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[9000443.] رقم البحث : 9000443 - |
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SENTINEL LYMPH NODE IDENTIFICATIONS IN PAPILLARY THYROID CANCER. / |
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قطاع الدراسات الطبية / أنف وأذن |
| تخصص البحث : أنف وأذن |
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Menoufia Medical Journal / / Vol. 25, No. 2 - July 2012 |
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د/ عصام عبدالونيس بحيرى ( 122160184 ) |
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CLND, Otolaryngology |
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Background:- Cervical lymph node metastases are very common in
patients with papillary thyroid cancer (PTC). The sentinel lymph node
(SLN) is defined as the first draining lymph node in the lymphatic
basin into which the primary tumor drains. The pathological status of
SLN actually reflects the histology of the remaining regional
lymphatic and extension of the primary tumor and so presence or
absence of the SLN determines whether neck dissection of the
regional lymphatic is indicated or not. Also neck dissection in patients
with papillary thyroid carcinoma (PTC) is a matter of controversy
because it depends mainly on expectation not actual lymphatic
spread of the tumor. although PTC has an excellent prognosis,
lymphatic spread is associated with increased risk of loco-regional
recurrence, which significantly impairs quality-of-life and can alter
prognosis of the patient. Therefore, the identification of lymph node
metastases preoperatively is very important for the surgeon to plan
the optimal surgical therapy for the individual patient. also study of
SLN in patients with PTC is true and recent advance in the
management of PTC.
Our aim is to study the feasibility of sentinel lymph node
identifications in patients with PTC and its influence in modifying the
surgical management of lymph node metastases.
Patients & methods - Over the period from May 2010 to March 2013,
12 patients had PTC by FNAC were enrolled in this study .Metheline
blue dye was injected in the primary site of the thyroid tumor via
thyroidectomy approach with special precautions. After SLN
identification ,histopathological analysis were done included
microscopic examination and histological grading.
Results-from the 12 patient enrolled in the study, we were able to
identify sentinel lymph node in 10/12 cases (83.3%).with true + VE
7/12 and true – VE1/12 the mean number of sentinel lymph nodes
were 2 (range 1-3).The histopathological study reveals 7/12 true
positive patients with cancer cells in the SLN obtained and only 1/12
true negative patients with no cancer cells in in the SLN obtained
,there is 3/12 false +ve and 1/12 false negative patients.
micrometastases was detected in 7/12 patients and occult
micrometastases was detected in3/12 patients.
Conclusions- This study showed that SLN was feasible, repeatable
and accurate and reduced false negative rates and increased
detection rates of lateral neck sentinel lymph nodes. The main value
of sentinel lymph node identification is to avoid unnecessary neck
dissection It helps to select patients for compartment neck dissection
to avoid unnecessary neck dissection and possible morbidity. also it
helps to select patients indicated or not indicated for ablative I 131
with accuracy. it helps to identify lymph node drainage outside the
central compartment with appropriate approach and extent of
surgery. Also it is cheap, easy ,safe, and can be performed in the
same site and time of the procedures planned. Further well designed
randomized studies are necessary to validate and further optimize
the SLN identification in patients with PTC. |
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