J Korean Surg Soc.  2013 Sep;85(3):104-108. 10.4174/jkss.2013.85.3.104.

On-site ultrasound-guided localization for impalpable nodal recurrences in papillary thyroid carcinoma patients

• Kim KJ
• Kim BW
• Lee YS
• Chang HS
• Park CS

• KMID: 1426341
• DOI: http://doi.org/10.4174/jkss.2013.85.3.104

Abstract

PURPOSE
The cervical lymph nodes are the most common sites of locoregional recurrence in patients with papillary thyroid carcinoma (PTC). Accurate tumor localization is important for the successful removal of impalpable recurrences in the cervical lymph nodes. We evaluated the benefits of ultrasound-guided localization (UGL) performed by a single surgeon on site.
METHODS
Of 53 PTC patients who underwent reoperation for impalpable nodal recurrences, 32 (group 1) were assessed only using preoperative imaging, while 21 (group 2) were additionally evaluated by on-site UGL performed by the operating surgeon. Postoperative outcomes were compared between the two groups.
RESULTS
Operation times were significantly shorter (P < 0.001) and the mean size of the resected lymph nodes were smaller (P = 0.013) for group 2 patients. More lymph nodes were identified and resected in group 1 (3.56 vs. 3.19), but the rate of positive lymph nodes was significantly higher in group 2 (P < 0.001). There were no differences between the two groups in terms of resection success rate, complication rate, and postoperative hospital stay. During a mean follow-up period of 27.6 months, 52 patients (98.1%) showed no evidence of recurrence on routine ultrasound, and serum thyroglobulin concentrations remained < 1 ng/mL in 49 patients (92.5%).
CONCLUSION
On-site UGL performed by the operating surgeon is useful for accurate resection of impalpable nodal recurrences in PTC patients.

Keyword

On-site ultrasound; Localization; Impalpable nodal recurrences; Papillary thyroid carcinoma

MeSH Terms

Carcinoma
Factor IX
Follow-Up Studies
Humans
Length of Stay
Lymph Nodes
Recurrence
Reoperation
Thyroglobulin
Thyroid Gland
Thyroid Neoplasms
Carcinoma
Factor IX
Thyroglobulin
Thyroid Neoplasms

Figure

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  Fig. 1 (A) Transverse ultrasound image of a nodal recurrence (arrow) in central neck, (B) a patient undergoing on-site ultrasound-guided localization of recurrent lymph nodes after direct injection of methylene blue dye, and (C) a blue-stained lymph node in operative field (arrow). C, common carotid artery; T, trachea.

• 

  Fig. 2 Preoperative (Pre-op) and last follow-up (F/U) serum thyroglobulin (Tg) concentration of (A) group 1 (32 patients) and (B) group 2 (21 patients). Both levels were measured in T4-on states. There were 3 patients in group 1 and 1 patient in group 2 who showed serum Tg concentrations >1 ng/mL in last follow-up.

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