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Radio Guided Surgery (RGS) in Differentiated Thyroid Cancer

Zurleni T*, Gjoni E and Altomare M
Department of General Surgery, Hospital of Busto Arsizio (VA), Italy


*Corresponding author: Tommaso Zurleni, Department of General Surgery, Hospital of Busto Arsizio (VA), Piazzale Solaro 3, Busto Arsizio, Italy


Published: 18 Dec, 2017
Cite this article as: Zurleni T, Gjoni E, Altomare M. Radio Guided Surgery (RGS) in Differentiated Thyroid Cancer. Clin Surg. 2017; 2: 1824.

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RGS is useful method to real time tumor localization, verification and complete excision of lymph node metastases in differentiated thyroid cancer [1]. The detection rate of 18F-FDG in literature is about 93% 3h after injection [2]. We present a case of 65 years old man with papillary thyroid cancer with central compartment and right cervical metastatic lymphadenopathies. Preoperative 18F-FDG PET/CT highlighted deep down massive mediastinal lymphadenopathies. We performed total thyroidectomy with Central Lymph Nodes Dissection (CND) and Modified Radically mph Nodes Dissection (MRND) of the right Laterocervical Compartment (LCC). RGS allowed the localization of the whole mediastinal pathologic tissues and provided excision of the bulky lymphadenopathies, around the aortic arch and the barety lodge. Using a handheld PET probe all suspicious lesions demonstrated by preoperative PET/CT were localized and resected. Thyroglobulin decreased from 2483 ng/ml (preoperative) to 312 at 6 months, and 99 ng/ml 12 months later. RGS represents a safe and effective approach if performed in a qualified center for high-volume thyroid disease. The completeness of excision with real time localization, reduce the number of reoperations and residual lesions (Figure 1).

Figure 1

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Figure 1
1. Anonimous vein, 2. Brachiocefalic artery, 3a. Right Recurrent Laryngeal Nerve, 3b. Left Recurrent Laryngeal Nerve, 4. Right Vagus nerve, 5. Right Carotid artery, 6. Right Jugular vein, 7. Right Sternocleidomastoid muscle.

References

  1. Tommaso Zurleni, Alberto Baroli, Elson Gjoni, Enzo Di Mauro, Luca Pedrazzini, Paola Ceriani, et al. Radio guided surgery in mediastinal disease derived from differentiated iodine negative thyroid cancer with persistent elevated thyroglobulin level. Thyroid Disorders Ther. 2013;2:136.
  2. Kim WW, Kim JS, Hur SM, Kim SH, Lee SK, Choi JH, et al. Radio guided surgery using an intra operative PET probe for tumor localization and verification of complete resection in differentiated thyroid cancer: a pilot study. Surgery. 2011;149(3);416-42.