísica, Hospital Universitario Virgen Macarena, Sevilla, España.
Rev Esp Med Nucl Imagen Mol (Engl Ed). 2020 May-Jun;39(3):140-145. doi: 10.1016/j.remn.2019.11.003. Epub 2020 May 8.
The aim of this work is the evaluation of usefulness of radioactive seed localization (RSL) for the detection of cervical recurrence of thyroid cancer in order to improve the surgical outcome.
Ten patients with thyroid cancer and lymph node involvement (4 naive and 6 with cervical recurrence) evidenced by ultrasound, cytology/Tg-FNAB (reoperated group) were selected for this procedure. A I seed was placed in the metastatic lesion using a needle guided by ultrasound. During surgery, a handheld gamma probe/portable gammacamera were used for lesion localization and excision. After removing the target tissue, it was verified that the seed was included in the excised tissue. Surgical intervention duration, lesion location, seed activity, thyroglobulin level, effective radiation dose, complications and the degree of surgical resection were analyzed.
All the marked nodes were positive in histology. The mean duration of the ultrasound procedure was 11.4±3.4minutes. Seed was kept inside the patient, in average, during 4days (1-7) and the average surgical time was 44.7±29.1minutes. We found 21 metastatic specimens with an average diameter 13.9±6.3mm. The mean activity of the implanted seed was 71.27±21.6MBq (42.8-105) In the reoperated group, thyroglobulin level was 2.08±1.56ng/dl and decreased after surgery to 0.13±0.12ng/dl, P<.01. Only one case of transient hypoparathyroidism was found in the total group.
The introduction of RSL in our unit has shown benefits for the patient and medical team, being a safe and effective procedure that also improves surgical programming.
本研究旨在评估放射性种子定位（RSL）在检测甲状腺癌颈部复发中的应用价值，以改善手术效果。
选择 10 例经超声、细胞学/Tg-FNAB（再次手术组）证实伴淋巴结转移的甲状腺癌患者（4 例初治，6 例颈部复发）进行该操作。使用超声引导的针将 I 种子放置在转移病灶中。术中使用手持伽马探针/便携式伽马相机进行病灶定位和切除。切除目标组织后，验证种子是否包含在切除的组织中。分析手术干预时间、病灶位置、种子活性、甲状腺球蛋白水平、有效辐射剂量、并发症和手术切除程度。
所有标记的淋巴结在组织学上均为阳性。超声操作的平均时间为 11.4±3.4 分钟。种子平均在患者体内保留 4 天（1-7 天），平均手术时间为 44.7±29.1 分钟。我们发现 21 个转移标本，平均直径为 13.9±6.3mm。植入种子的平均活度为 71.27±21.6MBq（42.8-105）。在再次手术组中，甲状腺球蛋白水平为 2.08±1.56ng/dl，手术后降至 0.13±0.12ng/dl，P<.01。在整个研究组中仅发现 1 例短暂性甲状旁腺功能减退症。
RSL 在我院的应用为患者和医疗团队带来了益处，是一种安全有效的方法，也改善了手术计划。
