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Sentinel Lymph Node Biopsy in Thyroid Cancer.

Max B Albers^1,2, Erik Nordenström³, Johan Wohlfahrt³

¹Department of Surgery, Skåne University Hospital, Lund University, 22185, Lund, Sweden. albersm@med.uni-marburg.de.

World Journal of Surgery

|October 5, 2019

Summary

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Sentinel lymph node biopsy in suspected thyroid cancer has a low detection rate and moderate sensitivity. This technique is not currently a useful adjunct to surgery for optimizing treatment in these patients.

Area of Science:

Oncology
Surgical Oncology
Nuclear Medicine

Background:

Prophylactic central neck dissection for papillary thyroid carcinoma remains controversial.
Sentinel lymph node biopsy (SLNB) is being investigated to refine surgical treatment for thyroid cancer.
Previous studies show variable detection rates and diagnostic accuracy for SLNB in thyroid cancer.

Purpose of the Study:

To evaluate the efficacy of sentinel lymph node biopsy as an adjunct to central neck dissection in patients with suspected thyroid carcinoma.
To establish the role and diagnostic value of SLNB in the surgical management of thyroid cancer.

Main Methods:

A single-center prospective interventional study was conducted from 2010 to 2017.
Sentinel lymph node biopsy was performed using a 99mTc-nanocolloidal albumin tracer in patients undergoing thyroid surgery for suspected cancer.

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Central neck dissection was performed on all patients post-SLNB.

Main Results:

The study included 96 patients. Sentinel node detection rates were 67% (scintigraphy) and 45% (gamma probe).
Detection rates were not correlated with Bethesda score, malignancy, or lymph node metastasis.
SLNB demonstrated 80% sensitivity, 97% negative predictive value, and 98% accuracy for detecting central neck lymph node metastasis, with a 20% false negative rate.

Conclusions:

Sentinel lymph node biopsy exhibited low detection rates and only moderate sensitivity in patients with suspected thyroid carcinoma.
The findings suggest SLNB is not a useful adjunct to surgery within current treatment paradigms for thyroid cancer.