ORIGINAL ARTICLE   

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2020 December;64(4):400-5

DOI: 10.23736/S1824-4785.18.03097-2

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Applicability of sentinel lymph node biopsy in papillary thyroid cancer

Eduardo DELGADO-OLIVER ¹ ✉, Sergi VIDAL-SICART ², Daniel MARTÍNEZ ³, Mattia SQUARCIA ⁴, Mireia MORA ⁵, Felizia A. HANZU ⁵, Irene HALPERIN ⁵, David FUSTER ², Constantino FONDEVILA ¹, Óscar VIDAL-PEREZ ¹

¹ 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; ² Department of Nuclear Medicine, Image Diagnostic Center, Clinical Hospital, University of Barcelona, Barcelona, Spain; ³ Department of Pathological Anatomy, Biomedical Diagnostic Center, Clinical Hospital, University of Barcelona, Barcelona, Spain; ⁴ Department of Radiology, Image Diagnostic Center, Clinical Hospital, University of Barcelona, Barcelona, Spain; ⁵ 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

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.

KEY WORDS: Sentinel lymph node; Thyroid cancer, papillary; Lymphatic metastasis; Thyroid neoplasms