The Utility of Sentinel Lymph Node Biopsy in Papillary Thyroid Carcinoma with Occult Lymph Nodes

Abstract

BackgroundThe sentinel lymph node (SLN) is defined as the first draining node from the primary lesion, and it has proven to be a good indicator of the metastatic status of regional lymph nodes in solid tumors. The aim of this study was to evaluate the clinical application of SLN biopsy (SLNB) in papillary thyroid carcinoma (PTC) with occult lymph nodes.MethodsFrom April 2006 to October 2012, 212 consecutive PTC patients were treated with SLNB using carbon nanoparticle suspension (CNS). Then, the stained nodes defined as SLN were collected, and prophylactic central compartment neck dissection (CCND) followed by total thyroidectomy or subtotal thyroidectomy were performed. All the samples were sent for pathological examination.ResultsThere were 78 (36.8%) SLN metastasis (SLNM)-positive cases and 134 (63.2%) SLNM-negative cases. The sensitivity, specificity, positive and negative predictive values, and false-positive and false-negative rates of SLNB were 78.8%, 100%, 100%, 84.3%, 0%, and 21.2%, respectively. The PTC patients with SLNM were more likely to be male (48.2% vs. 32.7%, p = 0.039) and exhibited multifocality (52.6% vs. 33.3%, p = 0.025) and extrathyroidal extension (56.7% vs. 33.5%, p = 0.015). A greater incidence of non-SLN metastases in the central compartment was found in patients with SLNM (41/78, 52.6%) than in those without SLNM (21/134, 15.7%; p < 0.05). However, the SLNM-negative PTC patients with non-SLN metastases were more likely to be male (37.9% vs. 9.5%, p < 0.05).ConclusionsThe application of SLNB using CNS is technically feasible, safe, and useful, especially for male patients with co-existing multifocality and extrathyroidal extension. However, the sensitivity of SLNB must be improved and its false-negative rate reduced before it can be a routine procedure and replace prophylactic CCND. More attention should be paid to PTC patients (especially males) without SLNM for signs of non-SLN metastases.

Application of carbon nanoparticles in lymph node dissection and parathyroid protection during thyroid cancer surgeries: a systematic review and meta-analysis

“…However, it should be noted that the total metastatic rate of the retrieved lymph nodes and the metastatic rate of stained or unstained lymph nodes did not significantly differ between the 2 groups, consistent with the findings of previous studies 46,68. In Gao and Zhao study,46 more metastatic lymph nodes were eliminated in the CN group (6±2.37 vs 4±2.49; P <0.01), but the rate of metastatic lymph nodes did not differ (45.97% vs 47.10%; P >0.05).…”

Magnetic detection of sentinel lymph node in papillary thyroid carcinoma: The MAGIC-PAT study results

“…Radio-guided SLN (rSLNB) achieves better detection rates in comparison with vital dyes, avoids lymphatic disruption during surgery and false negative from parathyroid glands, and allow SLN outside the central compartment to be identified [24,40]. Recently, other methodologies such as carbon nanoparticle suspension are being investigated as a technique for SLNB and parathyroid gland recognition [41,42]. We achieved satisfactory mSLNB performance with an 80% detection rate.…”

Effect of the application of prophylactic central compartment lymph node dissectionon radioiodine ablation doses in patients with papillary thyroid carcinoma

“…Although central lymph node dissection is recommended for cN1 patients, the need for PCLND in cN0 PTC patients is still controversial (10)(11)(12)(13)(14)(15). Generally, it is accepted that lymph node metastasis is associated with higher locoregional recurrence and distant metastasis rates.…”