Is radioguided occult lesion localization (ROLL) an effective and reliable method in thyroid cancer and parathyroid redo surgery?

Objective: The aim of this study is to share the efficacy of the radionuclide occult lesion localization (ROLL) technique in secondary neck exploration in patients who had undergone neck exploration due to thyroid or parathyroid pathology and to share our clinical experience.
Material and Method: Data of 25 patients who underwent secondary neck exploration for recurrent thyroid cancer and parathyroid adenoma between January 2016 and December 2018 at the General Surgery Clinic of Balcalı Hospital, Çukurova University Faculty of Medicine were collected retrospectively. On the operation day, 0.5 mCi Tc-99m macroaggregate albumin was injected into the lesion under ultrasound guidance (USG). Nerve monitoring was used in all patients.
Results: Twenty-five patients (21 females, 4 males) were included in the study. The mean age of the patients was 54.5 (24-79) years. Five patients were operated for parathyroid adenoma, 6 patients for papillary cancer after subtotal thyroidectomy, 13 patients for papillary cancer recurrence, 2 patients for medullary cancer recurrence, 2 patients for papillary cancer cervical lymph node metastasis and 1 patient for anaplastic cancer recurrence.Mean operative time was 100.6 min (60-160 min). Two patients had transient hypocalcemia and no other complications were seen. Parathyroid hormone (PTH) levels in patients with hyperparathyroidism, Thyroglobulin (Tg) levels in patients with recurrent papillary cancer, were significantly lower than preoperative levels (p<0.05).
Conclusion: We believe that ROLL technique reduces the complication rate by decreasing dissection time and width. We recommend using it for thyroid cancer and parathyroid redo surgery.
Key Words: Parathyroid redo surgery, Radioguided surgery, Thyroid cancer.