Radio-guided selective compartment neck dissection improves staging in papillary thyroid carcinoma: A prospective study on 345 patients with a 3-year follow-up

Radioguided sentinel lymph node biopsy in patients with papillary thyroid carcinoma

“…Thus, following the ATA guidelines these PTC patients would have been staged as lymph node negative, and not submitted to radioiodine ablation. These findings are underlined in the studies performed by Cabrera (21), Lee SK (24), Huang (19), and Carcoforo (10) in which if the ATA guidelines had been followed by the Authors, respectively 70.6% (21), 100% (24), 100% (19) and 98.9% (10) of patients with lymph node metastasis would have not been submitted to LND due to the tumor stage T1-T2, and they would have been understaged; thus a persistent disease would have expected in these patients. Due to the high FNR of the SLN frozen section, this procedure is not recommended to avoid LND during the surgical operation for papillary thyroid cancer.…”

“…By contrast, Carcoforo et al in the largest study on rSLNB in PTC patients showed the same identification rate (100%) but, if the rSLNB is applied like in breast cancer or melanoma by removing the lowest number of SLN for the identification of the true first lymph node that drain the primary tumor (e.g., median of 1 SLN), the FNR increase exponentially to about 40%, showing that for the treatment of PTC, the rSLNB by itself may be abandoned unless the introduction of a new role of radioguided surgery (10). Due to the high FNR of rSLNB, the Authors introduced a new concept of the application of the radioguided technique in the treatment of PTC, proposing a radioguided selective compartment neck dissection (RSCND) performed only in the same compartment of the SLN without both a frozen section of the SLN and a routine/prophylactic central LND.…”

“…During the analysis of the selected studies, if the FNR was erroneously considered by the Authors as the rate of false negative cases over the entire group of patients, the FNR was calculated with a rigorous formula as previously reported (10,12). Briefly, the FNR for rSLNB was calculated as the number of patients with negative SLN but positive non-SLN after LND in the same compartment of the SLN (i.e., false negative cases) over the sum of the true positive (i.e., patients with positive SLN) plus the false negative cases, multiplied by 100.…”

“…The aims of the 12 articles included in the review analysis were: (I) to evaluate the feasibility of rSLNB in four studies (15)(16)(17)(18); (II) to compare the identification of SLN with rSLNB versus SLNB performed by a dye technique in two studies (19,20); and (III) to determine the role of rSLNB for PTC lymph node staging in six studies (9,10,(21)(22)(23)(24). Only PTC patients who underwent rSLNB were included in the analysis, achieving a total of 800 patients.…”

“…Among all other patients the SLN was in the central compartment in 53.1% (391/737), in the lateral one in 26.2% (193/737), in both central and lateral compartments in 2.3% (17/737), and in the contralateral compartments in 1.9% (14/737). Table 2, a LND in the same compartment of the SLN regardless of the SLN status was performed in 5 out of 12 studies (449 patients; 60.9%) (10,15,16,19,21). Instead, in five studies the LND of the SLN compartment was done if positive SLN at intraoperative frozen section (283 patients; 38.4%) (9,20,(22)(23)(24).…”