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

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.