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

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.

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.

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.

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