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SPECT-CT imaging of metastatic lymph nodes labeled with ROLL technique. (a) CT, (b) SPECT and (c–e) SPECT-CT fusion images show radiolabelled right level 4 metastatic lymph node (white arrow) and central metastatic lymph nodes (white arrowhead)
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Purpose
Well planned re-surgery is critical for recurrent/persistent thyroid cancer (TC). We aimed to investigate the clinical outcome of radioguided-occult lesion localization (ROLL) guided surgery in patients with recurrent/persistent TC.
Methods
This study includes 29 patients [F/M: 22/7, median age 43 ± 12 years (18–58)] with a diagnosis of TC...
Citations
... The 27.45% loco-regional relapse rate observed in our study group after ROLL is comparable to the 37.5% reported by Borsò et al. 6 However, it contrasts with other series, such as Tuncel and Süslü, 8 Our limitations include those inherent to retrospective studies as medical records are often incomplete, and to descriptive studies with no comparator group. Although our study has the largest sample size of patients with loco-regional persistent/recurrent DTC treated with ROLL at the same cancer centre, a prospective investigation with long-term follow-up to further validate our results is required. ...
Objectives
We aimed to determine the radioguided occult lesion localization (ROLL) reliability in the reoperation of patients with differentiated thyroid cancer (DTC) and persistent or recurrent non‐palpable loco‐regional disease who underwent surgery at the Instituto Nacional de Cancerología between 2012 and 2021.
Design
Observational retrospective cohort study.
Participants
We included data from patients with DTC that underwent resection with ROLL.
Main Outcome Measures
Reliability analysed as percentage of patients with complete resection of tumour lesion using ROLL, disease‐free survival, second loco‐regional relapse, adequate resectability and complications.
Results
Two hundred and four cases were obtained. Pathological examination revealed papillary thyroid carcinoma in 202 patients, and follicular thyroid carcinoma in 2. Reliability was 96.57% in patients who underwent ROLL. When wide resection was performed—at surgeon's discretion—the reliability increased to 97.5%.
Conclusions
The high reliability obtained suggests that ROLL was effective to localize non‐palpable relapsing lesions. To our knowledge, this is the largest sample size published on this topic to date.
... Planar images provide a two-dimensional overview, where SLNs can be localized and marked on the patient's skin with the use of an external radioactive marker, such as a 57 Co-source pen. Transmission images can be used to improve anatomical orientation; to obtain these images, a 57 Co flood source is positioned so that the head of the patient is between the camera and the source during static imaging. ...
... Besides SLN biopsy, another GOSTT application concerns intratumoral radiotracer administered by means of ultrasonography, which has been used for a successful radioguided occult lesion localization (ROLL) in 28 out of 29 patients with recurrent thyroid cancer [57]. The use of ROLL and SLN biopsy has led to combine both methods following the GOSTT application SNOLL (Sentinel Node Occult Lesion Localization) by means of intratumoral radiocolloid administration in the thyroid guided by ultrasound to subsequently facilitate resection of both the primary lesion and the SLNs (Fig. 9). ...
Radioguided surgery for head and neck cancer has emerged as an important field of interventional nuclear medicine. Currently, the two most important applications concern sentinel lymph node (SLN) biopsy for cutaneous melanoma and oral cavity squamous cell carcinoma (OCSCC). An emerging application is SLN biopsy in thyroid cancer. Similar to other anatomic regions, the dynamic concept Guided intraOperative Scintigraphic Tumor Targeting (GOSTT) is also of use for the head and neck, and besides the SLN procedure, the use of local or systemic administered radiotracers has led to gradually integrate interventional nuclear medicine to surgery of radiotagged lesions related to thyroid cancer and parathyroid adenomas. For all these procedures, the successive incorporation of SPECT/CT and PET/CT in the last years has optimized the generation of specific imaging roadmaps to guide head and neck surgery. On the other hand, new technological advances like portable gamma cameras, hybrid tracers integrating radioactivity and fluorescence in one signature with the addition of near-infrared cameras to gamma guidance in the operating room, and tracked image-guided navigation have further reinforced the role of GOSTT and interventional nuclear medicine. In combination with the topographical localization of SLNs following internationally recognized surgical and radiotherapeutic lymph node levels, recent consensus initiatives from nuclear medicine and oncologic organizations have been of considerable help to homogenize approaches and practice of radioguided surgery in the head and neck.
... Surgery was performed by ND or radio-guided occult lesion location (ROLL) surgery. 10,11 Review of the second histopathology, included determination of the size and number of resected lymph nodes, size of the metastasis, or soft tissues and verification of extension to adjacent tissues. The second adjuvant radioiodine therapy with RAI activity, range from 100 to 200 mCi, mean of 102.7 mCi (3.7-7.4 ...
Introduction Differentiated thyroid carcinoma (DTC) has increased incidence. Intermediate- and high-risk patients have lymph node relapse rate ranging from 10 to 50%, and receive multiple reinterventions, increasing the morbidity of the disease. Currently, there are no established guidelines for the use of second radioactive iodine (RAI) therapy after the reintervention for local recurrence.
Materials and Methods This is a retrospective review of the medical records of 1,299 patients treated from January 2016 to July 2019 with DTC. We included 48 patients who received total thyroidectomy, RAI remnant ablation, surgery to remove the locally recurrent/persistent papillary thyroid carcinoma (PTC), and received a second RAI therapy.
Results There were no significant differences between thyroglobulin (Tg) levels before reoperation (Tg0), Tg levels postoperatively (Tg1), and Tg levels after 6 months of second adjuvant RAI therapy (Tg2). However, we evidenced a 69.79% drop in first Tg levels (Tg0: 24.7 vs. Tg1: 7.56, p=0.851) and 44.4% decrease in second Tg levels (Tg1: 7.56 vs. Tg2: 4.20, p=0.544). Also, 77.1% of the patients did not have another documented recurrence. The median relapse-free time was 10.9 months (range: 1.3–58.2 months).
Conclusion The results of the study cannot assess that a second RAI treatment after reoperation for locoregionally persistent or recurrent disease have a significant impact on treatment outcomes in intermediate- or high-risk patients with PTC. However, the 77.1% of patients have not presented a second documented recurrence and the median values of Tg and TgAb levels showed a substantial decrease after surgery and second RAI treatment.
... Surgical bed was re-scanned for the confirmation of accurate resection. Surgery was completed when no fluorescence or significant radioactive signal (above background) was detected [9,10]. ...
... Recently, radio-guided occult lesion localization (ROLL) technique that aids in the detection of recurrent lesions with a gamma probe after ultrasound-guided intra-lesional radiotracer injection was introduced in the literature [3]. In our previous study consisting of 29 patients with recurrent thyroid cancer, we have shown that ROLL-guided surgery yielded no evidence of disease and increased excellent response rates according to ATA guidelines, with a success rate of 97% [9]. After gaining experience with radiotracer 99m Tc, we encountered a problem with this technique during neck surgery. ...
PurposeNeck dissection (ND), whether therapeutic or elective, is an essential component of the treatment of head and neck squamous cell carcinoma (HNSCC). Due to altered anatomy and fibrosis caused by initial treatments, surgeons face challenges during salvage ND. A combination of Technetium-99 m and indocyanine green (ICG) previously used in the sentinel lymph node (SLN) biopsy for oral cavity cancers, may be useful in different types of neck surgeries. We aimed to show the additional advantage of this combination in detecting HNSCC and thyroid cancer recurrences, as well as individual lymphatic drainage in elective ND.Methods
We retrospectively reviewed medical records of patients, underwent neck surgery guided with ICG and Tc-99 m, in Hacettepe University Hospital between June 2018 and December 2020. In a total of 28 patients, intraoperative gamma probes were paired with near infrared (NIR) cameras. Patients are divided into two groups: neck surgery with recurrent occult lesion localization (NS- ROLL) (n: 14) and ND with SLN screening (ND-SLNS) (n: 14).ResultsAmong all 14 patients in NS-ROLL group, recurrent diseases, hidden behind tissues were 100% successfully localized. In ND-SLNS group, 238 lymph nodes were harvested, metastasis rate was 31.3% (10/32) in sentinel nodes. SLNS revealed 100% accuracy in detecting metastasis in clinically N0 neck (10/238). Contralateral lymphatic drainage was observed in three patients (lateral-sided oral cavity SCC). In two patients (floor of mouth), three sentinel nodes were detected by NIR only.Conclusion
The use of ICG-radiotracer provides additional value in disease removal for both primary and recurrent tumors of the head and neck.
... La técnica de ROLL se introdujo para la detección de tumores no palpables de mama en 2011, pero en estos últimos años se han ido ampliando sus indicaciones a otros tumores, como son los de cabeza cuello; habiéndose comunicado su utilidad en recurrencia/persistencia cervical de cáncer de tiroides por diversos grupos con buenos resultados [9,17,[34][35][36]. Esta técnica de cirugía radioguiada ha sustituido a la realizada con trazadores sistémicos. ...
Introducción y objetivo: La cicatrización y los planos tisulares alterados se suman a la ya compleja anatomía del cuello y dificultan la localización de recidivas o metástasis no palpables en las reintervenciones cervicales del cáncer de tiroides. Síntesis: Describimos el uso de diversos técnicos de señalización empleadas para optimizar la cirugía y los resultados terapéuticos de pacientes con carcinoma papilar de tiroides con enfermedad cervical persistente o metastásica. Especialmente nos centramos en la técnica de localización utilizando semillas radiactivas (RSL) en la que se ha descrito, al igual que en la mama, excelentes resultados. Conclusiones: La RSL es una técnica segura, asociada a una mayor satisfacción del cirujano, con excelente tolerancia por el paciente, que, además, reduce el tiempo de la intervención quirúrgica proporciona mejores resultados cosméticos reduciendo el riesgo de morbilidad en comparación con el uso de colorantes, arpones y tatuajes. Además, permite el desacoplamiento completo de los programas de radiología y cirugía optimizando los tiempos y la programación de los quirófanos.
... MRG, karaciğer metastazı şüphesi olan hastalarda tercih edilen yöntemdir ve tüm PET radyofarmasötiklerinden üstündür (51,53) (Şekil 7): LN metastazının saptanması için USG tercih edilir, ancak duyarlılığı USG uzmanının deneyimine ve kullanılan malignite kriterlerine bağlı olarak %29 ile 100 arasında değişir. Hasta grubumuzda 5/38 hastada Ga-68 DOTATATE PET/BT konvansiyonel yöntemlerle gözden kaçan lenf nodu metastazlarını tespit ederek tekrarlayan boyun cerrahisinin, PET/BT kılavuzluğunda ve peri-operatif işaretleme ile, gerçekleşmesini sağlamıştır(47,54).Tirozin kinaz inhibitörleri, kemoterapi ve radyasyon tedavisi bu hastalar için mevcut tedavi seçenekleridir. Bu tedavilere yanıt vermeyen hastalar için alternatif seçenekler arasında peptit reseptör radyonüklit tedavisi (PRRT) yer alır. ...
Ultrasonography is the most commonly used and most
effective imaging modality in thyroid cancer imaging. It is
the most successful method for evaluating primary tumor and
local disease. I-131 scintigraphy is also a useful method in
evaluating the whole body, but lacks anatomical detail. The
absence of radioiodine uptake in 30-40% of patients also
reduces the reliability of the test. These imaging methods alone
are insufficient, especially in advanced stage and aggressive
thyroid cancer subtypes. In this article, the additional roles,
advantages and limitations of the several other imaging
techniques, which are used for thyroid cancer staging and
follow-up, will be discussed.
... These metastases can be readily detected with high-resolution USG performed by an experienced ultrasonographer. Since there is no comprehensive imaging modality, the optimal use of multi-modality imaging and peri-operative labeling techniques may improve surgical success [20]. ...
Purpose:
Medullary thyroid cancer (MTC) arises from neuroendocrine C cells of the thyroid. There is no single diagnostic imaging method that can reveal all MTC recurrences or metastases. 68Ga-DOTATATE is an alternative PET radiotracer that showed acceptable efficacy in the detection of MTC. In this study, we aimed to reveal the clinical efficacy and impact of this radiotracer on the management of patients with MTC.
Methods:
The 68Ga-DOTATATE PET-CT records of 38 patients with confirmed MTC were included in the study. The demographic data, clinical indication for the scan, previous therapies, and tumor marker levels were recorded. The site and SUVmax of the lesions were also noted. A consensus was reached on the additional value of 68Ga-DOTATATE PET-CT, and sites with discordant results on conventional imaging (CI). Finally, changes in management after the scan were evaluated.
Results:
68Ga-DOTATATE PET-CT outperformed CI in 14/38 (37%) patients. In these 14 patients, metastatic lymph nodes were detected in 8, bone metastases in 4, and both bone and lymph nodes metastases in 2 patients. In 16/38 (42%) patients, 68Ga-DOTATATE PET-CT performed equally well as CI. In 5/38 (13%) patients, CI outperformed PET-CT. Most of the patients (4/5) in this group had hepatic metastases. 68Ga-DOTATATE PET-CT positivity was also correlated with tumor marker expression [median calcitonin; PET-positive: 743 ± 5439 vs PET-negative: 45 ± 17 (p:0.012), median CEA; PET-positive: 41 ± 162 vs PET-negative: 2.6 ± 1.4 (p:0.015)]. 68Ga-DOTATATE PET-CT changed the clinical management of 13/38 (34%) patients. The information provided by PET-CT resulted in neck surgery in 5/13 patients, external radiotherapy in 3/13 and both in one patient. Four of these thirteen patients were found to be eligible for peptide receptor radionuclide therapy.
Conclusion:
68 Ga-DOTATATE is an essential part of the work-up for patients with MTC. This modality outperformed CI in 14/38 (37%) patients and changed the clinical management in 13/38 (34%) patients. Prospective randomized studies with image-guided therapy decisions are needed to further reveal the impact of PET imaging in patients with MTC.
... Other groups have described the radio-guided localization of recurrent thyroid cancer and metastatic lymph nodes using injections of either Technecium-99m or radioactive iodine treatment. Technecium-99m was injected in the lesions under ultrasonography 24 hours prior to surgery and the resection was performed with a gamma probe [2,3]. Low failure rates [2,3] were found and in one study 19 out of 32 patients were free of disease with a median follow-up of 29 months [3]. ...
... Technecium-99m was injected in the lesions under ultrasonography 24 hours prior to surgery and the resection was performed with a gamma probe [2,3]. Low failure rates [2,3] were found and in one study 19 out of 32 patients were free of disease with a median follow-up of 29 months [3]. Nevertheless, we did not opt for this technique in this case report since radiotracer leakage can occur in the surrounding tissue [3] and the distinction between cancer tissue and fibrosis can be difficult with injection compared to seed insertion, especially in a patient with several previous procedures. ...
Introduction
Surgery is the preferred treatment for recurrent differentiated thyroid carcinoma. However, scar tissue and tissue plane distortion can significantly limit the safety and the precision of the dissection. Careful preoperative planning is key to minimizing perioperative morbidity and positive margins.
Case summary
We present a case of mixed thyroid carcinoma in a patient with multiple endocrine neoplasia type 1 syndrome. Following the initial surgery, the patient developed two recurrences, resistant to radioactive iodine treatment and had a history of positive margins. A year and a half later, the patient developed a third recurrence that was not palpable. We used a radioactive iodine-125 seed, preoperatively inserted under ultrasonography, to help retrieve the lesion intraoperatively and improve the precision of the dissection.
Discussion
This is the first case report on the use of radioguidance with an iodine-125 seed to enhance the safety and exactitude of the surgical resection of a locally recurrent thyroid carcinoma. Although radioactive seed localization has been mostly used in breast cancer, this technique demonstrates great potential in becoming a useful adjunct to complex thyroid surgery in selected cases.
... Use of radioguided surgery technique for the treatment of thyroid cancer recurrence: clinical, surgical and anatomopathological aspects of thyroid neoplasms. They also corroborated the findings of other studies that evaluated thyroid tumor recurrences in Italy 14-15 , Turkey 9, [16][17][18][19] , and Brazil 20-21 . ...
... In 30 of the 37 cases in which the TG level was available in the medical records, it was the increase in the value of this marker that indicated the presence of thyroid neoplasia recurrence. A similar study carried out by Tuncel et al. in Turkey in 2019 showed increased TG levels in all patients 18 . Postoperative follow-up with measurement of TG levels is extremely sensitive and specific to identify the presence of tumor recurrence, because its values should not be detected in individuals who do not have thyroid tissue 25 . ...
... Among the similar studies evaluated, that conducted by Giles et al. was the only one that specified the number of previous surgeries: of the 11 patients analyzed, nine had undergone only one surgical procedure and two performed two surgeries 19 . The other articles analyzed only described the fact that patients had already been operated on and comment on reoperation difficulties 9, [15][16][17][18]26 . ...
