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. 2009 Dec;29(6):321-5.

99Tc nanocolloid sentinel node procedure in papillary thyroid carcinoma: our mono-institutional experience on a large series of patients

M R Pelizzo  1 , A Toniato, N Sorgato, A Losi, F Torresan, I Merante Boschin
Affiliations

99Tc nanocolloid sentinel node procedure in papillary thyroid carcinoma: our mono-institutional experience on a large series of patients

M R Pelizzo et al. Acta Otorhinolaryngol Ital. 2009 Dec.

Abstract
in English, Italian

The sentinel lymph node was defined as the first lymph node to receive drainage from a primary cancer. The aims of this study were to investigate the efficacy of radiocolloid lymphoscintigraphy and of the hand-held gamma probe procedure for sentinel lymph node biopsy in papillary thyroid carcinoma and to evaluate these results in clinical staging. A total of 99 consecutive papillary thyroid carcinoma patients entered the study. Patients underwent radiocolloid lymphoscintigraphy before surgery. Intra-operative sentinel lymph node localization was performed using a hand-held gamma probe. Patients were observed at follow-up at 2 and 6 months and, thereafter, yearly. Sequential lymphoscintigraphy was able to identify at least one sentinel lymph node in 98/99 cases (99%), using intra-operative hand-held gamma probe, the surgeon was able to detect at least one sentinel lymph node in all cases. Sentinel lymph node metastases were diagnosed in 49%. Overall, 79 patients underwent ablative (131)I therapy. The median value of thyroglobulin in N0 vs. N1 patients was 1 ng/ml vs. 1.9 ng/ml (p = 0.03) and 0.2 ng/ml vs. 1 ng/ml (p = 0.001) before and after (131)I therapy, respectively. The pre-operative lymphoscintigraphy and the intra-operative gamma probe offer significant advantages over the vital dye technique, described in our previous experience. The rate of nodal involvement (49%) is very high considering that no patients had clinically palpable nodes or suspected at echography. (131)I whole body scan and thyroglobulin measurements confirmed sentinel lymph node in papillary thyroid carcinoma as a reliable procedure. In patients classified N0, by sentinel lymph node biopsy, ablative (131)I therapy could be avoided.

Il linfonodo sentinella è stato definito come il primo linfonodo che riceve il drenaggio linfatico dal tumore primitivo. Gli obiettivi di questo studio sono stati indagare l’efficacia della procedura mediante linfoscintigrafia preoperatoria con radio colloide e sonda gamma manuale intraoperatoria per la ricerca del linfonodo sentinella nel carcinoma papillare della tiroide e valutare i risultati nella stadiazione clinica. Novantanove pazienti consecutivi affetti da carcinoma papillare della tiroide sono stati arruolati in questo studio. I pazienti sono stati sottoposti a linfoscintigrafia con radio colloide prima dell’intervento chirurgico. La localizzazione intraoperatoria del linfonodo sentinella è stata realizzata utilizzando una sonda gamma manuale. I pazienti sono stati seguiti nel follow-up a 2, 6 mesi e in seguito annualmente. Il linfonodo sentinella è stato individuato in 98/99 casi (99%) mediante linfoscintigrafia e in tutti i casi mediante la sonda manuale intraoperatoria. Metastasi linfonodali del linfonodo sentinella sono state individuate nel 49% dei casi. Settantanove pazienti sono stati sottoposti a terapia ablativa con 131I. Il valore mediano della tireoglobulina nei pazienti N0 vs. N1 è risultato pari a 1 ng/ml vs. 1,9 ng/ml (p = 0,003) e 0,2 ng/ml vs. 1 ng/ml (p = 0,001) rispettivamente prima e dopo la terapia con 131I. La ricerca del linfonodo sentinella mediante linfoscintigrafia preoperatoria e gamma camera intraoperatoria offrono significativi vantaggi rispetto alla tecnica con il colorante vitale, descritta nella nostra precedente esperienza. La percentuale di metastasi linfonodali pari a 49% è molto alta considerando che nessun paziente presentava linfonodi sospetti né clinicamente né alla ecografia preoperatoria. La scintigrafia total body con 131I e i dosaggi di tireoglobulina hanno confermato l’attendibilità della procedura del linfonodo sentinella nel carcinoma papillare della tiroide. Nei pazienti definiti N0 mediante la tecnica del linfonodo sentinella la terapia con 131I può essere evitata.

Keywords: Cancer; Node metastases; Radiocolloid lymphoscintigraphy; Sentinel lymph node; Thyroid.

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