Although studies have shown that the presence of lymph nodes metastases in papillary thyroid carcinoma does not alter survival, other studies have shown that it increases morbidity and mortality and that the presence of cervical lymph node metastasis at diagnosis is the single most important factor that ultimately increases the risk of local recurrence. The American Thyroid Association (ATA) recommends therapeutic central compartment (level VI) neck dissection only for those patients with clinically involved central LNs. Additionally, the ATA recommends prophylactic central compartment neck dissection (ipsilateral or bilateral) in patients with clinically uninvolved central neck LNs (cN0) who have advanced primary tumors (T3 or T4). Although ultrasonography has a high specificity for detecting cervical lymph node metastases (95-97%), the range of sensitivity is wide (52-84%), mainly because of occult disease. Single-photon emission computed tomography/computed tomography (SPECT/CT) and radioguided sentinel lymph node biopsy (rSLNB) are techniques that could potentially benefit surgeons and pathologists in the identification of sentinel lymph node (SLN) metastases in patients with papillary thyroid carcinoma (PTC).
In this prospective cohort study on 42 patients, sentinel lymph nodes were identified in 92% of the patients, and among these metastases were present in 46% of patients. The sentinel lymph node biopsy techniques lead to management change in 14 patients (37.8%).
Further prospective multicenter studies for longer periods and with a larger number of SLNBs are needed to corroborate these findings.
