甲状腺疾患と治療のジャーナル
オープンアクセス

概要

Sentinel Lymph Node Biopsy in Papillary Thyroid Carcinoma

Dan-Gui Yan, Bin Zhang, Lin Liu, Li-Juan Niu, Chang-Ming An, Zheng-Jiang Li, Zhen-Gang Xu and Ping-Zhang Tang

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.