Transoral Surgical Approach for Retropharyngeal Node Involvement in I-131-Negative 18-fluoro-2-deoxyglucose Positron Emission Tomography–Positive Recurrent Thyroid Cancer

ABSTRACT

Transoral pharyngotomy is a viable minimally invasive approach for resection of metastatic thyroid cancer in retropharyngeal lymph nodes in highly select patients. A few authors have already reported on its safe application with excellent outcomes. We herein describe a case where the technique is assisted with the Omniguide CO₂ laser system to safely access and remove a metastatic node in the retropharyngeal space of a 24 year-old Caucasian woman. Furthermore, her disease was I-131-negative and positron emission tomography–positive, demonstrating the technique is still feasible in this dedifferentiated cancer state.

KEYWORDS

Retropharyngeal - thyroid cancer - transoral - lymph node - minimally invasive surgery

REFERENCES

• 1 Otsuki N, Nishikawa T, Iwae S, Saito M, Mohri M, Nibu K. Retropharyngeal node metastasis from papillary thyroid carcinoma.  Head Neck. 2007;  29 508-511
• 2 Shellenberger T, Fornage B, Ginsberg L, Clayman G L. Transoral resection of thyroid cancer metastasis to lateral retropharyngeal nodes.  Head Neck. 2007;  29 258-266
• 3 Le T D, Cohen J I. Transoral approach to removal of the retropharyngeal lymph nodes in well-differentiated thyroid cancer.  Laryngoscope. 2007;  117 1155-1158
• 4 Laccourreye L, Breheret R, Rohmer V, Dubin J, Bizon A. [Transoral resection of thyroid cancer metastasis to retropharyngeal lymph node].  Ann Otolaryngol Chir Cervicofac. 2008;  125 309-312
• 5 Kaplan S L, Mandel S J, Muller R et al.. The role of MR imaging in detecting nodal disease in thyroidectomy patients with rising thyroglobulin levels.  AJNR Am J Neuroradiol. 2009 Mar;  30(3) 608-12 , Epub 2008 Nov 27
• 6 Rivera M, Ghossein R A, Schoder H, Gomez D, Larson S M, Tuttle R M. Histopathologic characterization of radioactive iodine-refractory fluorodeoxyglucose-positron emission tomography-positive thyroid carcinoma.  Cancer. 2008;  113 48-56
• 7 Finkelstein S E, Grigsby P W, Siegel B A, Dehdashti F, Moley J F, Hall B L. Combined [18F]Fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) for detection of recurrent, 131I-negative thyroid cancer.  Ann Surg Oncol. 2008;  15 286-292
• 8 Roberts M, Maghami E, Kandeel F, Yamauchi D, Ellenhorn H L, Ellenhorn J D. The role of positron emission tomography scanning in patients with radioactive iodine scan-negative, recurrent differentiated thyroid cancer.  Am Surg. 2007;  73 1052-1056
• 9 Wang W, Macapinlac H, Larson S M et al.. [18F]-2-fluoro-2-deoxy-D-glucose positron emission tomography localizes residual thyroid cancer in patients with negative diagnostic (131)I whole body scans and elevated serum thyroglobulin levels.  J Clin Endocrinol Metab. 1999;  84 2291-2302