Dzodic Radan, Markovic Ivan, Inic Momcilo, Jokic Neven, Djurisic Igor, Zegarac Milan, Pupic Gordana, Milovanovic Zorka, Jovic Viktor, Jovanovic Nikola
Medical School University of Belgrade, Institute of Oncology and Radiology of Serbia, National Cancer Research Center, Pa sterova 14, 11000, Belgrade, Serbia and Montenegro.
World J Surg. 2006 May;30(5):841-6. doi: 10.1007/s00268-005-0298-0.
The prognostic significance of lymph node metastases (LNM) in follicle cell-derived differentiated thyroid carcinoma (DTC) is still controversial. The management of cervical lymph nodes varies from "berry picking" to modified radical neck dissection (MRND). The incidence of LNM in papillary thyroid carcinoma varies from 27% to 80%. The importance of sentinel lymph node (SLN) biopsy for decisions about the surgical management of lymph nodes in DTC has been the subject of several previous studies.
In 40 patients with DTC methylene blue dye was applied peritumorally. Both SLN and non-SLN in the lower third of the jugulo-carotid chain were dissected prior to total thyroidectomy and routine dissection of the central neck compartment and examined by frozen-section and standard histology. MRND was performed in 9 cases of LNM in the lateral neck compartment.
The SLN identification rate was 92.5%. Metastases in SLNs were revealed by frozen-section histology in 7 cases, leading to immediate MRND. The findings were confirmed on standard HE examination. In 2 false-negative cases SLN metastases were revealed on standard histology and MRND was performed 1 week later. The specificity of the method was 100%, sensitivity 77.7%, negative predictive value 94%, positive predictive value 100%, with overall accuracy of 95%.
Our results seem to imply that SLN biopsy in the jugulo-carotid chain using methylene blue dye mapping may be a feasible and valuable method for estimating lymph node status in the lateral neck compartment. It may be helpful in the detection of true-positive but nonpalpable lymph nodes, and in such cases may support the decision to perform MRND in patients with DTC.
在滤泡细胞来源的分化型甲状腺癌（DTC）中，淋巴结转移（LNM）的预后意义仍存在争议。颈部淋巴结的处理方式从“摘草莓”式手术到改良根治性颈清扫术（MRND）各不相同。甲状腺乳头状癌中LNM的发生率在27%至80%之间。前哨淋巴结（SLN）活检对于决定DTC患者淋巴结的手术处理的重要性已成为此前多项研究的主题。
对40例DTC患者在肿瘤周围注射亚甲蓝染料。在全甲状腺切除及中央颈部区域常规清扫之前，对颈内静脉 - 颈动脉链下三分之一区域的SLN和非SLN进行清扫，并通过冰冻切片和标准组织学检查。对9例侧颈部区域出现LNM的患者实施了MRND。
SLN识别率为92.5%。7例患者通过冰冻切片组织学检查发现SLN有转移，随即进行了MRND。标准苏木精 - 伊红（HE）检查证实了这些结果。在2例假阴性病例中，标准组织学检查发现SLN有转移，1周后进行了MRND。该方法的特异性为100%，敏感性为77.7%，阴性预测值为94%，阳性预测值为100%，总体准确率为95%。
我们的结果似乎表明，使用亚甲蓝染料定位法对颈内静脉 - 颈动脉链进行SLN活检可能是一种评估侧颈部区域淋巴结状态的可行且有价值的方法。它可能有助于检测真正阳性但触诊不到的淋巴结，在这种情况下，可能支持对DTC患者实施MRND的决策。
