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Radioguided occult lesion localization in patients with recurrent thyroid cancer

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Abstract

Purpose

Well planned re-surgery is critical for recurrent/persistent thyroid cancer (TC). We aimed to investigate the clinical outcome of radioguided-occult lesion localization (ROLL) guided surgery in patients with recurrent/persistent TC.

Methods

This study includes 29 patients [F/M: 22/7, median age 43 ± 12 years (18–58)] with a diagnosis of TC (22 papillary, 2 follicular and 5 medullary). Before surgery, all patients underwent ultrasonography (USG) guided mapping and intra-lesional radioactivity injection. Surgery was performed based on the excision of radioactivity injected lesions by a gamma probe and non-injected tumor foci via USG-neck map. Researchers determined surgical success by post-operative tumor markers and neck-USG.

Results

Among 29 patients, 60 metastatic lesions were identified by USG [median size 10 ± 6.3 mm (range 5–30)]. Neck-USG performed after surgery provided no evidence of disease (NED) in %97 (28/29) of TC patients. In the follow-up, stimulated thyroglobulin (Tg) levels were less than 1 ng/ml in 79%(19/24) of DTC patients and suppressed Tg < 0.2 ng/ml was noted in 92% (22/24).In patients with DTC with an incomplete structural response, we dramatically changed the American Thyroid Association (ATA) response category and achieved an excellent response in 92% (22/24) of patients. Among patients with MTC, 5/5 patients had normal USG and calcitonin levels were reduced by 60–80% in 4/5 and > 80% in1/5 patients.

Conclusions

In this study we have shown that, ROLL-guided surgery yielded NED rate of %97 (28/29) and increased excellent response rates according to ATA guidelines. Further studies with larger patient groups and longer follow-up should be performed to confirm the efficacy of this surgery.

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Funding

This study received no funding.

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Authors and Affiliations

  1. Departments of Nuclear Medicine, Hacettepe University, Faculty of Medicine, Sıhhiye, 06100, Ankara, Turkey

    Murat Tuncel

  2. Head and Neck Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey

    Nilda Süslü

Authors
  1. Murat Tuncel
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  2. Nilda Süslü
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Correspondence to Murat Tuncel.

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Authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional Ethical Committee at the University-Hospital Hacettepe approved this study (Approval number: GO 15/561-05).

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Informed consent was obtained from all individual participants included in the study.

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Tuncel, M., Süslü, N. Radioguided occult lesion localization in patients with recurrent thyroid cancer. Eur Arch Otorhinolaryngol 276, 1757–1766 (2019). https://doi.org/10.1007/s00405-019-05377-w

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  • DOI: https://doi.org/10.1007/s00405-019-05377-w

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