Our Summary

This research paper is about a study on the effectiveness of a medical procedure called sentinel lymph node biopsy in patients with suspected thyroid cancer. The biopsy uses a special tracer to help locate the first lymph node that cancer is likely to spread to (the sentinel node) during surgery. Between 2010 and 2017, 96 patients with no apparent lymph node involvement were included in the study.

The researchers found that the technique could locate the sentinel node in 67% of cases when using a scanning method called scintigraphy, and in 45% of cases when using an intraoperative gamma probe. These detection rates were not affected by factors like the severity of the disease or the presence of lymph node metastases.

The accuracy of this biopsy technique in representing whether or not cancer had spread to the lymph nodes in the neck was high (98%). The negative predictive value, which is the probability that patients with a negative result really don’t have the disease, was also high (97%). The sensitivity, or the ability to correctly identify patients with the disease, was moderate (80%). However, the false negative rate, meaning the technique indicated no cancer when it was actually present, was quite high (20%).

The study therefore concludes that sentinel lymph node biopsy is not very reliable in patients with suspected thyroid cancer and is not a useful supplement to surgery based on current treatment methods.

FAQs

  1. What is the role of sentinel lymph node biopsy in thyroid cancer?
  2. What was the detection rate of the sentinel node in the study conducted between 2010 and 2017?
  3. How effective is sentinel lymph node biopsy in patients with suspected thyroid carcinoma according to the study’s conclusion?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sentinel lymph node biopsy is to understand that while it can provide valuable information about the status of lymph node metastasis in the central neck compartment, it may not always detect all affected nodes. It is important to discuss the potential benefits and limitations of the procedure with your healthcare provider to determine if it is the right option for you.

Suitable For

Sentinel lymph node biopsy is typically recommended for patients undergoing thyroid surgery for suspected thyroid cancer who do not have clinical lymph node involvement. This procedure may be considered as an adjunct to optimize surgical treatment for these patients. It is important to note that the detection rate and diagnostic value of sentinel lymph node biopsy in thyroid cancer patients may vary, and further research is needed to establish its role in the management of these patients.

Timeline

Before sentinel lymph node biopsy:

  • Patient undergoes thyroid surgery for suspected thyroid cancer based on fine needle aspiration cytology
  • Patient is invited to participate in the study if they do not have clinical lymph node involvement
  • Sentinel lymph node biopsy using 99mTc-nanocolloidal albumin tracer is performed
  • Central neck dissection is performed on all patients after detection of sentinel lymph nodes

After sentinel lymph node biopsy:

  • Detection rates of sentinel node are 67% by scintigraphy and 45% by intraoperative gamma probe
  • Detection rate is not associated with Bethesda score, malignancy, or presence of lymph node metastases
  • Sensitivity, negative predictive value, and accuracy of sentinel node in representing lymph node metastasis status in central neck compartment are 80%, 97%, and 98%, respectively
  • False negative rate is 20%
  • Conclusion: Sentinel lymph node biopsy has low detection rate and only moderate sensitivity in patients with suspected thyroid carcinoma, and is not a useful adjunct to surgery in current treatment concepts.

What to Ask Your Doctor

  1. What is a sentinel lymph node biopsy and how is it different from a standard lymph node biopsy?
  2. What are the potential risks and complications associated with a sentinel lymph node biopsy?
  3. How likely is it that the sentinel lymph node biopsy will accurately detect lymph node metastases in my case?
  4. How will the results of the sentinel lymph node biopsy impact my treatment plan?
  5. Are there any alternative methods for detecting lymph node metastases that may be more effective in my case?
  6. How experienced are you and your team in performing sentinel lymph node biopsies for thyroid cancer patients?
  7. How will the sentinel lymph node biopsy be conducted (e.g. imaging techniques, surgical procedure)?
  8. Will I need to undergo additional treatments or procedures based on the results of the sentinel lymph node biopsy?
  9. What is the expected recovery time and follow-up care after a sentinel lymph node biopsy?
  10. Are there any specific guidelines or recommendations I should follow before and after the sentinel lymph node biopsy procedure?

Reference

Authors: Albers MB, Nordenström E, Wohlfahrt J, Bergenfelz A, Almquist M. Journal: World J Surg. 2020 Jan;44(1):142-147. doi: 10.1007/s00268-019-05218-1. PMID: 31583456