Utilization of radioguided occult lesion localization (ROLL) method in thyroid and parathyroid surgery
Journal
European journal of nuclear medicine and molecular imaging
Date Issued
2021
Author(s)
DOI
10.1007/s00259-021-05547-1
Abstract
Aim/Introduction: Assessment of the feasibility and
effectiveness of radioguided occult lesion localization (ROLL)
technique in patients undergoing surgical intervention for
excision of hyperfunctional parathyroid tissue and remnant
thyroid tissue or lymph node (LN) dissection in patients with
confirmed thyroid carcinoma (TC). Materials and Methods:
The study group consisted of 18 patients undergoing ROLL
from January 2017 to December 2018. 11 patients (54±13,91
years, five females and six males) were diagnosed with primary
hyperparathyroidism (confirmed by laboratory tests for PTH,
calcium and phosphorus levels and parathyroid ultrasound
performed before surgery). All underwent dual phase
99m
Tc-MIBI parathyroid SPECT/CT scintigraphy for correct
preoperative parathyroid adenoma localization. Another 7
patients (52,83±11,68 years, five females and two males) with
histologically proven thyroid carcinoma were scheduled for
reoperation (5 patients due to papillary TC remnant tissue,
1 patient due to recurrent papillary TC and 1 patient due to
LN metastasis of medullary TC). Ultrasound guided injection
of 7 Mbq 99m
Tc-macroagregate in each lesion on the day of
the surgery had been applied. Subsequently ROLL technique
with gamma probe had been used intraoperatively to
correctly identify the tissue for excision. Results: Parathyroid
adenomas were confirmed histologically in all 11 patients.
Mean PTH and total calcium levels were measured prior to
parathyroid surgery and were 1599,21±912,59 pg/ml and
2,89±0,67 mmol/L, respectively. Parathyroid adenoma’s size
ranged from 8 to 21 mm. In patients operated due to the
remnant thyroid tissue, lesions ranged from 21 to 27 mm
in diameter, measured postoperatively. In 1 patient who
underwent excision of recurrent papillary TC total of 3 foci
were excised, ranging 7-17 mm in diameter. Lymph node
dissection was performed in 1 patient with medullary TC
and 2 LN were extracted, 8mm and 18 mm in diameter.
Histological confirmation was obtained for all the extracted
lesions. Conclusion: ROLL should be used as an effective
technique for minimal invasive parathyroid and thyroid
surgery. The ROLL method seems to be very helpful to the
surgeons for precise localization of the small lesions. At the
same time, shortening the time of the surgical intervention
is another significant accomplishment of the technique.
effectiveness of radioguided occult lesion localization (ROLL)
technique in patients undergoing surgical intervention for
excision of hyperfunctional parathyroid tissue and remnant
thyroid tissue or lymph node (LN) dissection in patients with
confirmed thyroid carcinoma (TC). Materials and Methods:
The study group consisted of 18 patients undergoing ROLL
from January 2017 to December 2018. 11 patients (54±13,91
years, five females and six males) were diagnosed with primary
hyperparathyroidism (confirmed by laboratory tests for PTH,
calcium and phosphorus levels and parathyroid ultrasound
performed before surgery). All underwent dual phase
99m
Tc-MIBI parathyroid SPECT/CT scintigraphy for correct
preoperative parathyroid adenoma localization. Another 7
patients (52,83±11,68 years, five females and two males) with
histologically proven thyroid carcinoma were scheduled for
reoperation (5 patients due to papillary TC remnant tissue,
1 patient due to recurrent papillary TC and 1 patient due to
LN metastasis of medullary TC). Ultrasound guided injection
of 7 Mbq 99m
Tc-macroagregate in each lesion on the day of
the surgery had been applied. Subsequently ROLL technique
with gamma probe had been used intraoperatively to
correctly identify the tissue for excision. Results: Parathyroid
adenomas were confirmed histologically in all 11 patients.
Mean PTH and total calcium levels were measured prior to
parathyroid surgery and were 1599,21±912,59 pg/ml and
2,89±0,67 mmol/L, respectively. Parathyroid adenoma’s size
ranged from 8 to 21 mm. In patients operated due to the
remnant thyroid tissue, lesions ranged from 21 to 27 mm
in diameter, measured postoperatively. In 1 patient who
underwent excision of recurrent papillary TC total of 3 foci
were excised, ranging 7-17 mm in diameter. Lymph node
dissection was performed in 1 patient with medullary TC
and 2 LN were extracted, 8mm and 18 mm in diameter.
Histological confirmation was obtained for all the extracted
lesions. Conclusion: ROLL should be used as an effective
technique for minimal invasive parathyroid and thyroid
surgery. The ROLL method seems to be very helpful to the
surgeons for precise localization of the small lesions. At the
same time, shortening the time of the surgical intervention
is another significant accomplishment of the technique.