Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea.
Ann Surg Oncol. 2012 Jun;19(6):1868-73. doi: 10.1245/s10434-011-2109-1. Epub 2011 Oct 12.
Sentinel lymph node biopsy (SLNB) has recently been used to detect occult lymph node metastases. The aim of this study was to assess the feasibility and clinical efficacy of SLNB in the treatment of clinically node-negative papillary thyroid carcinoma.
A total of 114 consecutive patients with clinically node-negative papillary thyroid carcinoma were enrolled and underwent SLNB. After injection of 1% methylene blue around the tumors, blue-stained sentinel lymph nodes (SLN) were collected from the central compartments. All the patients underwent total thyroidectomy with bilateral central compartment neck dissection after SLNB.
SLN were identified in 84 (73.7%) of the 114 patients. Of these 84 patients, 24 (28.6%) had metastases in the SLN. Among the 60 patients who had no metastases in their SLN in frozen biopsy samples, seven had metastatic foci in their SLN in the permanent biopsy samples and six had metastases in their non-SLN samples. Central compartment lymph node metastases were detected in 11 of the 30 patients in whom SLN were not identified. Thus, the sensitivity, specificity, and positive and negative predictive values of SLNB were 64.9, 100, 100, and 78.3%, respectively. The false-positive and false-negative rates were 0 and 35.1%, respectively. The detection of SLN led to no major complications.
SLNB using methylene blue in papillary thyroid carcinoma is a safe and technically feasible procedure. However, it is of limited use in the management of clinically node-negative papillary thyroid carcinoma because of low sensitivity and a high false-negative rate.
前哨淋巴结活检（SLNB）最近已用于检测隐匿性淋巴结转移。本研究旨在评估 SLNB 在治疗临床淋巴结阴性甲状腺乳头状癌中的可行性和临床疗效。
共纳入 114 例临床淋巴结阴性甲状腺乳头状癌患者，行 SLNB。在肿瘤周围注射 1%亚甲蓝后，从中央区收集蓝色染色的前哨淋巴结（SLN）。所有患者在 SLNB 后均行全甲状腺切除术和双侧中央区颈部淋巴结清扫术。
在 114 例患者中，84 例（73.7%）识别出 SLN。在这 84 例患者中，24 例（28.6%）SLN 有转移。在冷冻活检样本中无 SLN 转移的 60 例患者中，7 例 SLN 永久活检样本有转移灶，6 例非 SLN 样本有转移。在 30 例未识别出 SLN 的患者中，11 例中央区淋巴结有转移。因此，SLNB 的敏感性、特异性、阳性和阴性预测值分别为 64.9%、100%、100%和 78.3%。假阳性率和假阴性率分别为 0 和 35.1%。SLN 的检测没有导致严重的并发症。
在甲状腺乳头状癌中使用亚甲蓝进行 SLNB 是一种安全且技术上可行的方法。然而，由于敏感性低和假阴性率高，它在临床淋巴结阴性甲状腺乳头状癌的治疗中应用有限。
