Sentinel lymph node biopsy guided neck dissection in patients with papillary thyroid carcinoma / 中华普通外科杂志

ABSTRACT

ObjectiveTo evaluate combined radioisotope and methylene blue dye method for identifying sentinel lymph node (SLN) for modified radical neck dissection of papillary thyroid carcinoma (PTC). MethodFifty-one consecutive PTC patients without clinical evidence of locoregional lymph node involvement were enrolled in the study between August 2007 and September 2010.5 h ( rangel.5 - 8 h) before the surgery,one single intratumoral injection of 74 MBq in a volume of 0.4 ml 99mTc -Dextran was administered under ultrasound guidance and 1％ methylene blue dye was injected into the parenchyma surrounding the primary tumor intraoperatively.Preoperative lymphoscintigraphy,intra-operative hand-held gamma probe detecting and blue dyed lymph node were used to identify the SLN.All SLNs were sent for frozen-section and the specimens of routine selective neck dissection were stained with haematoxylin and eosin (H&E). ResultsSLNs were identified in 48 of 51 cases (94.1％ ) with combination method.SLN identification rate were 66.7％by methylene blue dye method and 90.2％by radioisotope method respectively.Final pathologic examination revealed that 30 cases ( 58.8％ ),including 3 cases who had negative SLNs,had lateral neck occult lymph node metastasis.The rate of occult lymph node metastasis in level Ⅱ,level Ⅲ,level Ⅳ and level Ⅴ were 17.6％,52.9％,29.4％ and 0％.Thus,the sensitivity,specificity,accuracy, and positive and negative predictive values of SLN biopsy were 90％, 100％,94.1％,100％ and 87.5％,respectively. ConclusionsSLNB is feasible and safe,the findings correlate with lateral lymph node status.Therefore,SLN biopsy is a good method for estimating the status of lateral lymph node in patients with clinical negative lymph node papillary thyroid carcinoma.