26 May, 2021
Finding thyroid cancer metastases using preoperative SPECT-CT lymphography
Thyroid diseases in general, and thyroid cancer in particular, are pathologies on the rise. Its diagnosis and treatment require increasing precision and effectiveness. It is becoming increasingly important to be able to offer patients healing options, especially when faced with cancer. In this sense, knowing that thyroidectomy is the treatment of choice, it is vitally important to be able to eliminate the tumour and prevent the possible appearance of thyroid cancer metastasis. Thanks to lymphography with SPECT-CT, we can identify affected lymph nodes and export them accurately. All this in a single intervention, during the same thyroid cancer treatment surgery. In addition, we can obtain all the necessary information to plan and personalize subsequent treatment and follow-up.
Thyroid diseases and thyroid cancer, pathologies on the rise
Thyroid diseases are highly prevalent in modern society. If, years ago, these types of pathology were associated with specific geographical areas and old age groups, today we know that they are found in any area and affect more and more young people. It is estimated that more than 50% of the population is affected by thyroid diseases. In addition, we have data that shows thyroid cancer to be a malignant disease that is clearly on the rise. Between 4 and 11% of thyroid nodules could have cancer.
What is precision medicine and why is it important?
We have written in previous posts how we can diagnose and stratify thyroid nodules, attributing a potential risk of malignancy to them. When we have a suspected thyroid cancer, we must be able to offer accurate planning of the surgery. It must be individualized and extremely accurate, what we call “precision medicine”. Working in this way allows us not only to remove the thyroid cancer, but to obtain all the relevant and necessary information to continue with the planning of the treatment of each specific patient.
“When there is a suspicion of thyroid cancer, we must be able to offer precise planning of the surgery; individualized and extremely accurate, what we call “precision medicine”. Working in this way allows us to remove the thyroid cancer and obtain all the information to follow a personalized treatment”
Dr. Oscar Vidal
All the information we can obtain about the tumour is important for the prognosis of thyroid cancer. For this reason, at barnaclínic+ we have developed the application of the lymphography technique with preoperative SPECT-CT. This procedure allows us to know exactly the lymphatic drainage areas of the thyroid cancer and to be able to remove, if necessary, the affected lymph nodes during the thyroidectomy.
Toda la información que podamos obtener sobre el tumor es importante para el pronóstico del cáncer de tiroides. En este sentido, en barnaclínic+ hemos desarrollado la aplicación de la técnica de linfografía con SPECT-CT preoperatoria. Este procedimiento nos permite conocer con exactitud las zonas de drenaje linfático del cáncer de tiroides y poder extirpar, si fuese necesario, los ganglios linfáticos afectados durante la tiroidectomía.
Where do thyroid cancer metastases appear and how do they drain?
It is well established that the majority of thyroid cancer metastases usually appear in the lymph nodes in the neck. These nodes are located around this gland. The lymphatic drainage of the thyroid has been shown to be helical. This means that sometimes a right tumour can drain to the left side, or an upper pole tumour can drain to the lower area.
How to discover thyroid cancer metastases?
We know that one of the mainstays of thyroid cancer treatment is total thyroidectomy. However, in many cases this intervention is not enough. For this reason, the association between a selective lymphadenectomy and a thyroidectomy may be essential and necessary for the patient’s cure. Above all, so that thyroid cancer metastasis does not appear.
However, selective tumour-side lymphadenectomy has a limitation. With this test, sometimes the nodes that are removed do not correspond to the drainage area. If so, and in the event that the patient already has lymph node metastases, we would not remove them.
Lymphography with preoperative SPEC-CT, the solution to identify affected nodes
Preoperative SPEC-CT lymphography consists of puncturing the tumour, injecting it with a traceable radioactive isotope and subsequently performing a CT scan and a 3D reconstruction scintigraphy. This test can accurately identify potentially affected lymph nodes. Thanks to this technology, once the thyroid is removed, and in the same operating room and during the intervention, we can perform a check of these nodes and remove them safely.
Once the complete thyroid surgery is finished, we can ensure that we have removed the thyroid tumor with all the nodes affected by cancer. In this way, we will be able to establish the full stage of the disease.
IMAGE SOURCE: (2016). “Thyroid computed tomography imaging: pictorial review of variable pathologies”. Insights into Imaging 7 (4): 601–617. DOI:10.1007/s13244-016-0506-5. ISSN 1869-4101. Creative Commons Attribution 4.0 International License. AUTHOR: Mnahi Bin Saeedan, Ibtisam Musallam Aljohani, Ayman Omar Khushaim, Salwa Qasim Bukhari, and Salahudin Tayeb Elnaas