Ultrasound-Guided Needle Dye Injection by Surgeon Localizes Tumor

What is the effect of ultrasound-guided needle dye injection in localization of intraoperative tumors?

Background: Locating and surgically excising non-palpable neck tumors in an accurate, efficient and safe manner, particularly in previously operated areas, can be a challenge. Preoperative imaging with computed tomography, magnetic resonance, positron emission tomography, or ultrasound-guided fine-needle aspiration biopsy are tools typically used to identify a non-palpable tumor and its need for excision. However, a surgeon-performed ultrasound-guided needle blue dye injection has the potential to provide better tumor localization.

Study design: Prospective case series and technique description.

Setting: Division of Head, Neck, Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California.

Synopsis: Using surgeon-performed ultrasound and ultrasound-guided injection with blue dye, 20 of 20 cases were successful in retrieving the target tumor with no inadvertent nerve injuries. The dye injection was added five to 10 minutes 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.

Bottom line: Surgeon-performed ultrasound-guided needle injection is particularly helpful in directing the surgeon to the appropriate area for tumor resection in fibrotic areas, thereby possibly reducing surgical time, sampling error, and morbidity.

Citation: Ryan WR, Orloff LA. Intraoperative tumor localization with surgeon-performed ultrasound-guided needle dye injection. Laryngoscope. 2011;121(8):1651-1655.

-Reviewed by Sue Pondrom