Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
World J Surg. 2011 Dec;35(12):2675-82. doi: 10.1007/s00268-011-1254-9.
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.
虽然隐匿性颈部淋巴结转移到侧颈部在甲状腺乳头状癌中很常见，但甲状腺乳头状癌中侧颈部淋巴结转移的发生率和模式尚不清楚。我们假设放射性同位素示踪的前哨淋巴结活检（SLNB）在检测隐匿性侧颈部淋巴结转移方面将有助于描述甲状腺乳头状癌的转移情况。
我们纳入了 2009 年 6 月至 2010 年 3 月期间 94 例甲状腺乳头状癌患者进行侧颈部 SLNB。术前在超声引导下肿瘤内注射放射性同位素（99m）Tc-锡胶体后获得淋巴闪烁显像。甲状腺全切除术或腺叶切除术先于 SLN 检测，以避免放射性物质对原发病灶的干扰，然后在侧颈部淋巴结进行 SLNB。如果在冷冻活检中发现 SLN 转移，则立即进行改良根治性颈淋巴结清扫术。
在 60 例患者（63.8%）中共识别出 174 个 SLN。随着时间的推移，同位素识别 SLN 的成功率增加。19 例患者（31.7%）发现 SLN 转移。这种临床隐匿性转移仅与中央区转移性淋巴结的总数有关。患者年龄、性别、肿瘤大小、位置、侵袭程度、多发性和甲状腺炎的存在与侧颈部转移无关。在 II 区和对侧颈部行放射性同位素活检检测侧颈部 SLN 也是可行的。
SLNB 是评估甲状腺乳头状癌患者隐匿性侧颈部淋巴结状态的一种有用方法，特别是在中央颈部淋巴结转移的情况下。
