Initial surgery for medullary thyroid cancer (MTC) with no evidence of lymph nodal involvement in neck compartments consists of total thyroidectomy and prophylactic central neck dissection. This study evaluates the reliability of a radiotracer technique for the intraoperative detection of sentinel lymph node (SLN) in patients with early MTC; we also speculate about its potential clinical applications. Methods: Patients with limited (T1 cN0) MTC entered the study (2009-2012). A 0.1–0.3-ml suspension of macrocolloidal 99Tclabeled human albumin was injected in the tumor under echographic guidance 2 to 6 h prior to surgery. Preoperative lymphoscintigraphy confirmed the identification of SLN. At operation, the surgeon removed the SLN guided by a hand-held gamma-probe (Neoprobe). Level VI nodes were not considered as SLN (their removal is part of the operation for MTC). Then, a variable amount of surrounding soft tissue was resected to verify the absence of tumor cells out of SLN. The operation was completed by a total thyroidectomy and central neck dissection. Results: Four subjects were recruited. The tracer always indicated SLN. Pathology reports indicated micrometastases in SLN in three patients. No malignant cells were found in the surrounding nodes. At a mean follow-up of 30.5 months, all patients are biochemically cured. Discussion: The technique we describe to detect and remove neck SLN from MTC seems to be very accurate: it always showed the SLN (usually two) in the lateral compartments. Micrometastases were detected only in nodes classified as SLN, and not out of them. This finding allowed a correct staging in three out of four patients (otherwise understaged). Conclusions: The method here described for the detection of SLN in early MTC seems effective and reliable. It can be employed for a more precise N staging of the patients. It could play a role, alone or in combination with other parameters, in driving the extent of prophylactic neck dissection or other potential applications.

The sentinel node biopsy in early stage medullary thyroid cancer

PUCCINI, MARCO;UGOLINI C.;BUCCIANTI, PIERO
2013

Abstract

Initial surgery for medullary thyroid cancer (MTC) with no evidence of lymph nodal involvement in neck compartments consists of total thyroidectomy and prophylactic central neck dissection. This study evaluates the reliability of a radiotracer technique for the intraoperative detection of sentinel lymph node (SLN) in patients with early MTC; we also speculate about its potential clinical applications. Methods: Patients with limited (T1 cN0) MTC entered the study (2009-2012). A 0.1–0.3-ml suspension of macrocolloidal 99Tclabeled human albumin was injected in the tumor under echographic guidance 2 to 6 h prior to surgery. Preoperative lymphoscintigraphy confirmed the identification of SLN. At operation, the surgeon removed the SLN guided by a hand-held gamma-probe (Neoprobe). Level VI nodes were not considered as SLN (their removal is part of the operation for MTC). Then, a variable amount of surrounding soft tissue was resected to verify the absence of tumor cells out of SLN. The operation was completed by a total thyroidectomy and central neck dissection. Results: Four subjects were recruited. The tracer always indicated SLN. Pathology reports indicated micrometastases in SLN in three patients. No malignant cells were found in the surrounding nodes. At a mean follow-up of 30.5 months, all patients are biochemically cured. Discussion: The technique we describe to detect and remove neck SLN from MTC seems to be very accurate: it always showed the SLN (usually two) in the lateral compartments. Micrometastases were detected only in nodes classified as SLN, and not out of them. This finding allowed a correct staging in three out of four patients (otherwise understaged). Conclusions: The method here described for the detection of SLN in early MTC seems effective and reliable. It can be employed for a more precise N staging of the patients. It could play a role, alone or in combination with other parameters, in driving the extent of prophylactic neck dissection or other potential applications.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11568/246655
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