Radio-guided surgery for non-131I-avid thyroid cancer

Objective: In this paper we report in a larger series the use of radio-probe-guided surgery (RGS) in nonradioiodine-avid, well-differentiated thyroid cancer (DTC). Design: Thirty-seven patients with locoregional recurrent, non-radioiodine avid DTC were studied with Tc-99m-sestamibi directed RGS using a handheld gamma probe as an intraoperative detector. Outcome: Twenty-three women and 14 men were followed after RGS for 35.4 +/- 12.5 months (range 9-57). There were 33 papillary (one "tall" cell variant), 2 follicular, and 2 Hurthle cell cancers. In 7 patients, thyroid cancer recurred in the neck while cervical lymph node metastases were found in 31 patients (one patient had papillary cancer in both the thyroid bed and cervical lymph nodes). Sixty-six discrete nodules ranging from 6 to 45 mm (mean tumor diameter, 18.4 +/- 8.5 mm) were identified by both high-resolution ultrasound and Tc-99m-sestamibi probe-guided RGS. After RGS, Tg (thyroglobulin) fell in 33 of 37 patients and mean target/ nontarget sestamibi uptake ratios decreased in all 37 patients (p < 0.0001). Conclusion: These data confirm our earlier observations that a Tc-99m-sestamibi intraoperative gamma probe can be used to identify and guide resection of recurrent tumor and involved lymph nodes in locoregional metastases of nonradioiodine-avid thyroid cancer.