Abstract
Purpose
It is a matter of controversy whether prophylactic lymph node dissection improves prognosis and survival in papillary thyroid carcinoma (PTC) patients without suspicion of lymph node metastases either clinically or on ultrasonography. It is possible that in such patients the use of lymphatic mapping and sentinel lymph node (SLN) biopsy, as are employed for other tumours, will be of assistance. The aim of this study was to evaluate the feasibility of preoperative 99mTc-nanocolloid lymphoscintigraphy and an intra-operative SLN procedure in the management of PTC patients.
Methods
Twenty-five consecutive patients were entered in the study between April 2005 and October 2005. All had a preoperative diagnosis of malignancy obtained by fine-needle aspiration cytology (FNAC), without clinical or ultrasonographic evidence of loco-regional lymph node involvement. Patients underwent preoperative lymphoscintigraphy after the injection of 99mTc-nanocolloid [median 6 MBq (range 4–9 MBq) in 0.1–0.2 ml saline injected intratumorally under ultrasound guidance] and an intra-operative SLN procedure using a hand-held gamma probe. Surgery was performed by the same surgeon in all patients.
Results
Preoperative lymphoscintigraphy identified at least one SLN in all patients. During surgery, using the gamma probe, the surgeon was able to find at least one SLN in all cases. A good correlation was found between preoperative imaging and probe results. Metastasis was found in at least one SLN in 12 (48%) patients. In seven (28%) patients the involved SLN was the most radioactive SLN, while in five (20%) patients a less radioactive SLN was involved by malignancy. Ten of these 12 patients had only micrometastases (<2 mm). Micrometastases were found in the most radioactive SLN in six cases and in less radioactive SLNs in four cases, while in two patients more lymph nodes visualised at lymphoscintigraphy ipsilateral to the primary tumour were sites of metastasis.
Conclusion
The rate of nodal involvement was very high in our series: in 48% of patients at least one metastatic lymph node was found. From a technical point of view the intra-operative SLN procedure in PTC patients was easy to perform, without major intra-operative complications. Our promising preliminary experience needs to be confirmed in larger series of patients series with longer follow-up.
References
Morton DL, Wen DR, Wong JH, Economous JS, Cagle LA, Storm FK, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392–9.
Giuliano AE, Kirgan DM, Guenter JM, Morton DL. Lymphatic mapping and sentinel lymphoadenectomy for breast cancer. Ann Surg 1994;220:391–401.
Makar AP, Scheistroen M, van den Weyngaert D, Trope CG. Surgical management of stage I and II vulvar cancer: the role of the sentinel node biopsy. Review of literature. Int J Gynecol Cancer 2001;11:255–62.
Cabanas RM. Application of the sentinel node concept in uro-genital cancer. Recent Results Cancer Res 2000;157:141–9.
Sliutz G, Reinthaller A, Lantzsch T, Mende T, Sinzinger H, Kainz C, et al. Lymphatic mapping of sentinel nodes in early vulvar cancer. Gynecol Oncol 2002;84:449–52.
Pitman KT, Ferlito A, Devaney KO, Shada AR, Rinaldo A. Sentinel lymph node biopsy in head and neck cancer. Oral Oncology 2003;39:343–9.
Saha S, Nora D, Wong JH, Weise D. Sentinel lymph node mapping in colorectal cancer—a review. Surg Clin North Am 2000;80:1811–9.
Kelemen PR, Van Herle AJ, Giuliano AE. Sentinel lymphadenectomy in thyroid malignant neoplasms. Arch Surg 1998;133:288–92.
Gallowitsch HJ, Mikosch P, Kresnik E, Starlinger M, Lind P. Lymphoscintigraphy and gamma probe guided surgery in papillary thyroid carcinoma. Clin Nucl Med 1999;24:274–6.
Rettenbacher L, Sungler P, Gmeiner D, Kassmann H, Galvan G. Detecting the sentinel node in patients with differentiated thyroid carcinoma. Eur J Nucl Med 2000;27:1399–401.
Pelizzo MR, Boschin IM, Toniato A, Bernante P, Piotto A, Rinaldo A, et al. The sentinel node procedure with Patent Blue V dye in the surgical treatment of papillary thyroid carcinoma. Acta Otolaryngol 2001;3:421–4.
Salvatori M, Rubello D, O’Doherty MJ, Pelizzo MR, Mariani G. Sentinel lymph node biopsy in thyroid cancer. In: Giuliano AE, Strauss HW, editors. Radioguided surgery—a comprehensive team approach. New York: Springer; 2006; p. 178–89 (in press).
Mazzaferri EL, Kloos RT. Current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab 2005;86:1447–63.
Shaha AR, Shah JP, Loree TR. Patterns of nodal and distant metastasis based on histologic varieties in differentiated carcinoma of the thyroid. Am J Surg 1996;172:692–4.
Casara D, Rubello D, Saladini G, Masarotto G, Favero A, Girelli ME, et al. Different features of pulmonary metastases in differentiated thyroid cancer: natural history and multivariate statistical analysis of prognostic variables. J Nucl Med 1993;34:1626–31.
Haigh PI, Giuliano AE. Sentinel lymph node dissection for thyroid malignancy. Recent Results Cancer Res 2000;157:201–205.
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Pelizzo, M.R., Rubello, D., Boschin, I.M. et al. Contribution of SLN investigation with 99mTc-nanocolloid in clinical staging of thyroid cancer: technical feasibility. Eur J Nucl Med Mol Imaging 34, 934–938 (2007). https://doi.org/10.1007/s00259-006-0316-y
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DOI: https://doi.org/10.1007/s00259-006-0316-y