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Sentinel lymph node biopsy in clinically node negative patients with papillary thyroid carcinoma.

Ivan Markovic1, Merima Goran, Marko Buta

  • 1Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia.

Journal of B.U.ON. : Official Journal of the Balkan Union of Oncology
|April 12, 2020
PubMed
Summary

Sentinel lymph node biopsy (SLNB) using methylene blue dye accurately detects lateral neck lymph node metastases in papillary thyroid carcinoma (PTC) patients. This method aids decisions regarding selective neck dissection for clinically node-negative (cN0) PTC.

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Head and Neck Surgery

Background:

  • Papillary thyroid carcinoma (PTC) has a high incidence of lymph node metastases (LNM), reaching 80%.
  • Surgical management of clinically node-negative (cN0) PTC patients with potential LNM remains controversial.
  • Accurate staging of lateral neck lymph nodes is crucial for appropriate treatment decisions.

Purpose of the Study:

  • To evaluate the accuracy of sentinel lymph node biopsy (SLNB) using methylene blue dye for detecting LNM in the lateral neck compartment of cN0 PTC patients.
  • To determine the feasibility and safety of this SLNB technique.

Main Methods:

  • A study involving 153 cN0 PTC patients undergoing total thyroidectomy with central neck dissection and lateral neck SLNB using methylene blue dye.
  • Selective modified radical neck dissection was performed for patients with metastatic sentinel lymph nodes.
  • Analysis of SLN identification rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Main Results:

  • Histologically confirmed LNM in 40.9% of patients.
  • SLN identification rate was 91.8%, with 24% of SLNs positive for metastases.
  • The SLNB method demonstrated high accuracy (94.3%) with sensitivity (85.7%), specificity (96.7%), PPV (88.3%), and NPV (95.9%).
  • Predictive factors for LNM included male gender, age <45, tumor size >1cm, capsular, and vascular invasion.

Conclusions:

  • Sentinel lymph node biopsy with methylene blue dye is a feasible, safe, and accurate method for detecting lateral neck LNM in cN0 PTC.
  • This technique can effectively guide decisions for selective modified radical neck dissection, optimizing patient management.
  • The study supports the utility of SLNB in refining surgical strategies for PTC.