Context: As a result of more sensitive techniques to detect recurrent thyroid cancer, the number of patients presenting with small, non-palpable recurrent thyroid cancer in cervical lymph nodes is increasing. Surgical excision of non-palpable recurrent thyroid cancer can be difficult, particularly in a previously operated area.

Objective: To investigate whether preoperative insertion of a hook needle under ultrasound guidance is useful in neck reoperations for recurrent thyroid cancer.

Patients: Ten consecutive patients presenting over a 4-month period with non-palpable, ultrasound-visible, fine needle biopsy-proven recurrent thyroid cancer in previously operated neck compartment(s).

Main outcome measures: Whether it was technically possible to insert a hook needle pre-operatively, rate of negative neck exploration, complication rate.

Results: The hook needle was inserted in seven patients. In three patients, the hook needle was not inserted: one patient had palpable disease 4 months after the preoperative clinic visit, one patient had a tumor too close to the carotid artery and one patient had multiple, bilateral foci of recurrent disease in the central neck. One patient had bleeding after insertion of the needle due to a penetration of an anterior jugular vein which was easily managed at neck reexploration. No other complication occurred during the hook-needle insertion and the only surgical complication was a transient recurrent nerve palsy. All pathology reports showed malignant disease.

Conclusion: Hook needle-guided excision of recurrent thyroid cancer is feasible and appears to be a promising tool for safe and successful reoperation of patients with small recurrent thyroid cancer in cervical lymph nodes.