J Korean Surg Soc.  2013 Apr;84(4):195-201. 10.4174/jkss.2013.84.4.195.

The usefulness and accuracy of sentinel lymph node biopsy using single photon emission computed tomography/computed tomography with 99mTc phytate to detect locoregional lymph node metastases in patients with papillary thyroid carcinoma

• Lee J
• Na KY
• Lee J
• Lee SJ
• An YS
• Yoon JK
• Soh EY

• KMID: 2212463
• DOI: http://doi.org/10.4174/jkss.2013.84.4.195

Abstract

PURPOSE
Regional lymph node (LN) metastases are detected in 57-85% of patients with papillary thyroid carcinoma (PTC) and are associated with increased tumor recurrence. However, the management of lymphatic disease in patients with PTC has been ongoing source of debate. We have prospectively assessed the usefulness and accuracy of sentinel LN (SLN) biopsy for the detection of LN metastases in patients with PTC on preoperative imaging using single photon emission computed tomography/computed tomography (SPECT/CT) and 99mTc phytate.
METHODS
We prospectively assessed 39 patients with PTC who had risk factors for recurrence or with the necessity of intraoperative LN sampling for suspicious LN metastases on preoperative imaging from August 2010 to March 2011. The patients underwent preoperative lymphoscintigraphy and SPETC/CT and intraoperative SLN biopsy (SLNB).
RESULTS
99mTc lymphoscintigraphy and SPECT/CT localized SLN in 38 patients (97.4%), with the gamma probe identifying 2.15 mean SLNs in the lateral neck of the 39 patients. Skip metastasis was found in one patient, and lateral compartment LN metastasis in 17 (43.5%). The sensitivity, specificity, and accuracy of SLNB for lateral compartment LN metastasis were 88.2%, 100%, and 94.8%, respectively. SLNB was more accurate and useful for lateral than for central compartment LN metastasis.
CONCLUSION
SPECT/CT improved SLN detection and anatomical localization compared with lymphoscintigraphy. SLNB in patients with risk factors for recurrence or the necessity of intraoperative LN sampling for suspected LN metastases on preoperative imaging was accurate in detecting LN metastases and may help in deciding whether to perform lateral compartment dissection in patients with PTC.

Keyword

Papillary thyroid cancer; Sentinel lymph node biopsy; Single photon emission computed tomography; X-ray computed tomography

MeSH Terms

Biopsy
Carcinoma
Factor IX
Humans
Lymph Nodes
Lymphatic Diseases
Lymphoscintigraphy
Neck
Neoplasm Metastasis
Nitriles
Phytic Acid
Prospective Studies
Pyrethrins
Recurrence
Risk Factors
Sensitivity and Specificity
Sentinel Lymph Node Biopsy
Thyroid Gland
Thyroid Neoplasms
Tomography, Emission-Computed, Single-Photon
Tomography, X-Ray Computed
Carcinoma
Factor IX
Nitriles
Phytic Acid
Pyrethrins
Thyroid Neoplasms

Figure

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  Fig. 1 Frequency of tumor sites and metastatic lymph node distribution (P = 0.055). 1, upper; 2, middle and lower.

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  Fig. 2 Single photon emission computed tomography/computed tomography of the basin from the right jugular lymph node (LN) of cervical level II to the right retropharyngeal LN.

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  Fig. 3 Single photon emission computed tomography/computed tomography of the basin from the right paratracheal lymph node (LN) to the right high mediastinal LN.

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