Endocrine Abstracts

Background: The accuracy of sentinel lymph node biopsy (SLNb) in decisions for surgical management of lymph nodes in differentiated thyroid ccarcinoma (DTC) was demonstarted in a few previous studies.

Aim: To determine whether SLN biopsy of first draining node/s in jugulo-carotid chain is accurate technique to select patients with true positive LN for selective modified radical neck dissection (MRND).

Patients and methods: We have performed SLN biopsy in 172 patients with DTC. Before mobilization of the thyroid gland, 0.2 ml of 1% solution of methylen blue dye was injected peritumorally. After 10 min the dissection was continued around omohyoid muscle, towards the internal jugular vein and carotid artery until blue stained LN were found and sent for frozen-section examination. An extended dissection of level III/IV was done consecutively. All LN were examined by frozen section and conventional (HE) histopathology examination. If positive, MRND was performed after total thyroidectomy and routine dissection of central neck compartment.

Results: Identification rate of SLN was 93.5%. Specificity and sensitivity of the method were 100 and 80% respectively. Negative and positive predictive values were 94.7 and 100%. Overall accuracy of the method was 95.6%. Conclusions: According to previous data, status of lower jugulo-carotid LN significantly predicts the status in upper two thirds. Our results imply that SLNb in the jugulo-carotid chain using methylene blue dye mapping, is feasible and accurate method for estimating LN status in the lateral neck compartment. The method may support a decision to perform selective MRND in patients with DTC.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.