title: Frozen section analysis and sentinel lymph node biopsy in well differentiated thyroid cancer.
abstract: BACKGROUND
  The aim of this study is to prospectively review the role of sentinel lymph node (SLN) biopsy in the management of well differentiated thyroid carcinoma (WDTC), and to determine the efficacy of intraoperative frozen section analysis at detecting SLN metastasis and central compartment involvement.
  
  
  METHODS
  The SLN biopsy protocol using 1% methylene blue was performed in 300 patients undergoing thyroidectomy for WDTC. A limited pretracheal central compartment neck dissection (CCND) was performed on all patients. Lymph nodes staining blue were considered as SLN's. Both frozen and permanent section analyses were performed.
  
  
  RESULTS
  SLN's with metastasis were found in 14.3% (43/300) of cases. Of this, 11% (33/300) were positive on intraoperative frozen section analysis. Frozen section results failed in predicting central compartment involvement in 15 cases (5%) whereas central neck compartment involvement was missed in 5 cases (1.7%) when based on permanent section results. On frozen section analysis, the sensitivity, specificity, positive predictive value and negative predictive value (95% CI) of our SLN biopsy technique aiming to remove all disease from the central compartment was 68.8% (53.6-80.9), 100% (98.1-100), 100% (87.0-100) and 94.4% (90.7-96.7) respectively with P < 0.0001. On permanent section analysis, the values were 89.6% (76.6-96.1), 100% (98.1-100), 100% (89.8-100), and 98.1% (95.3-99.3) with P < 0.0001.
  
  
  CONCLUSIONS
  This data series demonstrates that patients with WDTC have positive SLN's in 14.3% of cases. Moreover, when the SLN's are negative for metastasis on frozen section, the central compartment was disease-free in 94.4% of cases. Finally, this study shows that 23.3% of positive SLN's were false negatives on intraoperative frozen section. According to this data, SLN involvement is an accurate predictor of central compartment metastasis, however surgeons should use caution when relying on intraoperative frozen section to determine whether to perform a CCND.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, McGill University Thyroid Cancer Center, 3755 Côte Ste-Catherine, Montreal, PQ, Canada. rkpayne@sympatico.ca.
authors.forename: Yelda
authors.initials: Y
authors.lastname: Jozaghi
authors.forename: Keith
authors.initials: K
authors.lastname: Richardson
authors.forename: Sumeet
authors.initials: S
authors.lastname: Anand
authors.forename: Alex
authors.initials: A
authors.lastname: Mlynarek
authors.forename: Michael P
authors.initials: MP
authors.lastname: Hier
authors.forename: Véronique-Isabelle
authors.initials: VI
authors.lastname: Forest
authors.forename: Eyal
authors.initials: E
authors.lastname: Sela
authors.forename: Michael
authors.initials: M
authors.lastname: Tamilia
authors.forename: Derin
authors.initials: D
authors.lastname: Caglar
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Payne
mesh_terms: D000328:Adult; D005260:Female; D005629:Frozen Sections; D006801:Humans; D007432:Intraoperative Period; D008207:Lymphatic Metastasis; D008297:Male; D008751:Methylene Blue; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy
chemical_list: D008751:Methylene Blue
references.citation: Acta Otolaryngol. 2001 Apr;121(3):421-4
references.pmid: 11425213
references.citation: Eur Arch Otorhinolaryngol. 2003 Aug;260(7):364-8
references.pmid: 12937912
references.citation: Int J Gynecol Cancer. 2001 Jul-Aug;11(4):255-62
references.pmid: 11520362
references.citation: Surgery. 2005 Dec;138(6):1095-100, discussion 1100-1
references.pmid: 16360396
references.citation: Ann Surg Oncol. 2010 Nov;17(11):2970-5
references.pmid: 20552407
references.citation: World J Surg. 2000 Nov;24(11):1396-401
references.pmid: 11038213
references.citation: Langenbecks Arch Surg. 1998 Apr;383(2):167-9
references.pmid: 9641892
references.citation: Cancer Control. 2000 May-Jun;7(3):240-5
references.pmid: 10832110
references.citation: Arch Otolaryngol Head Neck Surg. 2001 Aug;127(8):970-4
references.pmid: 11493208
references.citation: Am J Surg. 2006 Mar;191(3):305-10
references.pmid: 16490536
references.citation: Arch Surg. 1998 Mar;133(3):288-92
references.pmid: 9517742
references.citation: Cancer. 2001 Dec 1;92(11):2868-74
references.pmid: 11753960
references.citation: Oral Oncol. 2003 Jun;39(4):343-9
references.pmid: 12676253
references.citation: Recent Results Cancer Res. 2000;157:201-5
references.pmid: 10857173
references.citation: Head Neck. 1996 Mar-Apr;18(2):127-32
references.pmid: 8647677
references.citation: Arch Otolaryngol Head Neck Surg. 2009 Dec;135(12):1199-204
references.pmid: 20026816
references.citation: Br J Surg. 2011 Mar;98(3):334-44
references.pmid: 21246517
references.citation: World J Surg. 2006 May;30(5):841-6
references.pmid: 16680598
references.citation: Surg Gynecol Obstet. 1989 Aug;169(2):107-14
references.pmid: 2667172