title: The usefulness and accuracy of sentinel lymph node biopsy using single photon emission computed tomography/computed tomography with 99mTc phytate to detect locoregional lymph node metastases in patients with papillary thyroid carcinoma.
abstract: OBJECTIVE
  Regional lymph node (LN) metastases are detected in 57-85% of patients with papillary thyroid carcinoma (PTC) and are associated with increased tumor recurrence. However, the management of lymphatic disease in patients with PTC has been ongoing source of debate. We have prospectively assessed the usefulness and accuracy of sentinel LN (SLN) biopsy for the detection of LN metastases in patients with PTC on preoperative imaging using single photon emission computed tomography/computed tomography (SPECT/CT) and 99mTc phytate.
  
  
  METHODS
  We prospectively assessed 39 patients with PTC who had risk factors for recurrence or with the necessity of intraoperative LN sampling for suspicious LN metastases on preoperative imaging from August 2010 to March 2011. The patients underwent preoperative lymphoscintigraphy and SPETC/CT and intraoperative SLN biopsy (SLNB).
  
  
  RESULTS
  99mTc lymphoscintigraphy and SPECT/CT localized SLN in 38 patients (97.4%), with the gamma probe identifying 2.15 mean SLNs in the lateral neck of the 39 patients. Skip metastasis was found in one patient, and lateral compartment LN metastasis in 17 (43.5%). The sensitivity, specificity, and accuracy of SLNB for lateral compartment LN metastasis were 88.2%, 100%, and 94.8%, respectively. SLNB was more accurate and useful for lateral than for central compartment LN metastasis.
  
  
  CONCLUSIONS
  SPECT/CT improved SLN detection and anatomical localization compared with lymphoscintigraphy. SLNB in patients with risk factors for recurrence or the necessity of intraoperative LN sampling for suspected LN metastases on preoperative imaging was accurate in detecting LN metastases and may help in deciding whether to perform lateral compartment dissection in patients with PTC.
authors.affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Jeonghun
authors.initials: J
authors.lastname: Lee
authors.forename: Kuk Young
authors.initials: KY
authors.lastname: Na
authors.forename: Jandee
authors.initials: J
authors.lastname: Lee
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Lee
authors.forename: Young Sil
authors.initials: YS
authors.lastname: An
authors.forename: Joon Kee
authors.initials: JK
authors.lastname: Yoon
authors.forename: Euy Young
authors.initials: EY
authors.lastname: Soh
keywords: Papillary thyroid cancer; Sentinel lymph node biopsy; Single photon emission computed tomography; X-ray computed tomography