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Sentinel node biopsy in papillary thyroid cancer--what is the potential?
S P Balasubramanian1, J Brignall, H Y Lin
1Department of Oncology, University of Sheffield, Sheffield, UK, s.p.balasubramanian@sheffield.ac.uk.
Langenbeck'S Archives of Surgery
|January 22, 2014
Summary
Sentinel node biopsy (SNB) for papillary thyroid cancer (PTC) has limited benefits in reducing central node dissection (CND) and associated morbidity. The costs of implementing SNB outweigh potential savings, making its routine use questionable.
Area of Science:
- Oncology
- Surgical Pathology
- Nuclear Medicine
Background:
- Papillary thyroid cancer (PTC) management often involves central node dissection (CND).
- Sentinel node biopsy (SNB) is a technique to identify lymph node metastases, potentially guiding CND.
- Assessing SNB feasibility and impact in PTC is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the feasibility of implementing SNB in thyroidectomy patients with indeterminate/suspicious/malignant nodules.
- To determine the potential clinical outcome improvements and costs associated with SNB.
- To assess the role of SNB in selecting patients for central node dissection (CND).
Main Methods:
- Retrospective analysis of two cohorts (5-year period) from different centers.
- Evaluation of treatment strategies, clinical, and pathological outcomes.
- Estimation of SNB implementation benefits and costs.
Main Results:
- In center 1, 108 of 819 patients were suitable for SNB; 23 had PTC. Five of six patients undergoing CND had no metastasis, suggesting potential avoidance of CND morbidity.
- SNB implementation costs exceeded potential savings.
- Center 2 analysis showed similar limited benefits, with potential avoidance of CND morbidity in up to seven patients over 5 years.
Conclusions:
- Even with ideal SNB performance (100% identification, 0% false negatives), the short- to medium-term benefit is low.
- The potential to avoid morbidity from central node dissection (CND) is limited.
- SNB is unlikely to significantly improve outcomes or reduce costs in centers with selective or routine CND policies.
