The role of sentinel lymph node biopsy in differentiated thyroid carcinoma.
OBJECTIVE
To determine whether sentinel lymph node (SLN) biopsy can accurately predict central compartment metastasis in patients with differentiated thyroid carcinoma.


METHODS
Prospective clinical study.


METHODS
Academic tertiary care center.


METHODS
Ninety-eight patients (82 women and 16 men; mean age, 48.3 years) underwent a total thyroidectomy and central compartment dissection.


METHODS
Peritumoral injection of methylene blue dye, 1%, followed by SLN biopsy.


METHODS
The final pathology report established the presence of metastasis among SLNs and lymph nodes that did not stain blue (non-SLNs [NSLNs]).


RESULTS
Differentiated thyroid carcinoma was found in 75 of 98 patients (77%). Seventy of 75 patients with differentiated thyroid carcinoma presented with SLNs and/or NSLNs within the central compartment. Fifteen of 70 patients had metastasis-positive SLNs, while 55 had metastasis-negative SLNs. Six of 15 patients with positive SLNs also had positive NSLNs. No patients with negative SLNs were found to have positive NSLNs. Sentinal lymph node status was a highly significant predictor of NSLN result (Fisher exact test, P < .001). The accuracy, sensitivity, specificity, and positive and negative predictive values of SLN biopsy were 87%, 100%, 86%, 40%, and 100%, respectively.


CONCLUSIONS
To our knowledge, this is the largest series of SLN biopsy in patients with differentiated thyroid carcinoma. Our experience suggests that this is an accurate and noninvasive means to identify subclinical lymph node metastasis. Because negative SLNs correlate strongly with a negative central compartment (100% in this study, P < .001), this technique can be used as an intraoperative guide when determining the extent of surgery necessary in cervical level VI.
Anand
Sumeet M
SM
Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, 3755 Chemin de la Cote-Ste-Catherine Road, Montreal, QC, Canada.
Gologan
Olga
O
Rochon
Louise
L
Tamilia
Michael
M
How
Jacques
J
Hier
Michael P
MP
Black
Martin J
MJ
Richardson
Keith
K
Hakami
Hadi A
HA
Marzouki
Hani Z
HZ
Trifiro
Mark
M
Tabah
Roger
R
Payne
Richard J
RJ
D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery