Department of Oncological Surgery, St. Elisabeth Cancer Institute and Faculty of Medicine Comenius University, Bratislava, Slovakia.
Department of Nuclear Medicine, St. Elisabeth Cancer Institute and Faculty of Medicine Comenius University, Bratislava, Slovakia.
Neoplasma. 2024 Aug;71(4):387-391. doi: 10.4149/neo_2024_240521N228.
Our research seeks to evaluate the utility of intraoperative frozen analysis of sentinel lymph nodes (SLNs) in the lateral cervical compartment (LCC) as a tool to inform decision-making regarding therapeutic neck dissection in patients with medullary thyroid carcinoma (MTC). This is particularly relevant due to the variability observed in guidelines regarding the indication for lateral neck dissection in this patient population. The study comprised 64 patients (25 males, 39 females) aged between 29 and 81 years, with a median age of 59, who underwent surgery for MTC at stage T1-3N0-1M0 between January 1, 2012, and December 31, 2020. A standardized surgical approach involving total thyroidectomy with central neck dissection was adopted. LCC dissection was reserved for patients with clinically apparent nodal metastases. In patients lacking clinical evidence of nodal involvement, SLNs were identified using patent blue dye, excised, and subjected to intraoperative frozen analysis. If metastasis was confirmed, LCC dissection was subsequently performed. Among the study participants, 14 individuals (21.9%) underwent therapeutic LCC dissection due to clinical lymph node (LN) metastases. This intervention resulted in clinical remission for 9 patients, while disease progression was observed in 5 cases, leading to 2 fatalities. In the remaining cohort of 50 patients clinically negative for nodal involvement, SLNs were successfully identified and examined in 38 cases, revealing metastases in 6 patients (15.8%). Among both subsets of patients with analyzed SLNs, irrespective of metastatic status, one patient each required repeat surgery due to disease recurrence; however, all patients eventually achieved clinical remission. Lymphatic mapping in the LCC plays a pivotal role in detecting early metastases, thereby aiding in the avoidance of unnecessary repeat neck surgeries, and ultimately improving the prognosis in patients with MTC.
我们的研究旨在评估术中冷冻分析颈侧区（LCC）前哨淋巴结（SLN）在指导颈侧区淋巴结清扫术决策中的作用，以评估甲状腺髓样癌（MTC）患者的治疗性颈清扫术。由于在该患者人群中，指南对侧颈清扫术的适应证存在差异，因此这一点尤为重要。本研究纳入了 2012 年 1 月 1 日至 2020 年 12 月 31 日期间接受 T1-3N0-1M0 期 MTC 手术的 64 例患者（男 25 例，女 39 例），年龄 29-81 岁，中位年龄 59 岁。所有患者均接受了甲状腺全切除术和中央区淋巴结清扫术，对于临床存在淋巴结转移的患者保留了 LCC 清扫术，对于无临床证据的淋巴结受累患者，采用专利蓝染料识别 SLN 并进行术中冷冻分析，如果证实有转移，则进行 LCC 清扫术。在研究对象中，14 例（21.9%）患者因临床淋巴结（LN）转移而接受了治疗性 LCC 清扫术。该干预措施使 9 例患者获得临床缓解，5 例患者疾病进展，导致 2 例死亡。在其余 50 例临床无淋巴结受累的患者中，成功识别并检查了 38 例 SLN，其中 6 例（15.8%）患者存在转移。在这两组 SLN 有分析结果的患者中，无论转移状态如何，各有 1 例患者因疾病复发需要再次手术，但所有患者最终均获得临床缓解。LCC 中的淋巴示踪对于检测早期转移具有重要作用，从而有助于避免不必要的重复颈部手术，并最终改善 MTC 患者的预后。
