Ríos Antonio, Rodríguez Jose Manuel, Ibañez Noelia, Piñero Antonio, Parrilla Pascual
Departamento de Cirugía, Pediatría y Obstetricia y Ginecología, Universidad de Murcia, Murcia, España; Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Servicio Murciano de Salud, Murcia, España; Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, España.
Departamento de Cirugía, Pediatría y Obstetricia y Ginecología, Universidad de Murcia, Murcia, España; Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Servicio Murciano de Salud, Murcia, España; Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, España.
Cir Esp (Engl Ed). 2019 Mar;97(3):169-174. doi: 10.1016/j.ciresp.2018.12.003. Epub 2019 Feb 14.
There is no standard procedure for the detection of the sentinel node (SN) in thyroid disease. However, the recent detection of the SN using a paramagnetic tracer is proving to be useful in breast cancer and melanoma. The objective was to assess the utility of super paramagnetic iron oxide tracer for the intraoperative detection of the SN in patients with papillary thyroid cancer without nodal involvement in the preoperative study.
A single center, prospective pilot study of a class IIa medical device (a paramagnetic tracer). The study included thyroid cancers which were T1-T2 tumors in the cytohistological analysis with a negative preoperative nodal assessment, operated on consecutively during scheduled treatment. For the localization of the SN, an interlesional injection of 2mL of super paramagnetic iron oxide was administered. After ten minutes, ferromagnetic activity was detected in the adjacent nodes. Once the node had been detected, we proceeded by extracting it for intraoperative analysis. The effectiveness of the procedure for detecting the SN was assessed, with the main variable being whether it was detected or not.
The project was assessed after the first cases had been carried out. The SN was located in all cases, which was done easily in the first four, but in the fifth case the SN detection was complicated by the interference of the reusable neurostimulation electrodes with the ferromagnetic signal. Intraoperative histology revealed the SN was positive in 80% (n=4) of cases (20% [n=1] were macrometastases and 60% [n=3] micrometastases). Total thyroidectomies were carried out, with central lymph node dissection in 4 of the patients and lateral in one due to the result of the detected SN. The histology showed the carcinoma was papillary, a classic type, in 80% (n=4) and a follicular variant in 20% (n=1). Forty percent (n=2) were multifocal, 40% (n=2) had vascular infiltration, and 60% (n=3) had extrathyroidal extension. Staging determined the application of radioactive iodine therapy (150mCi) in 80% of cases (n=4).
A paramagnetic tracer can be useful for detecting the SN and correctly staging papillary carcinoma.
甲状腺疾病中前哨淋巴结（SN）的检测尚无标准程序。然而，近期使用顺磁性示踪剂检测SN在乳腺癌和黑色素瘤中已被证明是有用的。目的是评估超顺磁性氧化铁示踪剂在术前检查无淋巴结受累的甲状腺乳头状癌患者术中检测SN的效用。
一项关于IIa类医疗器械（一种顺磁性示踪剂）的单中心前瞻性初步研究。该研究纳入了在细胞组织学分析中为T1 - T2肿瘤且术前淋巴结评估为阴性的甲状腺癌患者，这些患者在 scheduled treatment期间连续接受手术。为了定位SN，在病灶内注射2mL超顺磁性氧化铁。十分钟后，在相邻淋巴结中检测到铁磁活性。一旦检测到淋巴结，我们就将其取出进行术中分析。评估了检测SN程序的有效性，主要变量是是否检测到SN。
在完成首批病例后对该项目进行了评估。所有病例均成功定位了SN，在前四例中操作轻松，但在第五例中，可重复使用的神经刺激电极对铁磁信号的干扰使SN检测变得复杂。术中组织学显示，80%（n = 4）的病例中SN为阳性（20% [n = 1]为大转移灶，60% [n = 3]为微转移灶）。均实施了全甲状腺切除术，4例患者进行了中央淋巴结清扫，1例因检测到的SN结果进行了侧方淋巴结清扫。组织学显示，80%（n = 4）的癌为乳头状，属经典类型，20%（n = 1）为滤泡变体。40%（n = 2）为多灶性，40%（n = 2）有血管浸润，60%（n = 3）有甲状腺外侵犯。分期确定80%（n = 4）的病例应用放射性碘治疗（150mCi）。
顺磁性示踪剂可用于检测SN并正确分期甲状腺乳头状癌。
