Endocrine Abstracts

Introduction: Intraoperative identification of neck lesions in patients who have undergone previous neck surgery is particularly difficult, because of operative scarring and distorted anatomy. Radioguided occult lesion localisation (ROLL) involves the preoperative intratumoral ultrasound-guided injection of a radioactive tracer. In the present study, we investigated the efficacy of roll in two patients with papillary thyroid cancer (PTC) who underwent previous neck exploration.

Material and methods: This study included two patients with recurrent/persistent PTC who have previously undergone operation. Patient 1: female, 65 years with PTC (T1bN1bM0) previously operated in 2010 with recurrence in the central neck (nodule with 9×7 mm). A fine-needle aspiration (FNA) cytology with FNA thyroglobulin (Tg) measurement was performed and confirmed the diagnosis of malignancy; patient 2: male, 50 years with PTC (T4aN1bM0) previously operated four times with three nodules in the central neck with 9, 7, and 6 mm. The largest nodule was submitted to FNA cytology confirming recurrence. In both patients ^99mTC-labeled macroaggregated albumin was injected directly into each lesion under US guidance 90 min before surgery. Scintigraphy was performed 30 min after injection to visualize the focally increased uptake of radiotracer. Intraoperative lesion detection was performed with gamma probe by identifying areas of maximum radioactivity.

Results: In patient 1 the lesion was identified and excised but in the patient 2 only two lesions were identified and excised. Histopathological examination confirmed recurrence of PTC in all of the nodules excised. In patient 1 serum Tg dropped from 15 to <2 ng/ml but in patient 2 Tg didn’t drop significantly and in the follow-up persisted a 7 mm nodule in the central neck.

Discussion: The Roll technique was efficient and safe in the perioperative identification of recurrent thyroid cancer in the central neck. This technique might help decrease the complications rates associated with reoperation.