Markovic, Ivan1,2; Santrac, Nada2; Goran, Merima2; Buta, Marko1, 2; Jevric, Marko2; Pupic, Gordana3; Petrovic, Nevena2; Markovic, Marija2; Dzodic, Radan1, 2
1 Medical Faculty, University of Belgrade, Belgrade, Serbia
2 Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
3 Department of Pathology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
Background: The incidence of histologically proven lymph node metastases (LNM) in papillary thyroid carcinoma (PTC) reaches 80%. According to different guidelines, surgical management in cN0 patients remains controversial. Efficacy of sentinel lymph node (SLN) biopsy in breast cancer and melanoma encouraged some authors to apply this concept in PTC [1,2].
Purpose: To investigate if SLN biopsy using methylene blue dye is accurate in detection of LNMs in lateral neck compartment in cN0 patients with PTC.
Methods: All 153 cN0 patients with PTC underwent total thyroidectomy, central neck dissection and SLN biopsy in lateral neck compartments. Selective modified lateral neck dissection was performed in cases of metastatic SLNs.
Results: Neck LNMs were histologically verified in 40.9% of cases. Predictive factors for LNMs were: male gender, age under 45 years, tumors greater than 1cm, capsular and vascular invasion. Central LNMs were predictive for lateral LNMs in 80.5% of cases. LNMs were confirmed in 21% of SLNs in lateral neck compartments, which were over 50% predictive of LNMs in other dissected lateral lymph nodes. SLNs identification rate was 91.8%. Sensitivity, specificity, positive and negative predictive value were 85.7%, 96.7%, 88.3% and 95.9%, respectively. The overall accuracy of the method was 94.3%, with probability of 91.2% (ROC AUC, 95% CI; 84.2 to 98.3%).
Discussion & Conclusion: The proposed method of SLN biopsy is feasible, safe and accurate in detection of LNMs in the lateral neck compartments and may help in decision to perform selective modified lateral neck dissection in cN0 patients with PTC [1-4].
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- Patron V, Hitier M, Bedfert C et al. Predictive factors for lateral occult lymph node metastases in papillary thyroid carcinoma. Eur Arch Otorhinolaryngol. 2013; 270:2095–2100.
- Lee SK, Kim SH, Hur SM, Choe JH, Kim JH, Kim JS. The efficacy of lateral neck sentinel lymph node biopsy in papillary thyroid carcinoma. World J Surg. 2011; 35(12):2675-2682.