Sentinel lymph node biopsy in patients with papillary thyroid carcinoma.
BACKGROUND
It remains controversial whether modified radical neck dissection (MRND) for patients with papillary thyroid carcinoma improves prognosis. However, it is highly probable that the incidence of local recurrence is reduced by lymph node dissection. Sentinel lymph node (SLN) biopsy (SLNB) for patients with melanoma and breast carcinoma has been validated as an accurate method for assessing lymph node status. The objective of this study was to determine the feasibility of SLNB for the evaluation of cervical lymph node status in patients with papillary thyroid carcinoma.


METHODS
After injection of methylene blue around the tumor in 22 patients with papillary thyroid carcinoma, blue-stained lymph nodes were dissected as SLNs. After the SLNB, all patients also underwent subtotal thyroidectomy and MRND. SLNs and other lymph nodes were investigated with regard to their number, distribution, size, lymph node status, and ratio of metastatic area.


RESULTS
There was concordance between the SLN findings and the regional lymph node status in 19 of 21 patients (90.5%; 7 patients had both positive SLN and regional lymph node results, and 12 patients had both negative SLN and regional lymph node results). Two patients had negative SLN results but, in the end, had positive nonsentinel lymph nodes (NSLNs). The overall reliability rate of SLNB was 86.3% (19 of 22 patients). The authors experienced no complications with the use of methylene blue for the detection of SLNs.


CONCLUSIONS
SLNB using methylene blue is feasible technically and is safe, and the findings correlate with cervical lymph node status. Therefore, SLNB is a good technique for estimating the status of cervical lymph nodes in patients with papillary thyroid carcinoma.
Fukui
Y
Y
Department of Surgery, Kochi Municipal Hospital, Kochi, Japan. jfkyo@bronze.ocn.ne.jp
Yamakawa
T
T
Taniki
T
T
Numoto
S
S
Miki
H
H
Monden
Y
Y
D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery