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The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2018 Jul 09

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 Surgery, Institut de Malalties Digestives I Metabòliques, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, University of Barcelona, Barcelona, Spain; 2 Department of Nuclear Medicine, Image Diagnostic Center, Hospital Clínic, University of Barcelona, Barcelona, Spain; 3 Department of Pathological Anatomy, Biomedical Diagnostic Center, Hospital Clínic, University of Barcelona, Barcelona, Spain; 4 Department of Radiology, Image Diagnostic Center, Hospital Clínic, University of Barcelona, Barcelona, Spain; 5 Department of Endocrinology and Nutrition, Institut de Malalties Digestives I Metabòliques, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, University of Barcelona, Barcelona, Spain


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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 - Papillary thyroid carcinoma - Lymphatic metastases - Thyroid cancer

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