RADIOGUIDED SURGERY IN THE TREATMENT OF RECURRENT OR RESIDUAL PAPILLARY THYROID CANCER

AUTHORS:
F. Gyory (Debrecen, Hungary) , M. Andrasi (Debrecen, Hungary) , D.A. Kovacs (Debrecen, Hungary) , D. Toth (Debrecen, Hungary) , S. Barna (Debrecen, Hungary) , L. Toth (Debrecen, Hungary) , E.V.N. Nagy (Debrecen, Hungary) , L. Sira (Debrecen, Hungary)
Background:
Long term follow-up, 131I therapy and if necessary repeated surgery has significant role to achieve excellent prognosis in the treatment of papillary thyroid cancer (PTC). Radio guided surgery (RGS) can lower the increased risk of complication in a previously operated sclerotic field.
Methods:
5166 patients had thyroid surgery, among them 755 for malignant thyroid tumour between 2011 and 2022.
Results:
37 patients underwent RGS for recurrent or residual PTC (age: 13-68 years). In 18 patients 131I guided surgery was performed on the 5th or 6th day after administration of 1000 or 3700 MBq radioiodine. In 19 patients 99mTc-MIBI guided metastasis or residual papillary tumour extirpation were performed. In one female patient mediastinal lymph node metastases were successfully extirpated through video-assisted thoracoscopy. Posttherapy whole body scan (WBS) SPECT CT after RGS confirmed the successful tumour extirpation in 11 patients in the radioiodine treated group.
Conclusions:
RGS has an important role in the management of recurrent/residual PTC in selected patients. RGS may significantly improve the completeness of surgical excision of neoplastic foci. 131I guided surgery depends on the date of radioiodine therapy, while 99mTc-MIBI guided surgery is independent. Continuous endocrine follow-up is needed to detect recurrence in time. Close multidisciplinary cooperation between professions (surgery, endocrinology, nuclear medicine, radiology, anaesthesiology) is essential for complex and effective treatment.