World Journal of Surgery

, Volume 33, Issue 3, pp 434–439 | Cite as

Localization of Recurrent Thyroid Cancer Using Intraoperative Ultrasound-Guided Dye Injection

  • Rebecca S. Sippel
  • Dina M. Elaraj
  • Liina Poder
  • Quan-Yang Duh
  • Electron Kebebew
  • Orlo H. Clark



Small, nonpalpable lymph node recurrences are frequently identified in the follow-up of patients with thyroid cancer, and finding and removing these lesions in a reoperative field can be very challenging. The goal of this study was to evaluate the utility of preincision ultrasound-guided injection of blue dye into the abnormal lymph nodes to facilitate their safe and efficient removal.


We performed a prospective study between January and June 2007 at a single academic institution. Ten patients with isolated, nonpalpable nodal recurrences of papillary thyroid cancer underwent an operation for a neck recurrence (8 central, 2 lateral). A preincision ultrasound was performed in the operating room to localize the lesions, and 0.1 ml of blue dye was injected under ultrasound guidance into each abnormal lymph node. We examined the feasibility of the injection procedure, the accuracy of identifying pathologic lymph nodes, and the complications of injection.


The pathologic lymph nodes averaged 11 mm in size (range = 6–16 mm) and were detectable by ultrasound in all cases. Ultrasound-guided blue dye injection was successful in all cases. There were no complications related to dye injection. The blue node was easily identified and removed in all cases. The mean operative time was 80.4 min (range = 37–157 min).


Blue dye injection was feasible and was very useful for the identification of lymph node recurrences, especially in the reoperative neck. There were no complications related to the injection in this series. Further study is needed to determine the widespread safety and efficacy of this technique.


Methylene Blue Thyroid Cancer Recurrent Laryngeal Nerve Papillary Thyroid Cancer Lateral Neck 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported in part by Friends of Endocrinology, The Gerald Heller Family Foundation, The Helen and Sanford Diller Foundation, and the Bell Charitable Trust.


  1. 1.
    Cady B, Sedgwick CE, Meissner WA et al (1979) Risk factor analysis in differentiated thyroid cancer. Cancer 43(3):810–820PubMedCrossRefGoogle Scholar
  2. 2.
    Kim MK, Mandel SH, Baloch Z et al (2004) Morbidity following central compartment reoperation for recurrent or persistent thyroid cancer. Arch Otolaryngol Head Neck Surg 130(10):1214–1216PubMedCrossRefGoogle Scholar
  3. 3.
    McCoy KL, Yim JH, Tublin ME et al (2007) Same-day ultrasound guidance in reoperation for locally recurrent papillary thyroid cancer. Surgery 142(6):965–972, discussion 965–975PubMedCrossRefGoogle Scholar
  4. 4.
    Triponez F, Poder L, Zarnegar R et al (2006) Hook needle-guided excision of recurrent differentiated thyroid cancer in previously operated neck compartments: a safe technique for small, nonpalpable recurrent disease. J Clin Endocrinol Metab 91(12):4943–4947PubMedCrossRefGoogle Scholar
  5. 5.
    Travagli JP, Cailleux AF, Ricard M et al (1998) Combination of radioiodine (131I) and probe-guided surgery for persistent or recurrent thyroid carcinoma. J Clin Endocrinol Metab 83(8):2675–2680PubMedCrossRefGoogle Scholar
  6. 6.
    Lennquist S, Persliden J, Smeds S (1988) The value of intraoperative scintigraphy as a routine procedure in thyroid carcinoma. World J Surg 12(5):586–592PubMedCrossRefGoogle Scholar
  7. 7.
    Gulec SA (2007) PET probe-guided surgery. J Surg Oncol 96(4):353–357PubMedCrossRefGoogle Scholar
  8. 8.
    Scurry WC, Lamarre E, Stack B (2006) Radio-guided neck dissection in recurrent metastatic papillary thyroid carcinoma. Am J Otolaryngol 27(1):61–63PubMedCrossRefGoogle Scholar
  9. 9.
    Negele T, Meisetschlager G, Bruckner T et al (2006) Radio-guided surgery for persistent differentiated papillary thyroid cancer: case presentations and review of the literature. Langenbecks Arch Surg 391(3):178–186PubMedCrossRefGoogle Scholar
  10. 10.
    Rubello D, Salvatori M, Casara D et al (2007) 99mTc-sestamibi radio-guided surgery of loco-regional 131Iodine-negative recurrent thyroid cancer. Eur J Surg Oncol 33(7):902–906PubMedGoogle Scholar
  11. 11.
    Khandelwal S, Sener SF, Purdy L et al (2007) I-123-guided excision of metastatic papillary thyroid cancer. J Surg Oncol 96(2):173–175PubMedCrossRefGoogle Scholar
  12. 12.
    Tukenmez M, Erbil Y, Barbaros U et al (2007) Radio-guided nonpalpable metastatic lymph node localization in patients with recurrent thyroid cancer. J Surg Oncol 96(6):534–538PubMedCrossRefGoogle Scholar
  13. 13.
    Dupuy DE, Monchik JM, Decrea C et al (2001) Radiofrequency ablation of regional recurrence from well-differentiated thyroid malignancy. Surgery 130(6):971–977PubMedCrossRefGoogle Scholar
  14. 14.
    Monchik JM, DeLellis RA (2006) Re-operative neck surgery for well-differentiated thyroid cancer of follicular origin. J Surg Oncol 94(8):714–718PubMedCrossRefGoogle Scholar
  15. 15.
    Lewis BD, Charboneau JW, Reading CC (2002) Ultrasound-guided biopsy and ablation in the neck. Ultrasound Q 18(1):3–12PubMedCrossRefGoogle Scholar
  16. 16.
    Desai D, Jeffrey RB, McDougall IR et al (2001) Intraoperative ultrasonography for localization of recurrent thyroid cancer. Surgery 129(4):498–500PubMedGoogle Scholar
  17. 17.
    Karwowski JK, Jeffrey RB, McDougall IR et al (2002) Intraoperative ultrasonography improves identification of recurrent thyroid cancer. Surgery 132(6):924–928, discussion 928–929PubMedCrossRefGoogle Scholar
  18. 18.
    Devine RM, van Heerden JA, Grant CS et al (1983) The role of methylene blue infusion in the management of persistent or recurrent hyperparathyroidism. Surgery 94(6):916–918PubMedGoogle Scholar
  19. 19.
    Bambach CP, Reeve TS (1978) Parathyroid identification by methylene blue infusion. Aust N Z J Surg 48(3):314–317PubMedCrossRefGoogle Scholar
  20. 20.
    Perry PM, Meinhard E (1974) Nectotic subcutaneous abscesses following injections of methylene blue. Br J Clin Pract 28(8):289–291PubMedGoogle Scholar
  21. 21.
    Schultz P, Schwarz GA (1970) Radiculomyelopathy following intrathecal instillation of methylene blue. A hazard reaffirmed. Arch Neurol 22(3):240–244PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  • Rebecca S. Sippel
    • 1
    • 2
    • 4
  • Dina M. Elaraj
    • 2
    • 4
  • Liina Poder
    • 3
    • 4
  • Quan-Yang Duh
    • 2
  • Electron Kebebew
    • 2
    • 4
  • Orlo H. Clark
    • 2
    • 4
  1. 1.Department of SurgeryUniversity of Wisconsin-MadisonMadisonUSA
  2. 2.Department of SurgeryUniversity of California-San FranciscoSan FranciscoUSA
  3. 3.Department of RadiologyUniversity of California-San FranciscoSan FranciscoUSA
  4. 4.UCSF Comprehensive Cancer Center at Mount ZionSan FranciscoUSA

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