Ann Surg Treat Res.  2017 Nov;93(5):240-245. 10.4174/astr.2017.93.5.240.

Feasibility of sentinel lymph node dissection using Tc-99m phytate in papillary thyroid carcinoma

• Paek SH
• Yi KH
• Kim SJ
• Choi JY
• Lee KE
• Park YJ
• Park DJ
• Kang KW
• Chung JK

• KMID: 2393988
• DOI: http://doi.org/10.4174/astr.2017.93.5.240

Abstract

PURPOSE
Various methods of sentinel lymph node (SLN) biopsy in thyroid cancer have been introduced. Tc-99m phytate as a radiotracer has been successfully utilized for SLN biopsy in breast, cervix, and endometrial cancer. We assessed the feasibility of SLN dissection using Tc-99m phytate in papillary thyroid carcinoma (PTC).
METHODS
Seventeen patients with PTC were prospectively enrolled. Ultrasound-guided peritumoral injection of 55.5 MBq Tc-99m phytate in 0.25-mL normal saline was performed. Preoperative single-photon emission-computed tomography (SPECT) and intraoperative gamma-probe were used for SLN detection during operation.
RESULTS
Identification rate of SLNs was 70.6% (12 of 17) with SPECT, and 88.2% (15 of 17) with gamma-probe. Combined SPECT and gamma-probe had identification rates of 88.2% (15 of 17). Identification rates of SLNs in central LN compartments were 82.4% (14 of 17) and 41.2% (7 of 17) in lateral LN compartments. Overall sensitivity, specificity, positive predictive value, and negative predictive value of the results of SLN biopsy were 91.6%, 100%, 88.4%, and 100%, respectively. Eight patients (47.1%) had metastasis in SLNs; all patients had SLN metastasis in the central compartment and 2 patients had SLN metastasis in both the central and lateral compartments.
CONCLUSION
Combined SPECT and gamma-probe could detect SLNs with an 88.2% identification rate in PTC. SLN biopsy using Tc-99m phytate is technically feasible. Further investigation is warranted for clinical application of Tc-99m phytate in PTC.

Keyword

Sentinel lymph node biopsy; Papillary thyroid cancer; Phytate; Gamma-probe; Single-photon emission-computed tomography

MeSH Terms

Biopsy
Breast
Cervix Uteri
Endometrial Neoplasms
Female
Humans
Lymph Node Excision*
Lymph Nodes*
Neoplasm Metastasis
Phytic Acid*
Prospective Studies
Sensitivity and Specificity
Sentinel Lymph Node Biopsy
Thyroid Gland*
Thyroid Neoplasms*
Tomography, Emission-Computed, Single-Photon
Phytic Acid

Figure

• 

  Fig. 1 Preoperative lymphatic mapping by single-photon emission-computed tomography. IV, intravenous injection.

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