Abstract
Background: The prognostic value of sentinel lymph node (SLN) biopsy mapping of tumor lymphatics for determining metastases in patients with papillary thyroid carcinoma (PTC) remains unconfirmed. Therefore, this study investigated the reliability and feasibility of the SLN biopsy to predict metastasis in PTC. Methods: Fifty-one PTC patients without clinical evidence of lymph node involvement (cN0) underwent preoperative lymphoscintigraphy with Technetium-99m-labeled dextran. Total or near-total thyroidectomy was performed with SLN biopsy guided by intraoperative injection of methylene blue dye and scanning with a hand-held gamma probe. All patients received selective neck dissections. Results: The SLN was identified by all three methods in all cases (100%). Identification rates for methylene blue dye and lymphoscintigraphy plus probe scanning were 90.2% and 96.1%, respectively. Metastases in SLNs were revealed in 31 and 38 cases by intraopertative frozen sectioning and final pathologic examination, respectively. Sensitivity, specificity, accuracy, and positive and negative predictive values of SLN biopsy were 97.4%, 100%, 98.0%, 100% and 92.3%, respectively. Conclusion: SLN biopsy in patients with cN0 PTC detected occult metastasis with high accuracy and may have the potential to select patients who require selective neck dissection.
Highlights
The diagnosis of papillary thyroid carcinoma is (PTC) usually accompanied by elective modified radical neck dissection in addition to total thyroidectomy or near-total thyroidectomy
Since lymphatic drainage is presumed to occur in a step-wise fashion, the sentinel lymph node (SLN) should reflect the pathological status of the remaining lymph node compartment
Patients were excluded based upon: suspected thyroid carcinoma identified as benign neoplasm by frozen biopsy; history of neck and/or thyroid surgery; or the presence of systemic distant metastases
Summary
The diagnosis of papillary thyroid carcinoma is (PTC) usually accompanied by elective modified radical neck dissection in addition to total thyroidectomy or near-total thyroidectomy. The proactive approaches involve the identification and excision of a sentinel lymph node (SLN), the first lymph node in a regional lymphatic basin that receives the lymph flow from a primary tumor. Since lymphatic drainage is presumed to occur in a step-wise fashion, the SLN should reflect the pathological status of the remaining lymph node compartment. From August 2007 and September 2010, we performed sentinel lymph node biopsy (SLNB) using various SLN identification techniques on 51 patients with PTC in order to detect cervical lymph node metastases. The prognostic value of sentinel lymph node (SLN) biopsy mapping of tumor lymphatics for determining metastases in patients with papillary thyroid carcinoma (PTC) remains unconfirmed. This study investigated the reliability and feasibility of the SLN biopsy to predict metastasis in PTC
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