Technique of ultrasound-guided hook needle insertion before reoperation for recurrent papillary thyroid cancer

Abstract

Purpose: Re-exploration of relapsing nonpalpable thyroid cancers are associated with high rate of false-negative operations, due to postoperative fibrosis. So that, various strategies have been developed to guide the excision of the recurrent disease. The aim of this study is to document the technique of ultrasound-guided hook needle insertion before operation and also to present the results of postinsertion, postoperation and three years follow-up.

Materials and methods: Three patients with recurrent papillary thyroid cancer, who had a history of negative reexploration but eleveted thyroglobulin assays underwent US examinations. Sonographically malign lymph nodes were detected, also malign nature of the lymph nodes was proven by US guided fine needle aspiration. There was only one metastatic lymph node in each of the first and second patients, therefore one hook-needle was inserted per each patient. The third patient had three lymph nodes, therefore we used one needle for the biggest node and only one for the smaller nodes, because they were so close.

Results: No complication occured due to biopsy or needle insertion. All patients underwent neck reoperation after needle insertion. Pathologic lymph nodes were identified easily by following hook-needles, and were excited in all patients. All lymph nodes were positive for papillary thyroid cancer on the final pathological examination. No surgical complication occured and, after 3 years follow-up, all patients were free of any detectable disease in the neck on radiologic examinations.

Conclusion: Ultrasound guided hook-needle insertion can be performed safely in patients with relapsing nonpalpable metastatic lymph nodes.