Avoid common mistakes on your manuscript.
Sentinel lymph node (SLN) is the first lymphatic station that drains from the primary tumor, and SLN biopsy is a standard procedure in solid cancers providing diagnostic and prognostic information [1, 2]. Despite SLN biopsy is not commonly used in thyroid cancer, the basis for its use is to detect lymph node occult metastases. The presence of lymph node metastases guides the therapeutic choice, mainly in differentiated thyroid cancer (DTC) that commonly spreads by lymphatic via [3]. Lymph node metastasis is a relatively common occurrence in DTC, and it is associated with an increased risk of recurrence [3, 4]. The presence of lymph node metastasis influences the choice of administration of adjuvant radioactive iodine (RAI) therapy. The DTC prognosis is usually good with over 90% of 10-year survival rate [4, 5]. Accurate staging of lymph node involvement is essential for determining the appropriate surgical approach and selecting patients who may benefit from RAI therapy. Recently prophylactic central neck dissection in clinically node-negative DTC has been extensively debated [6,7,8].
On the other hand, medullary thyroid cancer (MTC) originates from thyroid parafollicular C-cells and represents less than 5% of all thyroid cancers [9, 10]. Progression of the disease is usually slow, with long life expectancy even in the presence of persistent disease and in the absence of treatment. Neck surgery followed by external radiotherapy is the standard treatment [9, 10]. Therefore, in thyroid cancer, defining lymph node involvement is crucial for assessing patients’ prognosis [1,2,3,4,5,6].
Preoperative evaluation of neck lymph node status is usually based on imaging, mostly neck ultrasound, which represents the first level investigation in evaluation lymph node compartments of the neck [4, 11, 13]. The ultrasound SLN mapping allows for precise evaluation of the lymphatic spread, and it plays an important role in the staging disease. This approach can help avoid unnecessary comprehensive neck dissection and ensure an appropriate treatment [11,12,13].
In this background, we read a recent and interesting article by L. De Vries et al. [14]. The aim of her study was to demonstrate the feasibility and effectiveness of SLN visualization with a new positron emission tomography/computed tomography (PET/TC) tracer. In particular, [68Ga]Ga-tilmanocept was proposed as a new radiopharmaceutical for SLN detection in ten thyroid cancer patients (seven DTC and three MTC patients). In all patients, 10 MBq and 120 MBq of [68Ga]Ga-tilmanocept and ICG-[99mTc]Tc-nanocolloid, respectively, were injected. PET/CT scan at 15 min and 60 min post-injection were obtained. The approximate location of the SLNs was preoperatively assessed and marked on the skin by PET/CT data. Subsequently, during surgery, only the SLNs demonstrating ICG-[99mTc]Tc-nanocolloid uptake at hand-held gamma probe and fluorescence camera imaging were removed. PET/CT detected eight SLNs in central compartment and nineteen SLNs in the lateral compartment of the neck. The pathologist found seventeen lymph node micro metastases in all patients, except one. These results demonstrate a good performance of this new PET tracer in the detection of SLN, despite the small number of patients included [14].
In this work, a possible role of PET/CT in SLN detection in thyroid cancer has been proposed in patients with a more aggressive thyroid cancer, like metastatic and iodine-refractory disease [15,16,17,18,19,20,21,22]. This study opens an interesting debate on the diagnostic and prognostic value of PET/CT tracers in thyroid cancer patients.
References
Giammarile F, Schilling C, Gnanasegaran G, Bal C, Oyen WJG, Rubello D, et al. The EANM practical guidelines for sentinel lymph node localisation in oral cavity squamous cell carcinoma. Eur J Nucl Med Mol Imaging. 2019;46:623–37. https://doi.org/10.1007/s00259-018-4235-5.
Biganzoli L, Cardoso F, Beishon M, Cameron D, Cataliotti L, Coles CE, et al. The requirements of a specialist breast centre. The Breast. 2020;51:65–84. https://doi.org/10.1016/j.breast.2020.02.003.
Huang I-C, Chou F-F, Liu R-T, Tung S-C, Chen J-F, Kuo M-C, et al. Long-term outcomes of distant metastasis from differentiated thyroid carcinoma. Clin Endocrinol (Oxf). 2012;76:439–47. https://doi.org/10.1111/j.1365-2265.2011.04231.x.
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 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 Off J Am Thyroid Assoc. 2016;26:1–133. https://doi.org/10.1089/thy.2015.0020.
Klain M, Pace L, Zampella E, Mannarino T, Limone S, Mazziotti E, et al. Outcome of patients with differentiated thyroid cancer treated with 131-iodine on the basis of a detectable serum thyroglobulin level after initial treatment. Front Endocrinol. 2019:10. https://doi.org/10.1210/jcem.87.4.8274.
Calò PG, Conzo G, Raffaelli M, Medas F, Gambardella C, De Crea C, et al. Total thyroidectomy alone versus ipsilateral versus bilateral prophylactic central neck dissection in clinically node-negative differentiated thyroid carcinoma. A retrospective multicenter study. Eur J Surg Oncol. EJSO. 2017;43:126–32. https://doi.org/10.1016/j.ejso.2016.09.017.
Deligiorgi MV, Panayiotidis MI, Trafalis DT. Prophylactic lymph node dissection in clinically N0 differentiated thyroid carcinoma: example of personalized treatment. Pers Med. 2020;17:317–38. https://doi.org/10.2217/pme-2019-0119.
Lin X, Chen X, Jiru Y, Du J, Zhao G, Wu Z. Evaluating the influence of prophylactic central neck dissection on TNM staging and the recurrence risk stratification of cN0 differentiated thyroid carcinoma. Bull Cancer (Paris). 2016;103:535–40. https://doi.org/10.1016/j.bulcan.2016.04.003.
Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid Off J Am Thyroid Assoc. 2015;25:567–610. https://doi.org/10.1089/thy.2014.0335.
Klain M, Hadoux J, Nappi C, Finessi M, Ambrosio R, Schlumberger M, et al. Imaging medullary thyroid cancer patients with detectable serum markers: state of the art and future perspectives. Endocrine. 2022;75:330–7. https://doi.org/10.1007/s12020-021-02930-8.
Puccini M, Ambrosini CE, Rossi L, De Napoli L, Materazzi G. Sentinel node mapping in thyroid cancer: an overview. Front Med. 2023;10:1163151. https://doi.org/10.3389/fmed.2023.1163151.
Zhao H, Li H. Meta-analysis of ultrasound for cervical lymph nodes in papillary thyroid cancer: diagnosis of central and lateral compartment nodal metastases. Eur J Radiol. 2019;112:14–21. https://doi.org/10.1016/j.ejrad.2019.01.006.
Sorrenti S, Dolcetti V, Fresilli D, Del Gaudio G, Pacini P, Huang P, et al. The role of CEUS in the evaluation of thyroid cancer: from diagnosis to local staging. J Clin Med. 2021;10:4559. https://doi.org/10.3390/jcm10194559.
de Vries LH, Lodewijk L, Ververs T, Poot AJ, van Rooij R, Brosens LAA, et al. Sentinel lymph node detection in thyroid carcinoma using [68Ga]Ga-tilmanocept PET/CT: a proof-of-concept study. Eur J Nucl Med Mol Imaging. 2023; https://doi.org/10.1007/s00259-023-06449-0.
Salvatore B, Klain M, Nicolai E, D’Amico D, De Matteis G, Raddi M, et al. Prognostic role of FDG PET/CT in patients with differentiated thyroid cancer treated with 131-iodine empiric therapy. Med (Baltimore). 2017;96:e8344. https://doi.org/10.1097/MD.0000000000008344.
Zampella E, Klain M, Pace L, Cuocolo A. PET/CT in the management of differentiated thyroid cancer. Diagn Interv Imaging. 2021;102:515–23. https://doi.org/10.1016/j.diii.2021.04.004.
Klain M, Maurea S, Gaudieri V, Zampella E, Volpe F, Manganelli M, et al. The diagnostic role of total-body 18F-FDG PET/CT in patients with multiple tumors: a report of the association of thyroid cancer with lung or renal tumors. Quant Imaging Med Surg. 2021;11:4211–5. https://doi.org/10.21037/qims-21-36.
Pace L, Klain M, Salvatore B, Nicolai E, Zampella E, Assante R, Pellegrino T, Storto G, Fonti R, Salvatore M. Prognostic role of 18F-FDG PET/CT in the postoperative evaluation of differentiated thyroid cancer patients. Clin Nucl Med. 2015 Feb;40(2):111–5. https://doi.org/10.1097/RLU.0000000000000621.
Berdelou A, Lamartina L, Klain M, Leboulleux S, Schlumberger M. Treatment of refractory thyroid cancer. Endocr Relat Cancer. 2018 Apr;25(4):R209–23. https://doi.org/10.1530/ERC-17-0542.
Schmidt A, Iglesias L, Klain M, Pitoia F, Schlumberger MJ. Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation. Arch Endocrinol Metab. 2017;61(1):81–9. https://doi.org/10.1590/2359-3997000000245.
Porcelli T, Luongo C, Sessa F, Klain M, Masone S, Troncone G, et al. Long-term management of lenvatinib-treated thyroid cancer patients: a real-life experience at a single institution. Endocrine. 2021;73(2):358–66. https://doi.org/10.1007/s12020-021-02634-z.
Klain M, Zampella E, Nappi C, Nicolai E, Ambrosio R, Califaretti E, et al. Advances in functional imaging of differentiated thyroid cancer. Cancers (Basel). 2021;13(19):4748. https://doi.org/10.3390/cancers13194748.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
Institutional Review Board approval was not required because the paper is an Editorial.
Consent to participate
Not applicable
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Volpe, F., Piscopo, L. & Klain, M. Exploring the value of sentinel lymph node PET/CT detection in thyroid carcinoma. Eur J Nucl Med Mol Imaging 51, 510–511 (2024). https://doi.org/10.1007/s00259-023-06498-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00259-023-06498-5