Preoperative ultrasound-guided tattooing localization of recurrences after thyroidectomy: safety and effectiveness

Abstract

Background: The incidence of nonpalpable recurrence detected on follow-up ultrasound (US) after thyroidectomy has increased. However, surgical approach for nonpalpable lesions can be difficult. We assessed the safety and effectiveness of ultrasound-guided tattooing (US-tattoo) with a charcoal suspension for localizing nonpalpable cervical recurrences after thyroidectomy for thyroid cancer.

Methods: Between March 2004 and February 2008, we retrospectively assessed 55 consecutive patients with 83 lesions who underwent US-tattoo with injection of a charcoal suspension for nonpalpable lesions. All patients underwent the surgical dissection after US-tattoo. The complications and effectiveness of US-tattoo were evaluated using ultrasonographic, surgical, and pathologic records.

Results: Among 83 lesions, 72 recurrences and 11 benign lesions were confirmed by final pathology. The average size of the localized lesions was 0.7 cm (range 0.4-1.4 cm). The most common site of tattooing was cervical lymph nodes at level IV. The technical success rate of US-tattoo for suspicious lesions was 96% (80/83). Failure of US-tattoo occurred in lesions located posterior to major vessels. During surgery, all but two successful tattooed lesions were detected by surgeons. No residual lesion was detected at follow-up US. With regard to complications, two patients (4%) had a dot-like marking at the skin puncture site after US-tattoo.

Conclusion: Preoperative US-tattoo is a safe and effective method for successful reoperation of nonpalpable recurrences after thyroidectomy.