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Abstract
Background: The recurrence of thyroid cancer poses challenges compounded by postoperative fibrosis and anatomic changes. By overcoming the limitations of current localizing dye techniques, indocyanine green-macroaggregated albumin-hyaluronic acid (ICG-MAA-HA) mixture dye promises improved localization. This study aimed to evaluate the efficacy and safety of the dye for recurrent thyroid cancer.

Methods: The nine patients in this study underwent surgery and postoperative ultrasonography. The dye was injected into recurrent lesions in all the patients preoperatively. During surgery, the lesions were confirmed with an imaging system before and after excision. If the lesion was unidentifiable with the naked eye, surgical excision was performed under the corresponding fluorescent guide. Side effects related to the dye injection and completeness of the surgery were evaluated.

Results: No side effects such as bleeding, skin tattooing, or pain during or after the dye injection were reported, and no discoloration occurred that interfered with the surgical field of view during surgery. In three cases (33.3 %), because it was difficult to localize metastatic lesions with the naked eye, the operation was successfully completed using an imaging system. The completeness of the surgical resection was confirmed by ultrasonography after an average of 5 months postoperatively.

Conclusion: The study found that ICG-MAA-HA dye effectively located metastatic and recurrent thyroid cancer and had favorable results in terms of minimal procedural side effects and potential for assisting the surgeon. A large-scale multi-institutional study is necessary to prove the clinical significance regarding patient survival and disease control.

Affiliations

Seok-Ki Kim # 1, Jungirl Seok # 2, Chang Yoon Lee 3, Chang Hwan Ryu 4, Sung Yong Choi 4, Seog Yun Park 5, Young Ki Lee 6, Yul Hwangbo 6, Eun Kyung Lee 6, You Jin Lee 6, Sohyun Park 1, Tae Sung Kim 1, Tae Hyun Kim 7, Junsun Ryu 4, Yuh-Seog Jung 8
1Department of Nuclear Medicine, National Cancer Center, Goyang, Republic of Korea.
2Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
3Department of Radiology, National Cancer Center, Goyang, Republic of Korea.
4Department of Otorhinolaryngology-Head and Neck Surgery, National Cancer Center, Goyang, Republic of Korea.
5Department of Pathology, National Cancer Center, Goyang, Republic of Korea.
6Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea.
7Department of Radiation Oncology, National Cancer Center, Goyang, Republic of Korea.
8Department of Otorhinolaryngology-Head and Neck Surgery, National Cancer Center, Goyang, Republic of Korea. jysorl@ncc.re.kr.
#Contributed equally.