title: Sentinel lymph node biopsy in thyroid cancer: it can work but there are pitfalls.
abstract: OBJECTIVE
  The aim of this study is to retrospectively assess the specific perils associated with conducting sentinel lymph node biopsies to determine whether a central compartment neck dissection (CCND) is necessary in well-differentiated thyroid cancer. The goal was to assess the specific reasons for a false negative in 3 specific patients among a large population of thyroidectomy patients.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Three McGill University teaching hospitals that are part of the McGill University Thyroid Cancer Center in Montreal, Quebec, Canada.
  
  
  METHODS
  Patients undergoing thyroidectomy and CCND for nodules suspicious for thyroid cancer (June 2009 to May 2010).
  
  
  METHODS
  Retrospective analysis of 157 patients who underwent thyroidectomy and analysis of CCND as a function of sentinel lymph node status on frozen section as determined by a pathologist at one of the participating centers.
  
  
  RESULTS
  Three patients were considered true failures or false negatives of the original protocol. These 3 patients were deemed to have benign lymph node status intraoperatively but were found postoperatively to harbor malignancy and therefore should have undergone CCND. The critical reasons for the imperfect false-negative rate are believed to be secondary to samples falsely deemed benign as well as multinodular disease.
  
  
  CONCLUSIONS
  The value of sentinel lymph node biopsy in thyroid cancer, although largely debated, appears to be strong. If caution is taken in using dedicated head and neck pathologists for sentinel lymph node cases, as well as properly addressing multinodular malignancy, clinical decision making can be rendered more objective.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, McGill University Thyroid Cancer Center, Montreal, Canada. Alexander.amir@mail.mcgill.ca
authors.forename: Alexander
authors.initials: A
authors.lastname: Amir
authors.forename: Richard
authors.initials: R
authors.lastname: Payne
authors.forename: Keith
authors.initials: K
authors.lastname: Richardson
authors.forename: Michael
authors.initials: M
authors.lastname: Hier
authors.forename: Alex
authors.initials: A
authors.lastname: Mlynarek
authors.forename: Derin
authors.initials: D
authors.lastname: Caglar
mesh_terms: D000328:Adult; D000368:Aged; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy