Sentinel Lymph Node Dissection for Thyroid Malignancy

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Sentinel lymph node dissection (SLND) for melanoma and breast cancer has been validated as an accurate technique to assess the status of the lymph nodes in the regional drainage basin. The sentinel node concept has also been investigated in other solid tumors, and more recently, in thyroid carcinoma. SLND using a vital blue dye during thyroidectomy for suspected thyroid malignancy successfully identifies sentinel nodes, with minimal morbidity. Excised sentinel nodes can be examined for micrometastases, and if negative, then the rest of the cervical nodes are likely to be negative. The false negative rate of SLND for thyroid malignancy is unknown, however, because modified neck dissections have not accompanied all cases. The impact that lymph node metastasis in thyroid carcinoma has on prognosis is debatable, unlike breast cancer and melanoma, which therefore makes the utility of thyroid SLND less clear. The technique, results, and morbidity of SLND during thyroidectomy is presented, and its possible utility in well-differentiated and medullary thyroid carcinoma is discussed.