title: The Utility of Sentinel Lymph Node Biopsy in Papillary Thyroid Carcinoma with Occult Lymph Nodes.
abstract: BACKGROUND
  The sentinel lymph node (SLN) is defined as the first draining node from the primary lesion, and it has proven to be a good indicator of the metastatic status of regional lymph nodes in solid tumors. The aim of this study was to evaluate the clinical application of SLN biopsy (SLNB) in papillary thyroid carcinoma (PTC) with occult lymph nodes.
  
  
  METHODS
  From April 2006 to October 2012, 212 consecutive PTC patients were treated with SLNB using carbon nanoparticle suspension (CNS). Then, the stained nodes defined as SLN were collected, and prophylactic central compartment neck dissection (CCND) followed by total thyroidectomy or subtotal thyroidectomy were performed. All the samples were sent for pathological examination.
  
  
  RESULTS
  There were 78 (36.8%) SLN metastasis (SLNM)-positive cases and 134 (63.2%) SLNM-negative cases. The sensitivity, specificity, positive and negative predictive values, and false-positive and false-negative rates of SLNB were 78.8%, 100%, 100%, 84.3%, 0%, and 21.2%, respectively. The PTC patients with SLNM were more likely to be male (48.2% vs. 32.7%, p = 0.039) and exhibited multifocality (52.6% vs. 33.3%, p = 0.025) and extrathyroidal extension (56.7% vs. 33.5%, p = 0.015). A greater incidence of non-SLN metastases in the central compartment was found in patients with SLNM (41/78, 52.6%) than in those without SLNM (21/134, 15.7%; p < 0.05). However, the SLNM-negative PTC patients with non-SLN metastases were more likely to be male (37.9% vs. 9.5%, p < 0.05).
  
  
  CONCLUSIONS
  The application of SLNB using CNS is technically feasible, safe, and useful, especially for male patients with co-existing multifocality and extrathyroidal extension. However, the sensitivity of SLNB must be improved and its false-negative rate reduced before it can be a routine procedure and replace prophylactic CCND. More attention should be paid to PTC patients (especially males) without SLNM for signs of non-SLN metastases.
authors.affiliation: Department of Surgical Oncology, Taizhou Hospital, Wenzhou Medical University, Linhai, Zhejiang Province, People's Republic of China; Department of Surgical Oncology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China.
authors.forename: Xingqiang
authors.initials: X
authors.lastname: Yan
authors.affiliation: Department of Surgical Oncology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China.
authors.forename: Ruichao
authors.initials: R
authors.lastname: Zeng
authors.affiliation: Department of Surgical Oncology, Taizhou Hospital, Wenzhou Medical University, Linhai, Zhejiang Province, People's Republic of China.
authors.forename: Zhaosheng
authors.initials: Z
authors.lastname: Ma
authors.affiliation: Department of Surgical Oncology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China.
authors.forename: Chengze
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Surgical Oncology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China.
authors.forename: Endong
authors.initials: E
authors.lastname: Chen
authors.affiliation: Department of Surgical Oncology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China.
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Surgical Oncology, Taizhou Hospital, Wenzhou Medical University, Linhai, Zhejiang Province, People's Republic of China.
authors.forename: Feilin
authors.initials: F
authors.lastname: Cao
mesh_terms: D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013961:Thyroid Gland / Q000473:pathology / Q000601:surgery; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy; D055815:Young Adult