Abstract
Aim
Intraoperative gamma probe (GP) guidance with 99mTc-pertechnetate in the completion total thyroidectomy after a first thyroidectomy was investigated in this prospective study.
Methods
The study group comprises of fourteen consecutive patients (14 females, age mean 50.2 ± 12.0 years, age range 29–73 years). All patients underwent a second thyroidectomy due to inadequate (5/14 patients) and complementary (9/14 patients) interventions. Serum-free three iodothyronine, free thyroxin and thyroid stimulating hormone measurements, a neck ultrasonography (USG) and thyroid scintigraphy (TS) were performed in the preoperative and postoperative period. After a 185 MBq (5 mCi) injection of 99mTc-pertechnetate, background (BG), left thyroid lobe (LTL), right thyroid lobe (RTL) and pyramidal tyroid lobe (PTL) regions were counted in time before and after resection of thyroid remnants by intraoperative GP. All resection materials were evaluated by histopathologic examination.
Results
Preoperative TSH was less than 30 mIU/mL (mean 21 ± 7) in all patients. Functioning thyroid remnants were shown in 13/14 patients on the preoperative TS and USG, which were diagnosed by USG in one but by TS in other one. We calculated that percentage median (minimum–maximum) values were 220.90% (56.00–411.11%) in LTL, 80.43% (11.54–471.05%) in RTL and 66.60% (−3.33 to 158.33%) in PTL for counts before resection, on the other hand, 15.96% (−20.55 to 47.62%) in LTL, 17.59% (−15.07 to 38.46%) in RTL and 17.59% (−1.96 to 57.14%) in PTL regions for counts after resection. There were statistically significant differences between these values belonging to before and after resection for LTL (p = 0.001), RTL (p = 0.001) and PTL (p = 0.008). Bilateral small foci in a patient and unilateral focus in other patient were observed in postoperative TS. Unilateral focus was detected on the RTL by GP, but not bilateral foci. Postoperative TSH levels increased to 30 mIU/mL (mean 69 ± 26) at least. There was a statistically significant difference between preoperative and postoperative TSH values (p < 0.001). Histopathologic confirmation revealed that all removed materials were the thyroid tissues.
Conclusions
Gamma probe guidance with 99mTc-pertechnetate seemed to be a good option and easy available method in patients undergoing the completion total thyroidectomy.
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References
Reintgen D, Cruse CW, Wells K. The next revolution in general surgery: radioguided surgery. Ann Surg Oncol. 1999;6(2):125–6.
Negele T, Meisetschläger G, Brückner T, Scheidhauer K, Schwaiger M, Vogelsang H. Radio-guided surgery for persistent differentiated papillary thyroid cancer: case presentations and review of the literature. Langenbecks Arch Surg. 2006;391(3):178–86. [Epub 2006 Feb 21].
Rubello D, Salvatori M, Pelizzo MR, Rampin L, Fanti S, Gregianin M, et al. Radio-guided surgery of differentiated thyroid cancer using (131)I or 99mTc-Sestamibi. Nucl Med Commun. 2006;27(1):1–4.
Travagli JP, Cailleux AF, Ricard M, Baudin E, Caillou B, Parmentier C, et al. Combination of radioiodine (131I) and probe-guided surgery for persistent or recurrent thyroid carcinoma. J Clin Endocrinol Metab. 1998;83(8):2675–80.
Gallowitsch HJ, Fellinger J, Mikosch P, Kresnik E, Lind P. Gamma probe-guided resection of a lymph node metastasis with I-123 in papillary thyroid carcinoma. Clin Nucl Med. 1997;22(9):591–2.
Mishra A, Mishra SK. Total thyroidectomy for differentiated thyroid cancer: primary compared with completion thyroidectomy. Eur J Surg. 2002;168(5):283–7.
Eroğlu A, Unal M, Kocaoğlu H. Total thyroidectomy for differentiated thyroid carcinoma: primary and secondary operations. Eur J Surg Oncol. 1998;24(4):283–7.
Ley PB, Roberts JW, Symmonds RE, Hendricks JC, Snyder SK, Frazee RC, et al. Safety and efficacy of total thyroidectomy for differentiated thyroid carcinoma: a 20-year review. Am Surg. 1993;59(2):110–4.
Mazzaferri El, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994;97(5):418–28.
Erbil Y, Barbaros U, Deveci U, Kaya H, Bozbora A, Ozbey N, et al. Gamma probe-guided surgery for revision thyroidectomy: in comparison with conventional technique. J Endocrinol Invest. 2005;28(7):583–8.
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Aras, G., Gültekin, S.S., Küçük, N.Ö. et al. Intraoperative gamma probe guidance with 99mTc-pertechnetate in the completion thyroidectomy. Ann Nucl Med 23, 421–426 (2009). https://doi.org/10.1007/s12149-009-0251-7
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DOI: https://doi.org/10.1007/s12149-009-0251-7