Showing Latest Articles
Sentinel lymph node biopsy is unsuitable for routine practice in younger female patients with unilateral low-risk papillary thyroid carcinoma Full Text
BMC Cancer, 09/09/2011
Huang Q et al. – Compared to a single technique, there was a significantly higher SLN identification rate for the combined technique in younger female with ipsilateral, low–risk PTC (T1–2N0M0). Thus, a combined SLN biopsy technique seems to more accurately stage lymph nodes, with better identification of SLN located out of the central compartment. Regardless of the procedure used, the high FNR renders the current SLN techniques unsuitable for routine practice. Based on these results, prophylactic node dissection of level VI might be considered because 38.1% of the patients had such node metastases.
Methods- From January 2004 to January 2007, 90 female patients, ages 23 to 44 (mean = 35), with unilateral low–risk PTC (T1–2N0M0) were prospectively studied
- Mean tumor size was 1.3 cm (range, 0.8–3.7cm). All patients underwent unilateral modified neck dissection
- Prior to surgery, patients had, by random assignment, identification and biopsy of SLNs by methylene blue, alone (Group 1), or by sulfur colloid labeled with 99m Technetium, gamma–probe guided surgery and methylene blue (Group 2)
- In the methylene blue group, SLNs were identified in 39 of 45 patients (86.7%)
- Of 39 patients, 28 (71.8%) had positive cervical lymph nodes (pN+), and 21 patients (53.8%) had pSLN+
- In 7 of 28 pN+ patients (25%), metastases were also detected in non–SLN, thus giving a false–negative rate (FNR of 38.9% (7/18), negative predictive value (NPV) of 61.1% (11/18), and an accuracy of 82.1% (32/39)
- In the combined technique group, the identification rate (IR) of SLN was 100% (45/45)
- Of 45 patients, 27 (60.0%) had pN+, 24 (53.3%) had pSLN+
- FNR of 14.3% (3/21), a NPV of 85.7% (18/21), and an accuracy of 93.3% (42/45)
- Combined techniques group was significantly superior to methylene blue group in IR (p=0.035)
- No significant differences between 2 groups in sensitivity, specificity, NPV, or accuracy
- Location of pN+ (55 patients) in 84 patients was: level I and V, no patients; level II, 1 patient (1.2%); level III, 6 patients (7.2%); level III and IV, 8 patients (9.5%); level IV, alone, 8 patients (9.5%); level VI, 32 patients (38.1%)
- In all 90 patients, IR of SLN was 93.3%, FNR, 25.6%, NPV, 74.4%, and accuracy rate, 88.1 percent
