Intraoperative tumor localization with surgeon-performed ultrasound-guided needle dye injection

To describe our technique and initial experience of intraoperative tumor localization with surgeon-performed ultrasound-guided needle dye injection.

Prospective case series. Technique description.

Using surgeon-performed ultrasonography (SP-US), 20 tumors (lymph node metastases of papillary thyroid carcinoma [15], Hurthle cell carcinoma [2], medullary thyroid carcinoma [1], and lymphoma [1], and a parathyroid adenoma [1]) were localized in 13 patients. With ultrasound guidance, 0.1 mL of 1% methylene blue dye was injected into each targeted tumor. The blue color in contrast helped guide the dissection. Sixteen of 20 (80%) of dissections were revision cases through scar.

Using SP-US and US-guided injection with blue dye, 20 of 20 (100%) of cases were successful in retrieving the target tumor with no inadvertent nerve injuries (nerves at risk in scar: recurrent laryngeal [12], phrenic [3], vagus [3], and sympathetic chain [3]). Dye injection adds 5 to 10 minutes of time prior to incision. Injections appeared to increase visual differentiation of tissue, save time during dissection, particularly during revision dissections, and help ensure successful target retrieval. Injection into a parathyroid adenoma resulted in an overabundance of blue dye in nontumor tissue.

Surgeon-performed ultrasound guided needle dye injection is particularly helpful in directing the surgeon to the appropriate area for tumor resection in fibrotic areas and thereby possibly reducing surgical time, sampling error, and morbidity. A lower concentration or a different dye may be more helpful for parathyroid adenomas. Further study on this technique is needed and is under way with a larger group of patients.

At the conclusion of this manuscript, the participants should be able to understand the technique and advantages of intraoperative tumor localization with surgeon-performed ultrasound-guided needle blue dye injection.