Preoperative charcoal suspension tattoo for the detection of differentiated thyroid cancer recurrence

Soprani,Francesco; De Vito,Andrea; Bondi,Fabio; Magliulo,Giuseppe; Rene,Soon  Sue; Cappi,Caterina; Riganti,Fabrizio; Vicini,Claudio; Puccetti,Maurizio

doi:10.3892/mco.2019.1826

Preoperative charcoal suspension tattoo for the detection of differentiated thyroid cancer recurrence

Authors:
- Francesco Soprani
- Andrea De Vito
- Fabio Bondi
- Giuseppe Magliulo
- Soon Sue Rene
- Caterina Cappi
- Fabrizio Riganti
- Claudio Vicini
- Maurizio Puccetti
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Affiliations: Head and Neck Department, ENT Unit, Santa Maria delle Croci Hospital, Ravenna‑AUSL of Romagna, I‑48121 Ravenna, Italy, Head and Neck Department, ENT and Oral Surgery Unit, Morgagni‑Pierantoni Hospital, Forlì‑and‑Santa Maria delle Croci Hospital, Ravenna AUSL of Romagna, I‑47121 Forlì, Italy, Department of Endocrinology, Santa Maria delle Croci Hospital, AUSL of Romagna, I‑48121 Ravenna, Italy, Department of ‘Organi di Senso’, University ‘Sapienza’, I‑00161 Rome, Italy, Department of Otolaryngology Head and Neck Surgery, Ng Teng Fong General Hospital, Jurong Community Hospital, National University Health System, Singapore 648346, Republic of Singapore, Department of Pathology, Santa Maria delle Croci Hospital, AUSL of Romagna, I‑48121 Ravenna, Italy
Published online on: March 15, 2019 https://doi.org/10.3892/mco.2019.1826
Pages: 524-530

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Abstract

Recurrent differentiated thyroid carcinoma can easily be detected by means of ultrasound (US) and thyroglobulin, and often requires further surgical intervention. Revision surgery is often a technical challenge with significant risk of complications, considering the altered anatomy, with a possibility of leaving behind residual neoplasm. Preoperative US‑guided tattooing localization has been introduced to reduce and prevent these potential problems during revision surgery. Encouraging results have been reported in the literature. Under US guidance, the lesion is identified and 0.5‑2 ml of colloidal charcoal is injected in its proximity using a 23 gauge needle. The extraction is accompanied by injection at constant pressure of charcoal in order to leave a trace of pigment along the path of the needle till the skin. From April 2008 to January 2016 we performed revision surgery in 27 patients for lymph‑nodes metastasis in differentiated thyroid cancer, using the technique of preoperative charcoal tattoo localization. Our previous study on the first group of 13 patients published in 2012, reported the preliminary results in terms of success rate and complications. The tolerance of charcoal injection was good for all patients and the procedure was demonstrated to be useful, contributing to the removal of metastatic lesion in 93% of procedures. We have registered minor surgical complications during revision in the central compartment of the neck: Transitory hypoparathyroidism in 2 cases (11%) and transitory vocal cord paresis in 3 cases (16%). Based on these results, preoperative charcoal tattoo localization in revision surgery of the neck for differentiated thyroid cancer recurrence can be considered a safe technique, easy to perform, with low‑costs and useful during surgical procedures, providing a significant reduction of iatrogenic damage and risks.

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