Chow Tam-Lin, Lim Boon-Hua, Kwok Samuel Po-Yin
Division of Head & Neck, Breast and Reconstruction Surgery, Department of Surgery, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong SAR, China.
ANZ J Surg. 2004 Jan-Feb;74(1-2):10-2. doi: 10.1046/j.1445-1433.2003.02677.x.
Occult lymph node (LN) metastasis is common in papillary thyroid carcinoma. Sentinel lymph node (SLN) biopsy has been proven to be successful and accurate to predict the nodal status in melanoma and breast cancer. We investigate the use of SLN in papillary thyroid carcinoma.
Patients of previously untreated papillary thyroid carcinoma, diagnosed preoperatively by fine-needle cytology without any palpable cervical LN are prospectively studied. Blue dye injection was utilized for the SLN biopsy followed by central compartment lymphadenectomy. The histopathological results of the SLN and lymphadenectomy specimens were compared.
Fifteen consecutive patients underwent surgery including SLN biopsy for papillary thyroid carcinoma. Occult nodal metastases were identified in 10 patients (67%). The other five cases had no nodal metastasis. SLN were found in 10 cases. One, two and three SLN were present in three, three and four patients, respectively. SLN were located in the central compartment in eight cases. The SLN were found in the lateral compartment in one case. In the remaining one case, the SLN were found in both the central and lateral compartments. Of the group with found SLN, false negative occurred in one case. The overall accuracy of the SLN in predicting the nodal status was 90%. The sensitivity, specificity, positive predictive value and negative predictive value were 88%, 100%, 100% and 67%, respectively. No complications were directly related to SLN biopsy.
Occult nodal spread is frequently encountered in papillary thyroid carcinoma. SLN biopsy is safe and feasible in papillary thyroid cancer, however further studies are necessary to improve the diagnostic accuracy prior to routine clinical use.
隐匿性淋巴结转移在甲状腺乳头状癌中很常见。前哨淋巴结活检已被证明在黑色素瘤和乳腺癌中预测淋巴结状态是成功且准确的。我们研究前哨淋巴结在甲状腺乳头状癌中的应用。
对术前经细针穿刺细胞学诊断为甲状腺乳头状癌且无任何可触及颈部淋巴结的初治患者进行前瞻性研究。采用蓝色染料注射进行前哨淋巴结活检，随后行中央区淋巴结清扫术。比较前哨淋巴结和淋巴结清扫标本的组织病理学结果。
15例连续患者接受了包括甲状腺乳头状癌前哨淋巴结活检在内的手术。10例患者（67%）发现隐匿性淋巴结转移。其他5例无淋巴结转移。10例发现了前哨淋巴结。分别有3例、3例和4例患者发现1个、2个和3个前哨淋巴结。8例前哨淋巴结位于中央区。1例位于侧方区。其余1例在中央区和侧方区均发现前哨淋巴结。在发现前哨淋巴结的组中，1例出现假阴性。前哨淋巴结预测淋巴结状态的总体准确率为90%。敏感性、特异性、阳性预测值和阴性预测值分别为88%、100%、100%和67%。没有并发症与前哨淋巴结活检直接相关。
甲状腺乳头状癌中常出现隐匿性淋巴结转移。前哨淋巴结活检在甲状腺乳头状癌中是安全可行的，然而在常规临床应用前还需要进一步研究以提高诊断准确性。
