Santrac, Nada1; Markovic, Ivan1, 2; Goran, Merima1; Buta, Marko1, 2; Djurisic, Igor1; Pupic, Gordana3; Zivkovic, Ognjen3; Dzodic, Radan1,2
1 Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
2 Medical Faculty, University of Belgrade, Belgrade, Serbia
3 Department of Pathology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
Background: Management of lymph nodes (LN) in medullary thyroid carcinoma (MTC) is an ongoing debate.
Purpose: The aim was to analyze usefulness of sentinel lymph node biopsy (SLNB) of jugulo-carotid regions after methylene blue dye (MBD) mapping for selection of cN0, but true positive, patients with micro-MTC for one-time modified radical neck dissection (MRND).
Methods: From 2007 to 2016th, 15 cN0 patients were operated in our institution due to micro-MTCs (?10mm), with serum calcitonin levels <1000pg/ml. Total thyroidectomy with central neck dissection was done in all patients. Sentinel-LN mapping was performed by injecting 1%-MBD subcapsullary in both lobes. Levels II-III were explored on both sides, blue stained sentinel-LNs were removed and examined by frozen section . If sentinel-LNs were benign, additional surrounding non-colored-LNs were sent to standard histopathology. If sentinel-LNs were positive, one-time MRND was performed.
Results: One patient had hereditary, bilateral micro-MTCs, with calcitonin level 221pg/ml and central-LN metastases. Sentinel-LNs were positive on both sides, thus bilateral MRND was performed. Metastases in other lateral-LNs were found, as well. Other 14 patients had sporadic, unilateral micro-MTC and showed neither central nor lateral-LN metastases on bilateral SLNB. Frozen section and definite histopathology were 100% match.
Discussion & Conclusion: SLNB after MBD mapping can be precisely used for intraoperative assessment of lateral-LNs. It optimizes surgery of micro-MTCs, selecting cN0 patients, with lateral metastases on frozen section, for one-time MRND. This pilot study is the first reported experience with SLNB of jugulo-carotid regions in MTCs using MBD, focusing on the subgroup of microcarcinomas.
- Dzodic R, Markovic I, Inic M, Jokic N, Djurisic I, Zegarac M, Pupic G, Milovanovic Z, Jovic V, Jovanovic N. Sentinel lymph node biopsy may be used to support the decision to perform modified radical neck dissection in differentiated thyroid carcinoma. Wold J Surg 2006 May; 30(5): 841-6