Markovic Ivan, Goran Merima, Buta Marko, Stojiljkovic Dejan, Zegarac Milan, Milovanovic Zorka, Dzodic Radan
Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia.
J BUON. 2020 Jan-Feb;25(1):376-382.
The incidence of histologically proven lymph node metastases (LNM) in papillary thyroid carcinoma (PTC) reaches 80%. According to different guidelines surgical management in clinically N0 (cN0) patients with PTC remains controversial. The purpose of this study was to investigate if sentinel lymph node biopsy (SLNb) using methylene blue dye is accurate in the detection of LNM in the lateral neck compartment in cN0 patients with PTC.
Enrolled were 153 cN0 patients with PTC. All underwent total thyroidectomy with central neck dissection and SLNb in the lateral neck compartment, using methylene blue dye as marker. Selective modified radical neck dissection was performed in cases of metastatic SLNs.
Neck LNMs were histologically verified in 40.9% of the cases. Predictive factors for LNM were: males, younger than 45 years, tumors greater than 1cm, capsular and vascular invasion. The central neck compartment of LNM was predictive for lateral LNM in 80.5% of the cases. LNM were confirmed in 24% of SLNs in the lateral neck compartment, which were over 56% predictive of LNM to other dissected lateral LN. SLN identification rate (IR) was 91.8%. Sensitivity, specificity, positive value (PPV) and negative predictive value (NPV) were 85.7, 96.7, 88.3 and 95.9%, respectively. The overall accuracy of the method was 94.3%, with probability of 91.2% (ROC AUC, 95% CI; 84.2-98.3).
The proposed method of SLN biopsy using methylene blue dye is feasible, safe and accurate in the detection of LNM in the lateral neck compartment and may help in the decision to perform selective modified radical neck dissection in cN0 patients with PTC.
经组织学证实的甲状腺乳头状癌（PTC）淋巴结转移（LNM）发生率达80%。根据不同指南，临床N0（cN0）的PTC患者的手术治疗仍存在争议。本研究的目的是调查使用亚甲蓝染料的前哨淋巴结活检（SLNb）在检测cN0的PTC患者侧颈部区域LNM方面是否准确。
纳入153例cN0的PTC患者。所有患者均接受全甲状腺切除术及中央区颈淋巴结清扫，并在侧颈部区域进行SLNb，使用亚甲蓝染料作为标记。前哨淋巴结转移的病例行选择性改良根治性颈淋巴结清扫术。
40.9%的病例经组织学证实有颈部LNM。LNM的预测因素为：男性、年龄小于45岁、肿瘤大于1cm、包膜及血管侵犯。80.5%的病例中，中央区颈部LNM可预测侧颈部LNM。侧颈部区域24%的前哨淋巴结证实有LNM，其对其他清扫的侧颈部淋巴结LNM的预测率超过56%。前哨淋巴结识别率（IR）为91.8%。敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为85.7%、96.7%、88.3%和95.9%。该方法的总体准确率为94.3%，概率为91.2%（ROC曲线下面积，95%CI；84.2 - 98.3）。
所提出的使用亚甲蓝染料进行前哨淋巴结活检的方法在检测侧颈部区域LNM方面可行、安全且准确，可能有助于决定对cN0的PTC患者进行选择性改良根治性颈淋巴结清扫术。
