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The value of intraoperative scintigraphy as a routine procedure in thyroid carcinoma

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Abstract

Intraoperative scintigraphy (IOS) was performed with a previously developed and described technique in a prospective study of 64 patients with highly differentiated thyroid carcinoma. Residual iodine uptake after macroscopically radical thyroidectomy was registered at IOS in 43 patients. IOS permitted identification and removal of the residual tissue in 33 of these patients, leading to negative postoperative scintigraphy in 27. Of the 10 patients in whom the residual iodine uptake at IOS could not be eliminated, 3 had metastases outside the operative field (treated with postoperative radioiodine ablation) and 7 had a tiny remnant of thyroid tissue behind the entrance of the inferior laryngeal nerve.

The residual tissue detected by IOS was localized in or associated with the pyramidal lobe in 11 patients, and in 8 it was immediately behind and below the entrance of the inferior laryngeal nerve. Other locations were lymph nodes along the carotid artery or internal jugular vein, in the supraclavicular fossa or in the ligated inferior thyroid artery.

Conclusions from this case series were that IOS is more sensitive than regular postoperative scintigraphy for detection of residual thyroid tissue, that it significantly reduces the need for postoperative radioiodine ablation (which was avoided in more than half of the patients with residual uptake at IOS), and that it technically facilitates performance of the operation and greatly enhances the possibility of achieving complete thyroidectomy.

Résumé

La scintigraphie peropératoire (SPO), selon une technique décrite ailleurs, a été utilisée chez 64 patients présentant un cancer de la thyroïde bien différencié. Une activité résiduelle a été enregistrée par SPO chez 43 patients après une thyroïdectomie macroscopiquement totale. La SPO a permis d'identifier et d'enlever du tissu résiduel dans 33 de ces cas. Une scintigraphie négative postopératoire a donc été obtenue chez 27 de ces patients. Sur 10 patients présentant toujours une activité résiduelle à la fin de l'intervention, 3 avaient des métastases en dehors du champ opératoire; elles ont été traitées par de l'iode radioactif postopératoire; 7 patients avaient un petit reste de tissu thyroïdien attaché au nerf laryngé inférieur.

Le tissu résiduel détecté par la SPO était localisé dans ou était en rapport avec la pyramide de Lalouette dans 11 cas, et dans 8 cas, il était juste derrière et en-dessous de l'entrée du nerf laryngé inférieur. D'autres localisations ectopiques ont été mises en évidence: ganglions lymphatiques le long de l'axe carotidojugulaire, fosse susclaviculaire ou endoit de la ligature de l'artère thyroïdienne inférieure.

Les conclusions de cette série sont que la SPO est plus sensible que la scintigraphie postopératoire classique pour détecter du tissu thyroïdien résiduel, qu'elle réduit le besoin d'ablation radioactive postopératoire (qu'on a pu éviter chez plus de la moitié des patients ayant une activité scintigraphique peropératoire), et qu'elle facilite techniquement l'intervention et augmente de beaucoup les chances de thyroïdectomie complète.

Resumen

La escintigrafia intraoperatoria (EIO) fue realizada mediante una técnica previamente desarrollada y descrita, en un estudio prospectivo sobre 64 pacientes con carcinoma de tiroides altamente diferenciado. Se registró captación residual de yodo después de la tiroidectomía radical macroscópica en la EIO en 43 pacientes. La EIO permitió la identificación y remoción de tejido residual en 33 de estos pacientes, dando lugar a una escintigrafia postoperatoria negativa en 27. De los 10 pacientes en quienes la captación residual de yodo según la EIO no logró ser eliminada, 3 tenían metástasis por fuera del campo operatorio (fueron tratados con ablación postoperatorio con yodo radioactivo) y 7 presentaban un minúsculo remanente de tejido tiroideo ubicado por detrás de la entrada del nervio recurrente laríngeo.

El tejido residual detectado por la EIO apareció ubicado o asociado con el lóbulo piramidal en 11 pacientes, y en 8 se encontraba inmediatamente por detrás y por debajo de la entrada del nervio laríngeo inferior al cartílago laríngeo. Otras ubicaciones fueron los ganglios linfáticos a lo largo de la arteria carótida o de la vena yugular, la fosa supraclavicular y la ligada arteria tiroidea inferior.

Las conclusiones de este estudio son que la EIO es un método más sensible que la escintigrafía postoperatoria regular para la detección de tejido tiroideo residual, que reduce en forma significativa la necesidad de recurrir a la ablación post-operatoria con yodo radioactivo (que fue evitada más de la mitad de los pacientes con captación residual en la EIO), y que técnicamente facilita la realization de la operación e incrementa grandemene la posibilidad de lograr una tiroidectomía total.

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Lennquist, S., Persliden, J. & Smeds, S. The value of intraoperative scintigraphy as a routine procedure in thyroid carcinoma. World J. Surg. 12, 586–591 (1988). https://doi.org/10.1007/BF01655856

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