Radioguided thyroidectomy for follicular tumors: Multicentric experience

INTERNATIONAL JOURNAL OF SURGERY

卷:41

Article

Parmeggiani, D.¹  Gambardella, C.³  Patrone, R.³  Polistena, A.⁴  De Falco, M.²  Ruggiero, R.¹  Cirocchi, R.⁴  Sanguinetti, A.⁵  Cuccurullo, V.⁶  Accardo, M.⁷  Avenia, N.⁴  Docimo, G.¹  Tolone, S.¹  Bassi, V.⁸  Docimo, L.¹  Conzo, G.³ 

[1] SUN, Unit Surg, Dept Med Surg Neurol Metab & Aging Sci, Naples, Italy

[2] SUN, Unit Surg 5, Dept Surg Anesthesiol & Emergency Sci, Naples, Italy

[3] SUN, Unit Surg 7, Dept Surg Anesthesiol & Emergency Sci, Naples, Italy

[4] Univ Perugia, Endocrine Surg Unit, Perugia, Italy

[5] Univ Hosp Terni, UOC Gen Surg, Terni, Italy

[6] Univ Naples 2, Nucl Med, Naples, Italy

[7] Univ Naples 2, Dept Morphopathol, Naples, Italy

[8] S Giovanni Bosco Hosp, UOC Internal Med, ASL Ctr Na1, Naples, Italy

关键词: Thyroid cancer;    Thyroid follicular neoplasm;    99m Tc-MIBI scintigraphy;    MIBI uptake;    Radioguided surgery;    Thyroidectomy;   

DOI  :  10.1016/j.ijsu.2017.03.081

来源: Elsevier

【 摘 要 】

Background: The diagnosis of thyroid nodular diseases requires an integrated approach that has been widely established over the past years. This strategy includes: ultrasonography (US) with; implemented Color-Power-Doppler, conventional scintigraphy also with positive indicators, specific pathological studies targeted by immunohistochemically-assays, and the fine needle; aspiration biopsy (FNAB), which, usually, in case of Follicular Lesions (10-20%) findings is; unable to distinguish carcinoma from follicular adenoma, then indicating the necessity of surgery to; obtain a correct diagnosis. The aim of this study was to evaluate the role of the scintigraphy with; positive indicators, both preoperatively in diagnostic approach of the thyroid nodules and; intraoperatively as a guide to the extension of the surgical excision. Methods: On 4482 Thyroidectomy performed, we selected 360 cases of follicular neoplasms (192; females and 168 males). In the preoperative phase, these patients underwent 99 m Tc-sestaMIBI; scintigraphy with both early (10 min) and late (2 h) image acquisition, which were later; compared to the ones obtained by image subtraction of means 99 m Tc-pertechnetate. Following the; sestamibi administration before intervention, we selected the most up-taking nodularity with the; assistance of a specific surgical probe (Neoprobe), quantifying uptake with relation to the surgical pathology, for an amount of 324 total thyroidectomies and 36 hemi thyroidectomies. Results: In all cases of multinodular goiter the benign nodules showed an intraoperative low sestamibi uptake whereas follicular carcinomas showed both a high preoperative uptake and, as a; percentage, the highest values of intraoperative uptake; on the other hand, follicular adenomas had; both pre- and intraoperative mean values of uptake. On the contrary, papillary carcinomas only; showed a mild uptake. Conclusions: Preoperative sestamibi scintigraphy confirmed its importance in improving the information obtained through different diagnostic investigations. Also intraoperatively, it pointed; out high-risk nodules more accurately. Therefore, radio (Sestamibi) guided surgery could have an; interesting rule in the thyroid follicular lesion treatment. (C) 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

【 授权许可】

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