The application of sentinel lymph node biopsy for differentiated thyroid carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHAO Jing , LING Yuwei , HAN Jing , ZHAO Ye , WANG Yajun ,  KANG Hua

Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, P. R. China;

Corresponding?author：

KANG Hua, Email: kanghua@xwh.ccmu.edu.cn

Keywords：

differentiated thyroid carcinoma; sentinel lymph node biopsy; central cervical lymph node dissection; positive sentinel lymph node ratio; additional positive lymph nodes

DOI：

10.7507/1007-9424.201705112

Video：

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Objective To investigate the value of sentinel lymph node biopsy (SLNB) in predicting the metastasis of central cervical lymph nodes (CCLN) in differentiated thyroid carcinoma, and to explore reasonable program for CCLN dissection. Methods This retrospective analysis was performed basing on the clinical data of 407 patients with differentiated thyroid carcinoma who were admitted to the Department of General Surgery of Xuanwu Hospital from June 2013 to December 2016, including 237 patients with microcarcinoma. Results ① The results of the lymph nodes detection. All patients had detected 7 766 lymph nodes (1 238 metastatic lymph nodes were detected from 219 patients), and 2 085 sentinel lymph nodes were detected (448 metastatic sentinel lymph nodes were detected from 189 patients). In the patients with microcarcinoma, there were 3 614 lymph nodes were detected (390 metastatic lymph nodes were detected from 97 patients), and 1 202 sentinel lymph nodes were detected (149 metastatic sentinel lymph nodes were detected from 82 patients). ② The value of SLNB to predict CCLN metastasis. The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of SLNB to predict CCLN metastasis for all patients was 86.30% (189/219), 100% (188/188), 0 (0/189), 13.70% (30/219), 100% (189/189), and 86.24% (188/218) respectively; for patients with microcarcinoma was 84.54% (82/97), 100% (140/140), 0 (0/82), 15.46% (15/97), 100% (82/82), and 90.32% (140/155), respectively. ③ The value of SLNB to predict the presence of additional positive lymph nodes (APLN). The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of SLNB to predict the APLN for all patients was 81.48% (132/162), 76.73% (188/245), 23.27% (57/245), 18.52% (30/162), 69.84% (132/189) and 86.24% (188/218), respectively; for patients with microcarcinoma was 73.68% (42/57), 77.78% (140/180), 22.22% (40/180), 26.32% (15/57), 51.22% (42/82) and 90.32% (140/155) respectively. ④ The value of positive sentinel lymph node ratio (PSLNR) to predict the presence of the APLN. The sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of PSLNR to predict the APLN for all patients was 71.97%, 78.95%, 21.05%, 28.03%, 88.79%, and 54.88% respectively, and the cutoff for PSLNR was 0.345 2. For patients with microcarcinoma, the sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value of PSLNR to predict the APLN was 83.33%, 67.50%, 32.50%, 16.67%, 72.92%, and 79.41% respectively, and the cutoff for PSLNR was 0.291 7. Conclusion There is an important predicted value of SLNB for CCLN dissection in the patients suffered from differentiated thyroid carcinoma, and the PSLNR is a reliable basis for CCLN dissection.

Citation： ZHAO Jing, LING Yuwei, HAN Jing, ZHAO Ye, WANG Yajun, KANG Hua. The application of sentinel lymph node biopsy for differentiated thyroid carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(11): 1333-1341. doi: 10.7507/1007-9424.201705112 Copy

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1. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
2. 郭科, 尹樂平. 納米炭在分化型甲狀腺癌根治術中的應用. 實用醫院臨床雜志, 2014, 11(1): 191-193.
3. 中華醫學會內分泌學分會, 中華醫學會外科學分會內分泌學組, 中國抗癌協會頭頸腫瘤專業委員會, 等. 甲狀腺結節和分化型甲狀腺癌診治指南. 中華內分泌代謝雜志, 2012, 28(10): 779-797.
4. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016, 26(1): 1-133.
5. Kowalski LP, Bagietto R, Lara JR, et al. Prognostic significance of the distribution of neck node metastasis from oral carcinoma. Head Neck, 2000, 22(3): 207-214.
6. 白云城, 程若川. 前哨淋巴結活檢運用于甲狀腺癌的研究熱點與思考//中國抗癌協會甲狀腺腫瘤專業委員會. 第六屆全國甲狀腺腫瘤學術大會論文集, 天津, 2014: 314-318.
7. 孫威, 賀亮, 張浩. 美國癌癥聯合委員會甲狀腺癌分期系統 (第 8 版) 更新解讀. 中國實用外科雜志, 2017, 37(3): 255-258.
8. Mizrachi A, Shaha AR. Lymph node dissection for differentiated thyroid cancer. Mol Imaging Radionucl Ther, 2017, 26(Suppl 1): 10-15.
9. Wierzbicka M, Wa?niewska E, Szyfter W. Management of thyroid cancer metastases in lymph nodes. Otolaryngol Pol, 2008, 62(3): 267-271.
10. Yang Y, Chen C, Chen Z, et al. Prediction of central compartment lymph node metastasis in papillary thyroid microcarcinoma. Clin Endocrinol (Oxf), 2014, 81(2): 282-288.
11. 孫文文, 李秧秧, 鐘申, 等. 甲狀腺乳頭狀癌中橋本甲狀腺炎與頸部中央區淋巴結轉移的關系. 中華內分泌代謝雜志, 2016, 32(11): 906-909.
12. So YK, Son YI, Hong SD, et al. Subclinical lymph node metastasis in papillary thyroid microcarcinoma: a study of 551 resections. Surgery, 2010, 148(3): 526-531.
13. Bonnet S, Hartl D, Leboulleux S, et al. Prophylactic lymph node dissection for papillary thyroid cancer less than 2 cm: implications for radioiodine treatment. J Clin Endocrinol Metab, 2009, 94(4): 1162-1167.
14. Chéreau N, Buffet C, Trésallet C, et al. Recurrence of papillary thyroid carcinoma with lateral cervical node metastases: predictive factors and operative management. Surgery, 2016, 159(3): 755-762.
15. Nixon IJ, Wang LY, Palmer FL, et al. The impact of nodal status on outcome in older patients with papillary thyroid cancer. Surgery, 2014, 156(1): 137-146.
16. Nixon IJ, Kuk D, Wreesmann V, et al. Defining a valid age cutoff in staging of well-differentiated thyroid cancer. Ann Surg Oncol, 2016, 23(2): 410-415.
17. Moreno MA, Edeiken-Monroe BS, Siegel ER, et al. In papillary thyroid cancer, preoperative central neck ultrasound detects only macroscopic surgical disease, but negative findings predict excellent long-term regional control and survival. Thyroid, 2012, 22(4): 347-355.
18. Henry JF, Gramatica L, Denizot A, et al. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg, 1998, 383(2): 167-169.
19. Pereira JA, Jimeno J, Miquel J, et al. Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery, 2005, 138(6): 1095-1100.
20. Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg, 2007, 245(4): 604-610.
21. Palestini N, Borasi A, Cestino L, et al. Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience. Langenbecks Arch Surg, 2008, 393(5): 693-698.
22. Roh JL, Park JY, Park CI. Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection. Cancer, 2009, 115(2): 251-8.
23. Goropoulos A, Karamoshos K, Christodoulou A, et al. Value of the cervical compartments in the surgical treatment of papillary thyroid carcinoma. World J Surg, 2004, 28(12): 1275-1281.
24. Cheah WK, Arici C, Ituarte PH, et al. Complications of neck dissection for thyroid cancer. World J Surg, 2002, 26(8): 1013-1016.
25. Ito Y, Tomoda C, Uruno T, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg, 2006, 30(1): 91-99.
26. Giordano D, Valcavi R, Thompson GB, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid, 2012, 22(9): 911-917.
27. Cho SY, Lee TH, Ku YH, et al. Central lymph node metastasis in papillary thyroid microcarcinoma can be stratified according to the number, the size of metastatic foci, and the presence of desmoplasia. Surgery, 2015, 157(1): 111-118.
28. Wada N, Suganuma N, Nakayama H, et al. Microscopic regional lymph node status in papillary thyroid carcinoma with and without lymphadenopathy and its relation to outcomes. Langenbecks Arch Surg, 2007, 392(4): 417-22.
29. Ywata de Carvalho A, Chulam TC, Kowalski LP. Long-term results of observation vs prophylactic selective level Ⅵ neck dissection for papillary thyroid carcinoma at a cancer center. JAMA Otolaryngol Head Neck Surg, 2015, 141(7): 599-606.
30. Zhang L, Wei WJ, Ji QH, et al. Risk factors for neck nodal metastasis in papillary thyroid microcarcinoma: a study of 1066 patients. J Clin Endocrinol Metab, 2012, 97(4): 1250-1257.
31. Kwak JY, Kim EK, Kim MJ, et al. Papillary microcarcinoma of the thyroid: predicting factors of lateral neck node metastasis. Ann Surg Oncol, 2009, 16(5): 1348-1355.
32. Lundgren CI, Hall P, Dickman PW, et al. Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case-control study. Cancer, 2006, 106(3): 524-531.
33. Roh JL, Kim JM, Park CI. Central compartment reoperation for recurrent/persistent differentiated thyroid cancer: patterns of recurrence, morbidity, and prediction of postoperative hypocalcemia. Ann Surg Oncol, 2011, 18(5): 1312-1318.
34. 朱一鳴, 藺晨, 王健, 等. 甲狀腺乳頭狀癌側頸部淋巴結二次清掃的治療經驗. 中國醫刊, 2016, 51(6): 59-63.
35. Starmer H, Noureldine SI, Ozgursoy OB, et al. Voice outcomes following reoperative central neck dissection for recurrent/persistent thyroid cancer. Laryngoscope, 2015, 125(11): 2621-2625.
36. Choi JS, Kim J, Kwak JY, et al. Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. AJR Am J Roentgenol, 2009, 193(3): 871-878.
37. Hwang HS, Orloff LA. Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer. Laryngoscope, 2011, 121(3): 487-491.
38. Lee DW, Ji YB, Sung ES, et al. Roles of ultrasonography and computed tomography in the surgical management of cervical lymph node metastases in papillary thyroid carcinoma. Eur J Surg Oncol, 2013, 39(2): 191-196.
39. Wada N, Duh QY, Sugino K, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg, 2003, 237(3): 399-407.
40. Xu D, Lv X, Wang S, et al. Risk factors for predicting central lymph node metastasis in papillary thyroid microcarcinoma. Int J Clin Exp Pathol, 2014, 7(9): 6199-6205.
41. Sun W, Lan X, Zhang H, et al. Risk factors for central lymph node metastasis in CN0 papillary thyroid carcinoma: a systematic review and meta-analysis. PLoS One, 2015, 10(10): e0139021.
42. Cai YF, Wang QX, Ni CJ, et al. A scoring system is an effective tool for predicting central lymph node metastasis in papillary thyroid microcarcinoma: a case-control study. World J Surg Oncol, 2016, 14(1): 45.
43. Noguchi S, Noguchi A, Murakami N. Papillary carcinoma of the thyroid. Ⅰ. Developing pattern of metastasis. Cancer, 1970, 26(5): 1053-1060.
44. Choi SY, Cho JK, Moon JH, et al. Metastatic lymph node ratio of central neck compartment has predictive values for locoregional recurrence in papillary thyroid microcarcinoma. Clin Exp Otorhinolaryngol, 2016, 9(1): 75-79.
45. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7^th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010, 17(6): 1471-1474.
46. Mercante G, Frasoldati A, Pedroni C, et al. Prognostic factors affecting neck lymph node recurrence and distant metastasis in papillary microcarcinoma of the thyroid: results of a study in 445 patients. Thyroid, 2009, 19(7): 707-716.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The application of sentinel lymph node biopsy for differentiated thyroid carcinoma

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