title: 99Tc nanocolloid sentinel node procedure in papillary thyroid carcinoma: our mono-institutional experience on a large series of patients.
abstract: The sentinel lymph node was defined as the first lymph node to receive drainage from a primary cancer. The aims of this study were to investigate the efficacy of radiocolloid lymphoscintigraphy and of the hand-held gamma probe procedure for sentinel lymph node biopsy in papillary thyroid carcinoma and to evaluate these results in clinical staging. A total of 99 consecutive papillary thyroid carcinoma patients entered the study. Patients underwent radiocolloid lymphoscintigraphy before surgery. Intra-operative sentinel lymph node localization was performed using a hand-held gamma probe. Patients were observed at follow-up at 2 and 6 months and, thereafter, yearly. Sequential lymphoscintigraphy was able to identify at least one sentinel lymph node in 98/99 cases (99%), using intra-operative hand-held gamma probe, the surgeon was able to detect at least one sentinel lymph node in all cases. Sentinel lymph node metastases were diagnosed in 49%. Overall, 79 patients underwent ablative (131)I therapy. The median value of thyroglobulin in N0 vs. N1 patients was 1 ng/ml vs. 1.9 ng/ml (p = 0.03) and 0.2 ng/ml vs. 1 ng/ml (p = 0.001) before and after (131)I therapy, respectively. The pre-operative lymphoscintigraphy and the intra-operative gamma probe offer significant advantages over the vital dye technique, described in our previous experience. The rate of nodal involvement (49%) is very high considering that no patients had clinically palpable nodes or suspected at echography. (131)I whole body scan and thyroglobulin measurements confirmed sentinel lymph node in papillary thyroid carcinoma as a reliable procedure. In patients classified N0, by sentinel lymph node biopsy, ablative (131)I therapy could be avoided.
authors.affiliation: Surgical Pathology, Department of Medical and Surgical Sciences, University of Padua, Padua, Italy.
authors.forename: M R
authors.initials: MR
authors.lastname: Pelizzo
authors.forename: A
authors.initials: A
authors.lastname: Toniato
authors.forename: N
authors.initials: N
authors.lastname: Sorgato
authors.forename: A
authors.initials: A
authors.lastname: Losi
authors.forename: F
authors.initials: F
authors.lastname: Torresan
authors.forename: I
authors.initials: I
authors.lastname: Merante Boschin
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma; D002291:Carcinoma, Papillary; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D013668:Technetium Tc 99m Aggregated Albumin; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid
references.citation: Ann Surg Oncol. 2008 May;15(5):1518-22
references.pmid: 18324441
references.citation: Surg Oncol. 2002 Nov;11(3):137-42
references.pmid: 12356509
references.citation: Int Surg. 1987 Apr-Jun;72(2):100-3
references.pmid: 3610534
references.citation: CA Cancer J Clin. 2006 Sep-Oct;56(5):292-309; quiz 316-7
references.pmid: 17005598
references.citation: World J Surg. 2000 Nov;24(11):1396-401
references.pmid: 11038213
references.citation: World J Surg. 2007 May;31(5):879-87
references.pmid: 17308849
references.citation: Eur J Surg Oncol. 2007 Nov;33(9):1075-80
references.pmid: 17344018
references.citation: Langenbecks Arch Surg. 2008 Sep;393(5):705-8
references.pmid: 18626655
references.citation: Surg Oncol Clin N Am. 1996 Jan;5(1):43-63
references.pmid: 8789493
references.citation: J Clin Endocrinol Metab. 2001 Apr;86(4):1447-63
references.pmid: 11297567
references.citation: Surgery. 2001 Dec;130(6):907-13
references.pmid: 11742316
references.citation: Arch Otolaryngol Head Neck Surg. 1991 Jun;117(6):601-5
references.pmid: 2036180
references.citation: Cancer. 2008 Oct 1;113(7):1527-31
references.pmid: 18671238
references.citation: Eur J Surg Oncol. 2009 Sep;35(9):974-9
references.pmid: 19285827
references.citation: Otolaryngol Clin North Am. 1998 Aug;31(4):639-55
references.pmid: 9687326
references.citation: Eur J Nucl Med. 2000 Sep;27(9):1399-401
references.pmid: 11007523
references.citation: Otolaryngol Clin North Am. 1998 Oct;31(5):823-31
references.pmid: 9735110
references.citation: J Endocrinol Invest. 1991 Jul-Aug;14(7):543-9
references.pmid: 1940060
references.citation: Eur J Surg Oncol. 2006 Nov;32(9):917-21
references.pmid: 16621423
references.citation: Am J Med. 1994 Nov;97(5):418-28
references.pmid: 7977430
references.citation: Clin Nucl Med. 1999 Oct;24(10):744-6
references.pmid: 10512097
references.citation: Can J Surg. 1993 Aug;36(4):298-301
references.pmid: 8370008
references.citation: Br J Surg. 1998 Feb;85(2):252-4
references.pmid: 9501829
references.citation: J Surg Oncol. 2001 May;77(1):21-4; discussion 25
references.pmid: 11344476
references.citation: Nucl Med Commun. 2006 Nov;27(11):833-5
references.pmid: 17021421
references.citation: Br J Surg. 2001 Mar;88(3):321-2
references.pmid: 11260094
references.citation: Laryngoscope. 2005 Aug;115(8):1479-85
references.pmid: 16094129
references.citation: ANZ J Surg. 2004 Jan-Feb;74(1-2):2
references.pmid: 14725694
references.citation: Zentralbl Chir. 1997;122(4):259-65
references.pmid: 9221636
references.citation: Am J Surg. 1996 Dec;172(6):692-4
references.pmid: 8988680
references.citation: Eur J Nucl Med Mol Imaging. 2007 Jun;34(6):934-8
references.pmid: 17235530
references.citation: Arch Surg. 1998 Mar;133(3):288-92
references.pmid: 9517742
references.citation: World J Surg. 1999 Sep;23(9):970-3; discussion 973-4
references.pmid: 10449830
references.citation: Anticancer Res. 2003 Sep-Oct;23(5b):4283-8
references.pmid: 14666639
references.citation: J Exp Clin Cancer Res. 2006 Dec;25(4):483-6
references.pmid: 17310837
references.citation: World J Surg. 2002 Jan;26(1):22-8
references.pmid: 11898029