Successful localization of abnormal parathyroid tissue with ultrasound-guided methylene blue dye injection before surgery for metastatic or recurrent thyroid cancers and parathyroid adenomas.

Abstract

OBJECTIVES:

A surgery to be performed on a previously operated neck includes difficulties such as increased risk of complications and prolonged operation time. The aim of the present study is to analyze the benefit of pre-anesthetic ultrasound-guided injection of methylene blue into parathyroid adenomas and abnormal lymph nodes to simplify their safe and satisfactory extraction.

METHODS:

We analyzed the case series records of 14 patients who were operated for reoperative neck surgery due to recurrent thyroid cancer (8 patients) and parathyroid adenoma (6 patients) and in the technique; 0.2 ml of a 1:5 dilution of 1 % methylene blue solution was injected directly onto the target during real-time ultrasound guidance before the operating room.

RESULTS:

In adenomas, ultrasound-guided methylene blue injection was successfully applied in all cases, an average of 33.1 min before entering the operating room (range = 28-38 min). There were no complications related to dye injection. For patients with recurrent thyroid tumors, preoperative ultrasound-guided methylene blue injection was successfully applied in all patients, on average 27.5 min before entering the operating room (range = 20-35 min). No complications occurred due to dye injection. The blue stained lesion was easily identified during surgery.

CONCLUSIONS:

We analyzed the feasibility of the injection process, the certainty of defining pathological lymph nodes, and the complications of the procedure. Preoperative administration of methylene blue preserved its intraoperative efficacy and maintained the easy the detection of reoperative or primary pathologies. The present study suggest that methylene blue dye injection is a safe, sufficient, and quietly effective method for identifying recurrent tumors and parathyroid adenomas in scarred reoperative neck surgeries. Our cases had comparatively short operative times and lower complication rates.

• Authors: Çiğdem Fırat Koca, İsmail Okan Yıldırım, Mehmet Turan Çiçek, Mehmet Aslan
• Journal: American journal of otolaryngology (Am J Otolaryngol) 2023 Jan-Feb Vol. 44 Issue 1 Pg. 103678 ISSN: 1532-818X [Electronic] United States
• PMID: 36335660 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 Elsevier Inc. All rights reserved.

Chemical References

• Methylene Blue

Topics

• Humans
• Parathyroid Neoplasms (diagnostic imaging, surgery)
• Methylene Blue
• Neoplasm Recurrence, Local
• Thyroid Neoplasms (diagnostic imaging, surgery, pathology)
• Ultrasonography, Interventional