Sentinel Lymph Node Biopsy for Papillary Thyroid Cancer: 12 Years of Experience at a Single Institution

Abstract

Sentinel lymphadenectomy for papillary thyroid carcinoma is feasible, safe, and can identify patients who may benefit from central neck dissection.

Sentinel Lymph Node Biopsy in Well Differentiated Thyroid Cancer

“…The incidence of lymph node metastases has been reported to be as high as 90% and the incidence of palpable disease ranges between 30-50% (Dixon et al, 2000;Grodski et al, 2007). Histological evidence of nodal metastases in patients with clinically node negative PTC is approximately 50% (Balasubramanian & Harrison, 2011), but rates anywhere between 25 to 90% have been reported in studies where elective neck dissections were performed on patients without suspicious lymphadenopathies (Cunningham et al, 2010). Interestingly, in a similar group of patients who were observed and did not undergo a neck dissection, the rate of recurrence was only 1.4%, thus questioning the clinical significance of such lymph node metastases (Kelemen et al, 1998).…”

“…Notably, a control neck dissection was not carried out in all patients in both of these studies, and as such, positive and negative predictive values could not be determined. In a recent study, Cunningham et al (2010) performed a retrospective review of 211 patients and concluded that SLNB is feasible, safe and can identify patients who may benefit from CCND. As in the other previous studies, however, a CCND was not performed on all patients and thus a false negative rate could not be determined.…”

“…They describe three such cases where a blue node adherent to the substance of the thyroid gland was found ex vivo by the pathologist, and might have not been found intraoperatively because the blue-stained thyroid gland masked the blue tract and blue node (Cunningham et al, 2010).…”

“…This can, however, be easily overcome by slow intratumoral or peritumoral dye injection and immediate blotting of spillage at the injection site. One study has reported permanent hypoparathyroidism secondary to removal of a parathyroid gland that has stained blue (Cunningham et al, 2010). All degrees of skin responses to the blue dye have also been reported.…”

Minimally invasive techniques for head and neck malignancies: current indications, outcomes and future directions

“…However, more recent reports have shown that information on pathological nodal status may lead to a more personalized approach to adjuvant radioactive iodine treatment [65,66], and in this respect, accurate staging using sentinel node biopsy may provide an advantage as compared with routine elective neck dissection with regard to recurrent nerve paralysis and hypoparathyroidism. The technique has been shown to be feasible using blue dye and nanocolloid particles, with localization rates from 91 to 99% [67,68]. Pelizzo et al [68] have also shown a signiWcant diVerence in postoperative and postablation thyroglobulin levels in patients staged pN0(sn) versus pN1(sn).…”