1.Application of sentinel lymph node tracer techniques in prostate caner.
Cheng WANG ; Su ZHANG ; Li YANG
National Journal of Andrology 2016;22(9):850-855
The sentinel lymph node (SLN) is the first node receiving lymphatic drainage of a tumor and best reflects tumor metastasis. Whether there is a micrometastasis in SLN determines the choice of pelvic lymph node dissection for prostate cancer and is closely related to later treatment and prognosis. Therefore, precise localization of SLN is essential. This review discusses the application of SLN tracer techniques, such as preoperative imaging and intraoperative lymphoscintigraphy and localization of SLN, in prostate cancer.
Humans
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Lymph Node Excision
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Lymphatic Metastasis
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Lymphoscintigraphy
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Male
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Neoplasm Micrometastasis
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diagnostic imaging
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pathology
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Prognosis
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Prostatic Neoplasms
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pathology
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Sentinel Lymph Node
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diagnostic imaging
2.Sentinel lymph nodes lymphoscintigraphy and biopsy in breast cancer.
Min XU ; Lin LIU ; Yuntian SUN ; Shengzu CHEN
Chinese Medical Journal 2002;115(8):1137-1140
OBJECTIVESTo determine the clinical value of sentinel lymph node (SLN) detection by lympho- scintigraphy and gamma ray detecting probe (GDP) and to assess the value of hematoxylin and eosin (H&E) staining combined with immunohistochemistry (IHC) analys is for detecting micrometastasis in lymph nodes (LNs).
METHODSForty-two patients with breast cancer were included in this study. (99)Tc(m)-dextran was injected peritumourally. Lymphoscintigraphy images were obtained in anterior and lateral views. SLNs were removed with the aid of GDP during surgery. A standard axillary lymph nodes (ALNs) dissection was performed. All lymph nodes were first analyzed by HE staining. When all of the SLNs in a patient were negative, the ALNs were subjected to additional HE staining combined with IHC analysis.
RESULTSSLNs were successfully detected and removed in 39 (92.9%) of the 42 patients. The sensitivity, specificity and accuracy of SLN biopsy were 92.9% (13 in 14), 100% (25 in 25) and 97.4% (38 in 39) respectively. Additional HE staining combined with IHC analysis of the ALNs detected micrometastasis in 3 SLNs (2 cases), but there were no positives in the non-sentinal lymph nodes (NSLNs).
CONCLUSIONSThis study suggests that lymphoscintigraphy and GDP may be used to detect SLN. Additional HE staining combined with IHC analysis of the ALNs may help predict micrometastasis. Biopsy of SLN may be an accurate method for staging breast cancer.
Adult ; Aged ; Breast Neoplasms ; diagnostic imaging ; pathology ; Dextrans ; Female ; Humans ; Immunohistochemistry ; Lymph Nodes ; diagnostic imaging ; Middle Aged ; Organotechnetium Compounds ; Radionuclide Imaging ; Sentinel Lymph Node Biopsy
3.Intra-operative radionuclide lymphatic mapping in sentinel lymph node biopsy of breast cancer.
Cen LOU ; Zhong-ke HUANG ; Xiang-yang SONG ; Da-ping ZHANG ; Hua-cheng HUANG
Chinese Journal of Oncology 2003;25(6):604-606
OBJECTIVETo study intra-operative radionuclide lymphatic mapping in sentinel lymph node (SLN) biopsy of breast cancer.
METHODSForty-two breast cancer (diameter = 5.0 cm) patients with clinically negative axillary node were analyzed. 18.5 MBq/0.5 ml technetium-99m labeled sulfur colloid (labeling yield > 98%, size of colloid granule 100 approximately 200 nm) was injected into the mammary tissue around the tumor or biopsy site at four points. SLN in breast cancer was detected and dissected with the help of lymphoscintigraphy and intra-operative gamma probe. Routine lymph node dissection was performed for all patients.
RESULTSThe detection rate was 88.1% in lymphoscintigraphy and 97.6% in intra-operative gamma probe detection for SLN in breast cancer. The sensitivity, accuracy, false negative and specificity of SLN biopsy were 93.3% (14 in 15), 97.6% (40 in 41), 6.7% (1 in 15) and 100% (26 in 26).
CONCLUSIONSentinel lymph node in breast cancer, detected by preoperative lymphoscintigraphy combined with intra-operative gamma probe, is able to predict regional lymph node metastasis. The successful rate of SLN biopsy can be raised by improvement in the quality of nuclear imaging agent, technic of injection and method of measurement.
Adult ; Aged ; Breast Neoplasms ; diagnostic imaging ; pathology ; Female ; Humans ; Lymph Nodes ; diagnostic imaging ; Middle Aged ; Radionuclide Imaging ; Sentinel Lymph Node Biopsy ; Technetium Tc 99m Sulfur Colloid
4.Experimental study of sentinel lymph node biopsy in larynx by using radioactive Nano tracer.
Yonglan ZHANG ; Jiadong WANG ; Zheng ZHOU
Journal of Clinical Otorhinolaryngology Head and Neck Surgery 2010;24(18):847-850
OBJECTIVE:
Using radioactive Nano tracer at different sizes and doses in the Larynx of rabbits, to study the roles of them in the sentinel lymph node (SLN) biopsy in rabbits and to provide experimental evidences for the choices of ideal size and dose of radioactive Nano tracer of the sentinel lymph node biopsy in Laryngeal cancer patients.
METHOD:
thirty rabbits were randomly divided into six groups with five rabbits in each group. After 50 nm--0.01 ml, 50 nm--0.02 ml, 80 nm--0.01 ml, 80 nm--0.02 ml,100 nm--0.01 ml, 100 nm--0.02 ml of 99mTc-sulfur Colloid were separately injected into the Larynx, the number of SLNs, the initial and strongest radioactive time of SLNs, and the lasting time of radioactivity was obtained.
RESULT:
One to three SLNs were identified in one rabbit, so there were totally forty-five SLNs, which in the areas of II, III and IV. The group of 50 nm--0.02 ml had the largest number of SLNs and there were significant differences between the group of 50 nm-0.02 ml and 100 nm--0.01 ml. In the six groups, the group of 50 nm--0.02 ml was the earliest group of detecting the initial and strongest radioactivity of SLNs,which the time were 49.20 s and 178.60 s; the group of 100 nm--0.01 ml was the latest group of detecting the initial and strongest radioactivity of SLNs, which the time were 235.80 s and 311.20 s. Each group had radioactivity more than 30 minutes.
CONCLUSION
The group of 50 nm--0.02 ml was the best group, because it moved fast and had a higher rate of uptake in lymphangio. Moreover, the radioactivity time was more than 30 minutes. It was the ideal size and dose of SLN biopsy in larynx.
Animals
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Larynx
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diagnostic imaging
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Lymph Nodes
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diagnostic imaging
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pathology
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Male
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Nanostructures
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Rabbits
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Radioactive Tracers
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Radionuclide Imaging
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Sentinel Lymph Node Biopsy
;
methods
5.Time-lapse imaging of sentinel lymph node using indocyanine green with near-infrared fluorescence imaging in early endometrial cancer.
Hyun Jin CHOI ; Tae Joong KIM ; Yoo Young LEE ; Jeong Won LEE ; Byoung Gie KIM ; Duk Soo BAE
Journal of Gynecologic Oncology 2016;27(3):e27-
OBJECTIVE: Indocyanine green with near-infrared fluorescence imaging (NIR-ICG) is a new tracer modality in the limelight used for lymphatic mapping. The advantage of this method is to provide real-time image during surgery. To use ICG for image guided lymph node dissection, a surgeon needs to know initial appearing time and duration. METHODS: A 52-year-old woman undertook surgery diagnosed with endometrial cancer. She had no past medical history and her body mass index was 25.3 kg/m2. Preoperative magnetic resonance imaging examination revealed 2.7 cm sized cancerous mass in the endometrial cavity with superficial myometrial invasion without lymph node enlargement. Four mL (1.25 mg/mL) of ICG solution was prepared for injection. For each site, 1 mL of solution was injected superficially, 2-3 mm into the cervical submucosa and another 1 mL was injected deep, 1-2 cm into the stroma of the cervix. We recorded video with 30° 10 mm scope equipped with a specific lens and light source emitting both visible and NIR light (KARL STORZ GmbH & Co. KG, Tuttlingen, Germany). RESULTS: Pelvic lymph node was visualized from around 5 minutes. ICG was dispersed into organs after hysterectomy (53 minutes after ICG injection), yet we could clearly identify sentinel lymph node (SLN). Pathology revealed endometriod adenocarcinoma grade I, myometrial invasion with less than half of myometrium and no lymph node metastasis. CONCLUSION: Cervical injection of ICG provides good visualization of SLN from 5 minutes to over an hour. Our film gives an idea about time management to make a plan for surgery and not to miss SNLs.
Adenocarcinoma/diagnostic imaging/*pathology
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Coloring Agents/*therapeutic use
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Endometrial Neoplasms/diagnostic imaging/*pathology
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Female
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Humans
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Indocyanine Green/*therapeutic use
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Lymphatic Metastasis/diagnostic imaging
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Middle Aged
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Optical Imaging/methods
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Sentinel Lymph Node/*diagnostic imaging
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Time-Lapse Imaging/methods
6.Analysis of detecting value of ultrasound and the clinic-pathological features of axillary metastasis in breast cancer.
Ling XIN ; Luzeng CHEN ; Hong ZHANG ; Qian LIU ; Ling XU ; Bin WANG ; Ting LI ; Xuening DUAN ; Yinhua LIU
Chinese Journal of Surgery 2014;52(12):924-928
OBJECTIVESTo evaluate the value of ultrasound (US) in predicting axilla status and to investigate the clinic pathologic characters in the axillary node metastasis.
METHODSFrom June 2012 to June 2013, 323 female primary breast cancer patients who received both axilla ultrasound and pathology examinations were reviewed retrospectively. The features of axillary nodes including diameter, longitudinal-transverse axis ratio, cortical thickness and blood flow grade were used to evaluate axillary status. US accuracy of axillary node metastasis was analyzed correlated with the final pathology results. The clinical and histological features associated with axillary node metastasis was analyzed by χ² test.
RESULTSThe proportions of Luminal A-like, Luminal B-like, human epidermalgrowth factor receptor-2 positive and triple negative breast cancer were 11.1% (36/323), 58.5% (189/323), 13.3% (43/323) and 17.0% (55/323) . The sensitivity, specificity, positive predictive value and negative predictive value of axilla US in the diagnosis of nodal metastasis were 35.6% (46/129), 98.9% (181/183), 95.8% (46/48) and 68.6% (181/264). Axillary lymph node metastasis had statistically significant correlation with menopausal status and clinical tumor size (χ² = 4.337, 11.100; P = 0.037, 0.001).
CONCLUSIONSStandardized ultrasound is the basic way to evaluate axilla status. Sentinel lymph node biopsy should be done to acquire accurate preoperative staging of axilla when US shows no signs of metastasis. Axillary lymph node metastasis is significantly related to menopausal status and clinical tumor size, but not significantly related to subtype classification of primary breast cancer.
Axilla ; Breast Neoplasms ; pathology ; Female ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; diagnostic imaging ; Neoplasm Staging ; Retrospective Studies ; Sensitivity and Specificity ; Sentinel Lymph Node Biopsy ; Ultrasonography
7.Sentinel Lymph Node Radiolocalization with 99mTc Filtered Tin Colloid in Clinically Node-Negative Squamous Cell Carcinomas of the Oral Cavity.
Han Sin JEONG ; Chung Hwan BAEK ; Young Ik SON ; Do Yeon CHO ; Man Ki CHUNG ; Jin Young MIN ; Young Hyeh KO ; Byung Tae KIM
Journal of Korean Medical Science 2006;21(5):865-870
The objective of this study was to evaluate the feasibility of sentinel lymph node biopsy by using a radiotracer lymphatic mapping technique in patients with squamous cell carcinoma of the oral cavity, and the diagnostic value of this technique. We studied twenty patients with previously untreated squamous cell carcinomas of the oral cavity and N0 necks. After the peritumoral injection of 99mTc filtered tin colloid preop-eratively, lymphoscintigraphy and intraoperative mapping using a gamma detector were performed to localize sentinel nodes. An open biopsy of the sentinel node was followed by complete neck dissection. We identified the sentinel nodes in 19 of 20 patients (95.0%) by lymphoscintigraphy and in all (100%) by intraoperative gamma detector. In all cases, the status of the sentinel node accurately predicted the pathologic status of the neck with the false negative rate being 0%. The negative predictive value for the absence of cervical metastases was 100%. In conclusion, our radio-localization technique of sentinel nodes using 99mTc filtered tin colloid in N0 squamous cell carcinomas of the oral cavity is technically feasible and appears to accurately predict the presence of the occult metastatic disease.
Tin Compounds/*diagnostic use
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Technetium Compounds/*diagnostic use
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*Sentinel Lymph Node Biopsy
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Radiopharmaceuticals/*diagnostic use
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Mouth Neoplasms/*pathology/*radionuclide imaging
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Middle Aged
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Male
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Lymphatic Metastasis
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Lymph Nodes/*radionuclide imaging
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Humans
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Female
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Carcinoma, Squamous Cell/*pathology/*radionuclide imaging
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Aged
;
Adult
8.The Comparative Study of Ultrasonography, Contrast-Enhanced MRI, and 18F-FDG PET/CT for Detecting Axillary Lymph Node Metastasis in T1 Breast Cancer.
Seung Ook HWANG ; Sang Woo LEE ; Hye Jung KIM ; Wan Wook KIM ; Ho Yong PARK ; Jin Hyang JUNG
Journal of Breast Cancer 2013;16(3):315-321
PURPOSE: A more noninvasive evaluation of axillary lymph node in breast cancer is one of the principal challenges of breast cancer treatment. To detect axillary lymph node metastasis (ALNM) in T1 breast cancer, we have compared the axillary ultrasonography (AUS), contrast-enhanced magnetic resonance imaging (cMRI), and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) to determine the most adequate test or a combination of tests. METHODS: Retrospectively, 349 T1 breast cancer patients who were preoperatively examined using AUS, cMRI, and PET/CT between 2008 and 2011 and whom underwent pathological evaluations of axillary lymph nodes were reviewed and analyzed. RESULTS: In total, 26.4% (92/349) of patients exhibited ALNM. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of AUS for determining ALNM were 44.6%, 88.7%, 58.6%, 81.7%, and 77.1%, respectively. cMRI was similar to AUS. The sensitivity, specificity, PPV, NPV, and accuracy of PET/CT were 44.5%, 94.2%, 73.2%, 82.6%, and 81.1%, respectively. The combination including cMRI and PET/CT was the most accurate with sensitivity, specificity, PPV, NPV, and accuracy values of 39.1%, 98.8%, 92.3%, 81.9%, and 83.1%, respectively. The mean number (3.5+/-4.2) of ALNMs in the patients who were positive based on cMRI and PET/CT and also pathologically proven to exhibit ALNM was significantly larger than the number (2.16+/-2.26) in other patients who exhibited ALNM (p=0.035). CONCLUSION: There are no definitive modalities for detecting ALNM in T1 breast cancers to replace sentinel lymph node biopsy (SLNB). If ALNM is suspected based on cMRI and PET/CT, the axillary dissection without SLNB might be a better option because it is related to high possibilities of ALNM and large axillary metastatic volumes.
Axilla
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Breast
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Breast Neoplasms
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Diagnostic Imaging
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Electrons
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Fluorodeoxyglucose F18
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Humans
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Lymph Node Excision
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Lymph Nodes
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Magnetic Resonance Imaging
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Neoplasm Metastasis
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Nitriles
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Pyrethrins
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Retrospective Studies
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Sensitivity and Specificity
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Sentinel Lymph Node Biopsy
9.Sentinel lymph notes in female reproductive tract cancer.
Acta Academiae Medicinae Sinicae 2003;25(4):377-380
To reduce extensive radical procedures and decrease morbidity in gynecologic malignancies, much effort is being focused on implementing less aggressive interventions. Two different approaches such as lymphatic mapping and lymphoscintigraphy are currently used to identify sentinel lymph nodes. In vulvar and cervical carcinomas, metastatic spread of disease commonly follows stepwise progressive drainage. Thus, sentinel lymph node identification may significantly reduce the number of patients undergoing unnecessary, extensive lymphadenectomy in the absence of metastatic disease. The addition of novel techniques, such as histopathologic ultrastaging, step sectioning, and immunohistochemistry staining, will help increase the accuracy and rate of detection of the disease. Any definitive statements can be made to the validity of sentinel lymphadenectomy until we got data with long-term follow-up.
Endometrial Neoplasms
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pathology
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Female
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Genital Neoplasms, Female
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pathology
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surgery
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Humans
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Lymph Node Excision
;
methods
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Lymph Nodes
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diagnostic imaging
;
pathology
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Lymphatic Metastasis
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Radionuclide Imaging
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Sentinel Lymph Node Biopsy
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Uterine Cervical Neoplasms
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pathology
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Vaginal Neoplasms
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pathology
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Vulvar Neoplasms
;
pathology
10.Sentinel lymph node biopsy in papillary thyroid cancer.
Bin ZHANG ; Dan-gui YAN ; Lin LIU ; Li-juan NIU ; Chang-ming AN ; Zong-min ZHANG ; Zheng-jiang LI ; Zhen-gang XU ; Ping-zhang TANG
Chinese Journal of Oncology 2010;32(10):782-785
OBJECTIVETo investigate the reliability and feasibility of sentinel lymph node biopsy (SLNB) of papillary thyroid carcinoma using combination of lymphoscintigraphy, the gamma probe and methylene blue staining techniques.
METHODSTwenty-three consecutive patients with thyroid papillary carcinoma were entered in the study between August 2007 and August 2009. All cases were without clinical evidence of cervical lymph node involvement. The (99)Tc(m)-dextran of 74 MBq (2mCi) was injected intratumorally under ultrasound guidance about 2 h to 5 h prior to surgery. Methylene blue was injected around the tumor during surgery. Preoperative lymphoscintigraphy, intra-operative hand-held gamma probe detecting and methylene blue staining techniques were used to detect the sentinel lymph node (SLN). SLN biopsies were sent to prepare frozen sections and the results were compared with specimen of routine selective neck dissection.
RESULTSThe SLNs were identified in all cases with the combination techniques. The SLN identification rates were 87.0% and 100% with methylene blue staining and lymphoscintigraphy plus probe scanning, respectively. Metastases in SLNs were revealed by frozen-section histology in 12 patients. In one case, SLNs frozen-section were negative, but metastasis was detected in routine histology. In other case both SLN and routine histology were negative, but metastasis was detected in non-SLN (level VI) neck dissection. The overall accuracy of the SLN biopsy was 91.3%, positive predictive value 100% and negative predictive value 81.8%.
CONCLUSIONThe results seem the SLN biopsy technique is a feasible and valuable method for detecting cervical lymph node metastasis and is helpful to decide performing neck dissection in patients with cN0 papillary thyroid carcinoma.
Adult ; Aged ; Carcinoma, Papillary ; diagnostic imaging ; pathology ; surgery ; Dextrans ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; diagnostic imaging ; pathology ; Lymphatic Metastasis ; Male ; Methylene Blue ; Middle Aged ; Neoplasm Staging ; Organotechnetium Compounds ; Radionuclide Imaging ; Sentinel Lymph Node Biopsy ; Thyroid Neoplasms ; diagnostic imaging ; pathology ; surgery ; Young Adult