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Sentinel Lymph Node Biopsy in Thyroid Cancer

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Abstract

Background

Prophylactic central neck dissection in patients with papillary thyroid carcinoma is controversial. Sentinel node biopsy might be an adjunct to optimize surgical treatment for these patients. Earlier studies reported inconsistent detection rates and diagnostic value of this technique, and the role of sentinel lymph node biopsy in thyroid cancer needs to be established.

Patients and methods

During a single-center prospective interventional study between 2010 and 2017, sentinel lymph node biopsy using 99mTc-nanocolloidal albumin tracer was performed on patients undergoing thyroid surgery for suspected thyroid cancer by fine needle aspiration cytology. All eligible patients without clinical lymph node involvement were invited to participate. Central neck dissection was performed on all patients after the detection of sentinel lymph nodes.

Results

Ninety-six patients participated in the study. The detection rates of the sentinel node were 67% and 45% by scintigraphy and intraoperative gamma probe, respectively. The detection rate was not associated with Bethesda score, malignancy, or presence of lymph node metastases. Sensitivity, negative predictive value, and accuracy were 80%, 97%, and 98%, respectively, for the sentinel node to represent the status of lymph node metastasis in the central neck compartment. The false negative rate was 20%.

Conclusion

Sentinel lymph node biopsy had a low detection rate and only moderate sensitivity in patients with suspected thyroid carcinoma and is not a useful adjunct to surgery in the context of current treatment concepts.

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References

  1. Grebe SK, Hay ID (1996) Thyroid cancer nodal metastases: biologic significance and therapeutic considerations. Surg Oncol Clin N Am 5:43–63

    Article  CAS  PubMed  Google Scholar 

  2. Kouvaraki MA, Shapiro SE, Fornage BD et al (2003) Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery 134:946–954 (discussion 954–945)

    Article  PubMed  Google Scholar 

  3. Hwang HS, Orloff LA (2011) Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer. Laryngoscope 121:487–491

    Article  PubMed  Google Scholar 

  4. Stulak JM, Grant CS, Farley DR et al (2006) Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer. Arch Surg 141:489–494 (discussion 494–486)

    Article  PubMed  Google Scholar 

  5. Randolph GW, Duh QY, Heller KS et al (2012) The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid 22:1144–1152

    Article  PubMed  Google Scholar 

  6. Haugen BR, Alexander EK, Bible KC et al (2016) 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26:1–133

    Article  PubMed  PubMed Central  Google Scholar 

  7. Perros P, Boelaert K, Colley S et al (2014) Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf) 81(Suppl 1):1–122

    Article  CAS  Google Scholar 

  8. Cabanas RM (1977) An approach for the treatment of penile carcinoma. Cancer 39:456–466

    Article  CAS  PubMed  Google Scholar 

  9. Garau LM, Rubello D, Ferretti A et al (2018) Sentinel lymph node biopsy in small papillary thyroid cancer. A review on novel surgical techniques. Endocrine 62:340–350

    Article  CAS  PubMed  Google Scholar 

  10. Pelizzo MR, Toniato A, Sorgato N et al (2009) 99Tc nanocolloid sentinel node procedure in papillary thyroid carcinoma: our mono-institutional experience on a large series of patients. Acta Otorhinolaryngol Ital 29:321–325

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Carcoforo P, Portinari M, Feggi L et al (2014) Radio-guided selective compartment neck dissection improves staging in papillary thyroid carcinoma: a prospective study on 345 patients with a 3-year follow-up. Surgery 156:147–157

    Article  PubMed  Google Scholar 

  12. Lee SK, Lee JH, Bae SY et al (2015) Lateral neck sentinel lymph node biopsy in papillary thyroid carcinoma, is it really necessary? A randomized, controlled study. Surgery 157:518–525

    Article  PubMed  Google Scholar 

  13. Assadi M, Yarani M, Zakavi SR et al (2014) Sentinel node mapping in papillary thyroid carcinoma using combined radiotracer and blue dye methods. Endokrynol Pol 65:281–286

    Article  PubMed  Google Scholar 

  14. Cibas ES, Ali SZ, Conference NCITFSotS (2009) The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol 132:658–665

    Article  PubMed  Google Scholar 

  15. Garau LM, Rubello D, Morganti R et al (2018) Sentinel lymph node biopsy in small papillary thyroid cancer: a meta-analysis. Clin Nucl Med 44(2):1

    Google Scholar 

  16. Balasubramanian SP, Harrison BJ (2011) Systematic review and meta-analysis of sentinel node biopsy in thyroid cancer. Br J Surg 98:334–344

    Article  CAS  PubMed  Google Scholar 

  17. Giammarile F, Alazraki N, Aarsvold JN et al (2013) The EANM and SNMMI practice guideline for lymphoscintigraphy and sentinel node localization in breast cancer. Eur J Nucl Med Mol Imaging 40:1932–1947

    Article  CAS  PubMed  Google Scholar 

  18. Chakera AH, Hesse B, Burak Z et al (2009) EANM-EORTC general recommendations for sentinel node diagnostics in melanoma. Eur J Nucl Med Mol Imaging 36:1713–1742

    Article  CAS  PubMed  Google Scholar 

  19. Gelmini R, Campanelli M, Cabry F et al (2018) Role of sentinel node in differentiated thyroid cancer: a prospective study comparing patent blue injection technique, lymphoscintigraphy and the combined technique. J Endocrinol Invest 41:363–370

    Article  CAS  PubMed  Google Scholar 

  20. Rubello D, Pelizzo MR, Al-Nahhas A et al (2006) The role of sentinel lymph node biopsy in patients with differentiated thyroid carcinoma. Eur J Surg Oncol 32:917–921

    Article  CAS  PubMed  Google Scholar 

  21. Anand SM, Gologan O, Rochon L et al (2009) The role of sentinel lymph node biopsy in differentiated thyroid carcinoma. Arch Otolaryngol Head Neck Surg 135:1199–1204

    Article  PubMed  Google Scholar 

  22. Huang O, Wu W, Wang O et al (2011) Sentinel lymph node biopsy is unsuitable for routine practice in younger female patients with unilateral low-risk papillary thyroid carcinoma. BMC Cancer 11:386

    Article  PubMed  PubMed Central  Google Scholar 

  23. Boschin IM, Toniato A, Piotto A et al (2008) 99Tc nanocolloid sentinel node procedure in thyroid carcinoma. Langenbecks Arch Surg 393:705–708

    Article  PubMed  Google Scholar 

  24. Cabrera RN, Chone CT, Zantut-Wittmann DE et al (2016) The role of SPECT/CT lymphoscintigraphy and radioguided sentinel lymph node biopsy in managing papillary thyroid cancer. JAMA Otolaryngol Head Neck Surg 142:834–841

    Article  PubMed  Google Scholar 

  25. Nie X, Tan Z, Ge M (2017) Skip metastasis in papillary thyroid carcinoma is difficult to predict in clinical practice. BMC Cancer 17:702

    Article  PubMed  PubMed Central  Google Scholar 

  26. Machens A, Holzhausen HJ, Dralle H (2004) Skip metastases in thyroid cancer leaping the central lymph node compartment. Arch Surg 139:43–45

    Article  PubMed  Google Scholar 

  27. Lei J, Zhong J, Jiang K et al (2017) Skip lateral lymph node metastasis leaping over the central neck compartment in papillary thyroid carcinoma. Oncotarget 8:27022–27033

    PubMed  PubMed Central  Google Scholar 

  28. Skandalakis JE (2004) Neck: thyroid gland. In: Skandalakis JE (ed) Surgical anatomy the embryologic and anatomic basis of modern surgery. Paschalidis Medical Publications, Athens

    Google Scholar 

  29. Hollinshead WH (1982) Anatomy for surgeons. Lippincott Williams and Wilkins, Philadelphia

    Google Scholar 

  30. Pereira F, Pereira SS, Mesquita M et al (2017) Lymph node metastases in papillary and medullary thyroid carcinoma are independent of intratumoral lymphatic vessel density. Eur Thyroid J 6:57–64

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Arrangoiz R, Cordera F, Caba D et al (2018) Comprehensive review of thyroid embryology, anatomy, histology, and physiology for surgeons. Int J Otolaryngol Head Neck Surg 07:160–188

    Article  Google Scholar 

  32. Ito Y, Miyauchi A (2009) Prognostic factors and therapeutic strategies for differentiated carcinomas of the thyroid. Endocr J 56:177–192

    Article  PubMed  Google Scholar 

  33. Gale N, Zidar N (2009) Pathologie—Kopf-Hals-Region. In: Klöppel G, Kreipe HH, Remmele W (eds) Pathologie. Springer, Berlin, pp 3–46

    Chapter  Google Scholar 

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Funding

The first author (MBA) received the Sten Tibblin research fellowship grant from the Department of Surgery, University of Lund, supported by an unrestricted grant from Novartis AG. The sponsor had no role in the design, execution, analysis, and reporting of the study.

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Authors and Affiliations

  1. Department of Surgery, Skåne University Hospital, Lund University, 22185, Lund, Sweden

    Max B. Albers, Erik Nordenström, Johan Wohlfahrt, Anders Bergenfelz & Martin Almquist

  2. Department of Visceral, Thoracic, and Vascular Surgery, Philipps University Marburg, Marburg, Germany

    Max B. Albers

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  1. Max B. Albers
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  2. Erik Nordenström
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  3. Johan Wohlfahrt
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  4. Anders Bergenfelz
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Correspondence to Max B. Albers.

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Albers, M.B., Nordenström, E., Wohlfahrt, J. et al. Sentinel Lymph Node Biopsy in Thyroid Cancer. World J Surg 44, 142–147 (2020). https://doi.org/10.1007/s00268-019-05218-1

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  • DOI: https://doi.org/10.1007/s00268-019-05218-1

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