1
|
Boschin IM, Bertazza L, Scaroni C, Mian C, Pelizzo MR. Sentinel lymph node mapping: current applications and future perspectives in thyroid carcinoma. Front Med (Lausanne) 2023; 10:1231566. [PMID: 37942415 PMCID: PMC10629113 DOI: 10.3389/fmed.2023.1231566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/26/2023] [Indexed: 11/10/2023] Open
Abstract
Sentinel lymph node (SLN) mapping is a standard, minimally-invasive diagnostic method in the surgical treatment of many solid tumors, as for example melanoma and breast cancer, for detecting the presence of regional nodal metastases. A negative SLN accurately indicates the absence of metastases in the other regional lymph nodes (LN), thus avoiding unnecessary lymph nodal dissection. Papillary thyroid carcinoma (PTC) is the most common type of thyroid carcinoma (TC) with cervical LN metastases at diagnosis in 20-90%, and nodal involvement correlates with local persistence/recurrence. The SLN in PTC is an intraoperative method for staging preoperative N0 patients and for detecting metastatic LNs "in and outside" the cervical LN central compartment; it represents an alternative method to prophylactic central neck node dissection. In this review we summarize different methods and results of the use of SLN in TC. The SLN identification techniques currently used include the selective vital-dye (VD) method, 99mTc-nanocolloid planar lymphoscintigraphy with intraoperative use of a hand-held gamma probe (LS), the combination LS + VD, and the combination LS and preoperative SPECT-CT (LS + SPECT/CT). The application of the SLN procedure in TC has been described in many studies, however, the techniques are heterogeneous, and the role of SLN in TC, with indications, results, advantages and limits, is still debated.
Collapse
Affiliation(s)
- Isabella Merante Boschin
- UOC Endocrinology, Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche (DiSCOG), Università degli Studi di Padova, Azienda Ospedale-Università di Padova, Padua, Italy
| | - Loris Bertazza
- UOC Endocrinology, Dipartimento di Medicina (DIMED), Università degli Studi di Padova, Azienda Ospedale-Università di Padova, Padua, Italy
| | - Carla Scaroni
- UOC Endocrinology, Dipartimento di Medicina (DIMED), Università degli Studi di Padova, Azienda Ospedale-Università di Padova, Padua, Italy
| | - Caterina Mian
- UOC Endocrinology, Dipartimento di Medicina (DIMED), Università degli Studi di Padova, Azienda Ospedale-Università di Padova, Padua, Italy
| | - Maria Rosa Pelizzo
- Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche (DiSCOG), Università degli Studi di Padova, Padua, Italy
| |
Collapse
|
2
|
Kim HY, Kim DI, Jung CS, Lee SJ, Im DW, Jung YJ, Yeom JA, Choi JB. Utility of sentinel lymph node biopsy in papillary thyroid microcarcinoma. KOREAN JOURNAL OF CLINICAL ONCOLOGY 2021; 17:117-121. [PMID: 36945673 PMCID: PMC9942750 DOI: 10.14216/kjco.21018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/06/2021] [Accepted: 12/06/2021] [Indexed: 06/18/2023]
Abstract
PURPOSE There are many studies on sentinel lymph node (SLN) biopsy in thyroid carcinoma but SLN biopsy (SLNB) in papillary thyroid carcinoma (PTC) remains open to debate. Therefore in this retrospective study, the usefulness of SLNB in thyroid carcinoma patients who had micro-PTC without cervical lymphadenopathy was assessed. METHODS SLNB was performed in 114 patients who were diagnosed with micro-PTC in a single lobe without palpable or ultrasound-detected lymph node at the tertiary center between January 2012 and December 2013. After SLNB, all patients underwent total thyroidectomy and central neck dissection or thyroid lobectomy and central neck dissection of the single side. RESULTS SLNs were identified in 112 of 114 patients with 41 positive SLNs and 71 negative SLNs on intraoperative frozen sections. However, eight negative patients were found to be positive in the final pathology. Sentinel node identification rate and false negative value of SLNB were 98.2% and 11.3%, respectively. In the univariate analysis, higher lymph node metastasis was detected in men than in women. Higher detection number of SLN showed higher probability of lymph node metastasis. CONCLUSION SLNB may be helpful in papillary thyroid cancer, especially in male patients. Also, it is useful for the staging of nodal status and clearance of persistent disease.
Collapse
Affiliation(s)
- Hyun Yul Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong-il Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Chang Shin Jung
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seung Joo Lee
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Won Im
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Youn Joo Jung
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jeong-a Yeom
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jeong Bum Choi
- Department of Surgery, Pusan National University Hospital, Busan, Korea
| |
Collapse
|
3
|
Magnetic detection of sentinel lymph node in papillary thyroid carcinoma: The MAGIC-PAT study results. Eur J Surg Oncol 2019; 45:1175-1181. [DOI: 10.1016/j.ejso.2019.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/05/2019] [Accepted: 03/11/2019] [Indexed: 01/20/2023] Open
|
4
|
Abstract
PURPOSE The aim of this study was to compare reported results on available techniques for sentinel lymph node detection rate (SDR) in papillary thyroid cancer (PTC). METHODS The MEDLINE database was searched via a PubMed interface to identify original articles regarding sentinel lymph node biopsy (SNB) in thyroid cancer. Studies were stratified according to the sentinel lymph node (SLN) detection technique: vital-dye (VD), Tc-nanocolloid planar lymphoscintigraphy with the use of intraoperative hand-held gamma probes (LS), both Tc-nanocolloid planar lymphoscintigraphy with intraoperative use of hand-held gamma probe and VD (LS + VD), Tc-nanocolloid planar lymphoscintigraphy with the additional contribution of preoperative SPECT/CT, and intraoperative use of hand-held gamma probe (LS-SPECT/CT). Pooled SDR values were presented with a 95% confidence interval (CI) for each SLN detection techniques. A Z-test was used to compare pooled SDR estimates. False-negative rates were summarized for each method. RESULTS Forty-five studies were included. Overall SDRs for the VD, LS, LS + VD, and LS-SPECT/CT techniques were 83% (95% CI, 77%-88%; I = 78%), 96% (95% CI, 90%-98%; I = 68%), 87% (95% CI, 65%-96%; I = 75%), and 93% (95% CI, 86%-97%; I = 0%), respectively. False-negative rates were 0% to 38%, 0% to 40%, 0% to 17%, and 7% to 8%, respectively. CONCLUSIONS In patients with PTC, Tc-nanocolloids offer a higher SDR than that of the VD technique. The addition of SPECT/CT improved identification of metastatic SLNs outside the central neck compartment.
Collapse
|
5
|
Sapienza MT. Radioguided localization of recurrent lymph nodes in differentiated thyroid cancer - Where are we now? ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:491-492. [PMID: 30462799 PMCID: PMC10118647 DOI: 10.20945/2359-3997000000079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 10/16/2018] [Indexed: 11/23/2022]
|
6
|
Delgado-Oliver E, Vidal-Sicart S, Martínez D, Squarcia M, Mora M, Hanzu FA, Halperin I, Fuster D, Fondevila C, Vidal-Perez Ó. Applicability of sentinel lymph node biopsy in papillary thyroid cancer. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018; 64:400-405. [PMID: 29999291 DOI: 10.23736/s1824-4785.18.03097-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The optimal surgical management of papillary thyroid cancer (PTC) for T1-T2 tumors without pre or intrasurgical evidence of lymph node metastasis (cN0) remains controversial, since approximately 40% of patients have lymph node involvement (pN1) which becomes evident when a prophylactic lymphadenectomy (PL) is performed. The aim of this study was to investigate the feasibility of sentinel lymph node (SLN) identification with SPECT/CT lymphoscintigraphy imaging along with intraoperatory image techniques in early stages of PTC undergoing PL of central neck compartment (CNC). METHODS A single-center, prospective consecutive study was designed for SLN mapping in patients with high suspicion of PTC (Bethesda V or VI) in early stage (cT1-2, cN0). Twenty-four patients underwent SLN identification with preoperative SPECT/CT and planar images (99mTc-nanocolloid albumin intratumoral injection). During surgery, SLN located in CNC was found by means of a gamma probe and portable gamma camera, and excised. Afterwards, CNC lymphadenectomy was performed in all cases without modifying the established protocol. RESULTS SLNs were identified and accurately located in 23 (95.8%) patients. Nodal metastases (pN1) were confirmed in 9 (37.5%) patients, with one false negative case. The sensitivity was 88.9% and negative predictive value (NPV) was 93.3%, would have allowed to avoid PL in more than half of cases, a higher proportion than those found in other similar studies. No complications associated with the procedure were observed. CONCLUSIONS Our results support that SLN biopsy by SPECT/CT along with intraoperatory image techniques is applicable in early stages of PTC (cT1-2, cN0), allowing to avoid unnecessary PL.
Collapse
Affiliation(s)
- Eduardo Delgado-Oliver
- Department of General Surgery, Institute of Digestive and Metabolic Diseases, Center for Biomedical Research in Network of Hepatic and Digestive Diseases, August Pi i Sunyer Institute of Biomedical Research, Clinical Hospital, University of Barcelona, Barcelona, Spain -
| | - Sergi Vidal-Sicart
- Department of Nuclear Medicine, Image Diagnostic Center, Clinical Hospital, University of Barcelona, Barcelona, Spain
| | - Daniel Martínez
- Department of Pathological Anatomy, Biomedical Diagnostic Center, Clinical Hospital, University of Barcelona, Barcelona, Spain
| | - Mattia Squarcia
- Department of Radiology, Image Diagnostic Center, Clinical Hospital, University of Barcelona, Barcelona, Spain
| | - Mireia Mora
- Department of Endocrinology and Nutrition, Institute of Digestive and Metabolic Diseases, Center for Biomedical Research in Network of Hepatic and Digestive Diseases, August Pi i Sunyer Institute of Biomedical Research, Clinical Hospital, University of Barcelona, Barcelona, Spain
| | - Felizia A Hanzu
- Department of Endocrinology and Nutrition, Institute of Digestive and Metabolic Diseases, Center for Biomedical Research in Network of Hepatic and Digestive Diseases, August Pi i Sunyer Institute of Biomedical Research, Clinical Hospital, University of Barcelona, Barcelona, Spain
| | - Irene Halperin
- Department of Endocrinology and Nutrition, Institute of Digestive and Metabolic Diseases, Center for Biomedical Research in Network of Hepatic and Digestive Diseases, August Pi i Sunyer Institute of Biomedical Research, Clinical Hospital, University of Barcelona, Barcelona, Spain
| | - David Fuster
- Department of Nuclear Medicine, Image Diagnostic Center, Clinical Hospital, University of Barcelona, Barcelona, Spain
| | - Constantino Fondevila
- Department of General Surgery, Institute of Digestive and Metabolic Diseases, Center for Biomedical Research in Network of Hepatic and Digestive Diseases, August Pi i Sunyer Institute of Biomedical Research, Clinical Hospital, University of Barcelona, Barcelona, Spain
| | - Óscar Vidal-Perez
- Department of General Surgery, Institute of Digestive and Metabolic Diseases, Center for Biomedical Research in Network of Hepatic and Digestive Diseases, August Pi i Sunyer Institute of Biomedical Research, Clinical Hospital, University of Barcelona, Barcelona, Spain
| |
Collapse
|
7
|
Gelmini R, Campanelli M, Cabry F, Franceschetto A, Ceresini G, Ruffini L, Zaccaroni A, Del Rio P. Role of sentinel node in differentiated thyroid cancer: a prospective study comparing patent blue injection technique, lymphoscintigraphy and the combined technique. J Endocrinol Invest 2018; 41:363-370. [PMID: 28861856 DOI: 10.1007/s40618-017-0756-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/26/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of the present study was to evaluate the feasibility and reproducibility of the sentinel lymph node (SLNs) biopsy in differentiated thyroid cancer using patent blue injection, lymphoscintigraphy and the combined techniques. METHODS Between January 2011 and January 2013, 82 consecutive patients were enrolled in our prospective multicentre study. Inclusion criteria were 18 years of age, preoperative diagnosis of differentiated thyroid carcinoma, no evidence of lymph node enlargement and multifocal neoplasm. To investigate the benefits of each procedure, all patients underwent total thyroidectomy plus central compartment lymphadenectomy, and in all cases, the SLN was identified via one of three techniques using the same protocol. RESULTS Lymphoscintigraphy was used in five patients, patent blue injection was used in 40 patients, and a combined technique was used in 40 patients to identify sentinel lymph nodes (SLN). SLNs were identified in 61 cases. In the patent blue injection technique, the sensitivity, specificity and false negative rates were 88.9, 94.4 and 3.8%, respectively. In the lymphoscintigraphy technique, the percentages of sensitivity and specificity were 100%, and the percentage false negative was 0%. For the combined techniques, the corresponding values were, respectively, 69.2, 90, and 17.4%. Metastases were detected in nine cases of lateral-cervical nodes, ipsilateral tumour metastases were observed in eight cases, and contralateral tumour metastasis was observed in one case. CONCLUSION Additional well-designed randomized studies are needed to validate and further optimize the SLN biopsy in patients with differentiated thyroid cancer.
Collapse
Affiliation(s)
- R Gelmini
- Policlinico of Modena General Surgery 1 Unit, University of Modena and Reggio Emilia, Modena, Italy.
| | - M Campanelli
- Policlinico of Modena General Surgery 1 Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - F Cabry
- Policlinico of Modena General Surgery 1 Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - A Franceschetto
- Policlinico of Modena Nuclear Medicine Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - G Ceresini
- Department of Medicine, University Hospital of Parma, University of Parma, Parma, Italy
| | - L Ruffini
- Diagnostic Department, University Hospital of Parma, Parma, Italy
| | - A Zaccaroni
- Endocrine Surgery Unit, AUSL Romagna- Morgagni-Pierantoni Hospital Forlì, Forlì, Italy
| | - P Del Rio
- University Hospital of Parma Endocrine Surgery Unit, University of Parma, Parma, Italy
| |
Collapse
|
8
|
González Ó, Zafon C, Caubet E, García-Burillo A, Serres X, Fort JM, Mesa J, Castell J, Roca I, Ramón Y Cajal S, Iglesias C. Selective sentinel lymph node biopsy in papillary thyroid carcinoma in patients with no preoperative evidence of lymph node metastasis. ACTA ACUST UNITED AC 2017; 64:451-455. [PMID: 28895542 DOI: 10.1016/j.endinu.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/23/2017] [Accepted: 05/08/2017] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Lymphadenectomy is recommended during surgery for papillary thyroid carcinoma when there is evidence of cervical lymph node metastasis (therapeutic) or in high-risk patients (prophylactic) such as those with T3 and T4 tumors of the TNM classification. Selective sentinel lymph node biopsy may improve preoperative diagnosis of nodal metastases. OBJECTIVE To analyze the results of selective sentinel lymph node biopsy in a group of patients with papillary thyroid carcinoma and no evidence of nodal involvement before surgery. PATIENTS AND METHOD A retrospective, single-center study in patients with papillary thyroid carcinoma and no clinical evidence of lymph node involvement who underwent surgery between 2011 and 2013. The sentinel node was identified by scintigraphy. When the sentinel node was positive, the affected compartment was removed, and when sentinel node was negative, central lymph node dissection was performed. RESULTS Forty-three patients, 34 females, with a mean age of 52.3 (±17) years, were enrolled. Forty-six (27%) of the 170 SNs resected from 24 (55.8%) patients were positive for metastasis. In addition, 94 (15.6%) out of the 612 lymph nodes removed in the lymphadenectomies were positive for metastases. Twelve of the 30 (40%) low risk patients (cT1N0 and cT2N0) changed their stage to pN1, whereas 12 of 13 (92%) high risk patients (cT3N0 and cT4N0) changed to pN1 stage. CONCLUSIONS Selective sentinel lymph node biopsy changes the stage of more than 50% of patients from cN0 to pN1. This confirms the need for lymph node resection in T3 and T4 tumors, but reveals the presence of lymph node metastases in 40% of T1-T2 tumors.
Collapse
Affiliation(s)
- Óscar González
- Unidad de Cirugía Endocrina, Servicio de Cirugía General, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Carles Zafon
- Servicio de Endocrinología y Nutrición, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, España
| | - Enric Caubet
- Unidad de Cirugía Endocrina, Servicio de Cirugía General, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Amparo García-Burillo
- Servicio de Medicina Nuclear, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Xavier Serres
- Servicio de Radiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - José Manuel Fort
- Unidad de Cirugía Endocrina, Servicio de Cirugía General, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Jordi Mesa
- Servicio de Endocrinología y Nutrición, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, España.
| | - Joan Castell
- Servicio de Medicina Nuclear, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Isabel Roca
- Servicio de Medicina Nuclear, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Santiago Ramón Y Cajal
- Servicio de Anatomía Patológica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España; Grupo de Patología Molecular Traslacional, Institut de Recerca Vall d'Hebron, Barcelona, España
| | - Carmela Iglesias
- Servicio de Anatomía Patológica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España; Grupo de Patología Molecular Traslacional, Institut de Recerca Vall d'Hebron, Barcelona, España
| |
Collapse
|