The Efficacy of Lateral Neck Sentinel Lymph Node Biopsy in Papillary Thyroid Carcinoma
The Efficacy of Lateral Neck Sentinel Lymph Node Biopsy in Papillary Thyroid Carcinoma
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DOI：
10.1007/s00268-011-1254-9
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发表时间：
2011-12-01
影响因子：
2.6
通讯作者：
Kim, Jee Soo
中科院分区：
文献类型：
--
作者：
Lee, Se Kyung;Kim, Sung Hoon;Kim, Jee Soo
虽然甲状腺乳头状癌的颈外侧区室的隐匿性淋巴结转移是常见的，但其颈外侧淋巴结转移的发生率和模式尚不清楚。我们假设，使用放射性同位素进行前哨淋巴结活检（SLNB）检测隐性颈侧淋巴结转移将有助于描述乳头状癌的转移特征。2009年6月至2010年3月期间，纳入了94例乳头状甲状腺癌患者进行颈侧淋巴结活检。术前在超声引导下瘤内注射（99 m）Tc-锡胶体后进行淋巴结造影。在SLN检测之前进行甲状腺全切除术或腺叶切除术，以避免放射性对原发肿瘤的干扰，之后在侧颈淋巴结进行SLNB。冷冻活检发现前哨淋巴结转移者，立即行改良根治性颈淋巴结清扫术，60例（63.8%）共发现174个前哨淋巴结。随着时间的推移，同位素对前哨淋巴结的识别率逐渐增加。前哨淋巴结转移19例（31.7%）。这种临床隐匿性转移仅与中央室转移性淋巴结的总数有关。患者年龄、性别、肿瘤大小、位置、肿瘤浸润程度、多样性和甲状腺炎的存在与侧间室转移无关。在II级和对侧颈部，放射性同位素标记的前哨淋巴结活检也是可行的。前哨淋巴结活检是评估甲状腺乳头状癌患者，尤其是中央颈淋巴结转移患者隐匿性颈侧淋巴结状态的有效方法。
Although occult lymph node metastasis to the lateral neck compartment is common in papillary thyroid carcinoma, the incidence and patterns of lateral neck node metastasis in papillary carcinoma are not known. We hypothesized that sentinel lymph node biopsy (SLNB) with radioisotope in the detection of occult lateral neck node metastasis would be useful in characterizing metastasis in papillary carcinoma.Ninety-four patients with papillary thyroid carcinoma were included from June 2009 to March 2010 for lateral neck SLNB. Preoperative lymphoscintigraphy was obtained after intratumoral injection of a (99m)Tc-tin colloid under ultrasound guidance. Total thyroidectomy or lobectomy preceded SLN detection to avoid radioactivity interference with the primary tumor, after which SLNB was performed in the lateral neck nodes. In the cases where metastasis was detected in SLNs upon frozen biopsy, an immediate modified radical neck node dissection was performed.A total of 174 SLNs were identified in 60 patients (63.8%). The identification rate of the SLNs with isotope increased with time. Sentinel lymph node metastasis was found in 19 patients (31.7%). This clinically occult metastasis was only related to the total number of metastatic LNs in the central compartment. Patient age, gender, tumor size, location, extent of tumor invasion, multiplicity, and presence of thyroiditis were not related to metastasis in the lateral compartment. Detection of lateral neck SLNs upon biopsy with radioisotope was also feasible in level II and contralateral neck.Sentinel lymph node biopsy is a useful method for evaluating the occult lateral neck lymph node status in patients with papillary thyroid carcinoma, especially in the cases of central neck node metastasis.