Management of occult lymphatic disease in papillary thyroid cancer (PIC) is controversial. While occult regional lymph node involvement ranges from 25% to 90% and is associated with increase in tumor recurrence there is no evidence that removal of these nodes confers a survival advantage. (1-5)
American Thyroid Association 2006 guidelines specify that the primary disease and involved lymph nodes should be revolved and additionally that the operation should facilitate radioactive iodine administration permit accurate surveillance and minimize the risk of disease recurrence to these ends they recommend the following steps preoperative routine central compartment neck dissection and lateral neck compartment lymph node dissection for either clinical or image-identified lymph node metastasis. (6)
The extent of lateral neck dissection for fine-needle aspiration-confirmed disease in the lateral neck remains a controversial and hot topic for debate. (7-12)
Intra-operative lymphatic mapping with sentinel lymph node biopsy (the first lymph node draining into a lymphatic basin) has become a revolutionary concept in the management of solid malignancies and can be adopted also in thyroid carcinoma, especially in patients No at clinical and ultrasound examinations as an alternative to elective lymph node dissection.(4)
In the case of positive sentinel lymph node (SLN) findings it seems wise to extend lymph node dissection to the level to which the positive node belongs which may even be the laterocervical compartment. This helps to avoid a high incidence of node recurrence and the risks of prophylactic node dissection or reoperation.(13-15)
The aim of this non-randomized prospective study is to evaluate the role of sentinel lymph node biopsy (SLNB) in diagnosis of lateral nodal involvement in N0 papillary thyroid cancer patients.(4) |
