Operative bed recurrence of thyroid cancer: utility of a preoperative needle localization technique

Abstract

Background: Surgical management of recurrent disease after total thyroidectomy and/or neck dissection for thyroid carcinoma remains a challenging clinical problem. Reoperation is associated with a significant increase in morbidity. Preoperative needle localization technique for non-palpable breast tumors has recently been extrapolated to head and neck surgery. We report on the use of preoperative ultrasound-guided needle localization for non-palpable recurrent operative bed disease as an intraoperative aid in resection.Methods: Patients with thyroid carcinoma were identified from a retrospective database at a tertiary care center from 2011-2014. Inclusion criteria were history of thyroidectomy and/or neck dissection, nonpalpable recurrent disease in the resection bed on surveillance, and ultrasound-guided needle localization of recurrent disease before resection. Perioperative data and outcomes were analyzed.Results: Seventeen patients were identified using the inclusion criteria listed above. Median patient age was 46 years (53% male, 47% female). A total of 23 masses in the previous operative bed were needlelocalized successfully with no major long-term sequelae from this technique. The recurrent laryngeal nerve was involved with tumor in six patients. Two patients, in whom the tumor surrounded the nerve circumferentially, experienced recurrent laryngeal nerve injuries. No patients experienced postoperative hypocalcemia. With a routine surveillance and a median follow-up of 558 days, sixteen of the patients remain with no evidence of disease.Conclusions: Preoperative ultrasound-guided needle localization of non-palpable recurrent operative bed disease after thyroidectomy and/or neck dissection is a potentially safe method to aid in resection and cure.

Preoperative Localization of Recurrence in the Thyroidectomy Bed Using a Radioactive Iodine125 Seed

“…There is no standard for preoperative localization of nonpalpable extra‐mammary soft tissue masses, including residual or recurrent thyroid cancer. Localization methods such as needle localization, 1 intraoperative US, 4 intraoperative dye injection, 5 and radio‐guided surgery 6 have been described for residual and/or recurrent thyroid cancer in the literature. Due to our 13‐year experience with RSL in the breast and 4‐year experience with RSL in soft tissues beyond the breast, we began to offer RSL to patients with residual or locally recurrent thyroid cancer.…”

“…There are several risks involved with reoperation, including nerve injury, hypoparathyroidism, prolonged operative times due to scarring, and inability to find and resect the recurrence. 1…”

“…The safety and efficacy of preoperative ultrasound (US)–guided needle localization as an aid for intraoperative identification of recurrent thyroid cancer has been reported in the literature. 1 This technique has been widely used for nonpalpable breast lesions for many years, but at our institution, we have been successfully employing radioactive seed localization (RSL) in place of needle localization since 2004. RSL has had enduring positive impacts on our scheduling and patient and physician satisfaction.…”

“…The standard of care for palpable recurrence in cervical lymph nodes is a neck dissection, but there is no widely accepted standard treatment for nonpalpable recurrence in the neck, which can include repeat surgery, iodine 131 radioablation, and/or observation. There are several risks involved with reoperation, including nerve injury, hypoparathyroidism, prolonged operative times due to scarring, and inability to find and resect the recurrence 1 …”

Periostin silencing suppresses the aggressive phenotype of thyroid carcinoma cells by suppressing the Akt/thyroid stimulating hormone receptor axis

“…Thyroid carcinoma is one of the most frequently detected endocrine neoplasms (Cha and Koo 2016). Although the majority of patients with thyroid carcinoma have a good prognosis after curative resection, some patients (10-15%) have a poor outcome due to early relapse and distant metastasis (Eng et al 2016;Lim et al 2016). Thyroid stimulating hormone (TSH) receptor (TSHR) is a member of the G protein-coupled receptor superfamily and acts as a key regulator of thyrocyte growth and function (Kleinau et al 2017).…”