Our Summary

This paper reviews the use of sentinel lymph node biopsy (SNB) in patients with papillary thyroid carcinoma (PTC), a type of thyroid cancer, who show no signs of lymph node metastasis. The researchers searched a medical database for studies on this topic and found that different techniques - including blue dye, radioisotope, and a combination of both - are used in this procedure. The success rate of finding sentinel lymph nodes varied from 0 to 100% for blue dye, 83 to 100% for radioisotopes, and 66 to 100% for the combination of both techniques. The authors conclude that the radioisotope technique, using an intraoperative gamma-probe, is the most accurate and safe method, offering the highest detection rate. They suggest that this procedure could help avoid unnecessary preventative lymph node surgery in patients without clinical signs of lymph node involvement.

FAQs

  1. What is a sentinel lymph node biopsy (SNB) and how is it used in patients with papillary thyroid carcinoma (PTC)?
  2. What techniques are used in sentinel lymph node biopsy and how successful are they?
  3. What is the most accurate and safe method for sentinel lymph node biopsy according to the researchers?

Doctor’s Tip

A doctor might tell a patient undergoing sentinel lymph node biopsy for thyroid cancer to discuss the use of the radioisotope technique with an intraoperative gamma-probe with their surgeon. This method has been shown to be the most accurate and safe for detecting sentinel lymph nodes, potentially avoiding unnecessary preventative lymph node surgery. It is important for patients to be informed about the different techniques available and to work closely with their healthcare team to determine the best approach for their individual case.

Suitable For

Patients with papillary thyroid carcinoma (PTC) who show no signs of lymph node metastasis are typically recommended sentinel lymph node biopsy (SNB). This procedure can help determine if the cancer has spread to nearby lymph nodes, and can guide further treatment decisions. The use of SNB in these patients can help avoid unnecessary preventative lymph node surgery in those who do not have lymph node involvement.

Timeline

  1. Initial diagnosis of papillary thyroid carcinoma (PTC) in a patient without signs of lymph node metastasis.
  2. Consultation with a surgeon to discuss treatment options, including the possibility of a sentinel lymph node biopsy.
  3. Pre-operative evaluation to determine the best technique for SNB, which may include blue dye, radioisotope, or a combination of both.
  4. Surgical procedure to locate and remove the sentinel lymph node using the chosen technique.
  5. Pathological examination of the sentinel lymph node to determine if cancer cells are present.
  6. If cancer cells are found in the sentinel lymph node, further treatment may be recommended, such as lymph node dissection or radioactive iodine therapy.
  7. If no cancer cells are found in the sentinel lymph node, the patient may be spared unnecessary preventative lymph node surgery.
  8. Follow-up appointments with the surgeon and endocrinologist to monitor the patient’s progress and adjust treatment as necessary.

What to Ask Your Doctor

Some questions a patient should ask their doctor about sentinel lymph node biopsy for papillary thyroid carcinoma include:

  1. What is the purpose of a sentinel lymph node biopsy in my case?
  2. How is the procedure performed and what are the potential risks and complications?
  3. What is the success rate of finding sentinel lymph nodes using different techniques such as blue dye, radioisotope, or a combination of both?
  4. Which technique do you recommend for me and why?
  5. How accurate is the radioisotope technique with an intraoperative gamma-probe compared to other methods?
  6. Will the results of the sentinel lymph node biopsy affect my treatment plan?
  7. What are the implications if sentinel lymph nodes are found to be positive for cancer cells?
  8. How soon will I receive the results of the biopsy?
  9. Are there any alternative options to consider instead of a sentinel lymph node biopsy?
  10. What follow-up care will be needed after the procedure?

Reference

Authors: Garau LM, Rubello D, Ferretti A, Boni G, Volterrani D, Manca G. Journal: Endocrine. 2018 Nov;62(2):340-350. doi: 10.1007/s12020-018-1658-5. Epub 2018 Jul 2. PMID: 29968226