Background
The major concerns in the surgical treatment of extensive or recurrent thyroid cancer
include the difficulty of precise intraoperative and real-time tumor localization,
the possibility of missing small metastatic lymph nodes during the operation, the
need for reoperation due to recurrence, and complications. The usefulness and feasibility
of an intraoperative PET probe have been reported for many other cancers; however,
a standard, radioguided, operative protocol using a PET probe in thyroid cancer has
not been established. The purpose of the current study was to evaluate the feasibility
of an intraoperative PET probe with respect to precise tumor localization, verification
of complete resection, and a decrease in unnecessary reoperations and complications.
Methods
This was a prospective, controlled study. Inclusion criteria were thyroid cancer requiring
a total thyroidectomy with a modified radical neck dissection (MRND) and recurrent
thyroid cancer after thyroid surgery. The types of procedures included total thyroidectomy
with MRND, selective neck dissection (SND), and excision of recurrent thyroid masses.
The PET probe NodeSeeker® is a high-energy gamma probe seeking 511 keV photons. Operative exploration was carried
out between 2 and 6 h after injection of 18F-FDG. The surgeon calculated the target-to-background ratio (T/B ratio) by checking
the 10-sec accumulated count using the PET probe. We performed a re-exploration if
the T/B ratio was >1.3 in the operative bed.
Results
Twelve patients underwent PET probe-guided operation. SNDs, mass excisions, total
thyroidectomy with MRND, and MRND were performed on 7, 4, and 1 patient, respectively.
All tumors were localized by the PET probe precisely in real time, and the lesions
not observed on preoperative PET were detected by the PET probe in 7 patients. Furthermore,
additional lymph nodes that were not identified on preoperative ultrasonography were
detected in 1 patient. The mean T/B ratio of thyroid carcinoma was 1.51 ± 0.53 (range,
1.17–4.03) and the postoperative serum thyroglobulin off thyroid hormone was <2.0
ng/ml.
Conclusion
Radioguided surgery using an intraoperative PET probe in thyroid cancer appears to
be a useful method for real-time tumor localization, verification of complete excision,
and minimization of the possibility of residual cancer. Therefore, an intraoperative
PET probe in thyroid cancer may decrease unnecessary reoperations and complications
due to persistent disease.
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Article info
Publication history
Published online: October 22, 2010
Accepted:
August 5,
2010
Footnotes
W.W.K. and J.S.K. contributed equally to this work.
Identification
Copyright
© 2011 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
