Sentinel lymph node biopsy for papillary thyroid cancer: the effect of dose, tracer and application of massage

Document Type : Original Article

Authors

1 Department of surgery, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Nuclear Medicine, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran

3 Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

4 Department of Otolaryngology–Head and Neck Surgery, Otolaryngology Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Objective(s): In patients with papillary thyroid cancer (PTC), sentinel lymph node (SLN) radio-guided biopsy is not routinely used for detection of involved neck lymph nodes (NLN); 99mTc- antimony sulfide colloid (99mTc- ASC) has been used for this purpose. In this study, besides 99mTc-ASC another radiotracer, 99mTc-phytate (99mTc-P) with different doses and injection methods were evaluated.
Methods: Twenty-two patients, scheduled to undergo thyroidectomy for PTC, were injected for radio-guided SLN biopsy in the morning of operation in 3 groups: intra tumoral injection of about 1 mCi 99mTc-P (group A; n=5); peritumoral injection of less than 3 mCi 99mTc-ASC (group B; n=6); and peritumoral injection of 3 to 5 mCi 99mTc-ASC with application of massage (group C; n=9). A patient refused to complete the study. A patient with follicular thyroid cancer was also excluded. No NLN was detected in the pre-operative ultra-sonographic examinations of all patients. Central neck dissection was done for all the participants. The presence of radio guided detected NLN and results of pathology were assessed.
Results: In group A and B, no SLN was detected. NLNs were resected in 4 patients in group A and B; 2 of them involved by the tumor. In group C, 6 out of 9 patients (66.7%) had between 1 to 6 SLNs; the procedure failed to detect NLN in a patient in group C with surgically resected reactive NLN (failure rate 1 out of 7).
Conclusion: The results underscored the significance of SLN radio guided biopsy in patients with PTC; the radiotracer, dose and method of injection may affect the detection rate.

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References

1. Bluemel C, Herrmann K, Giammarile F, Nieweg OE, Dubreuil J, Testori A, et al. EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma. European journal of nuclear medicine and molecular imaging. 2015; 42(11):1750-66.
2. Giammarile F, Alazraki N, Aarsvold JN, AudisioRA, Glass E, Grant SF, et al. The EANM and SNMMI practice guideline for lymphoscintigraphy and sentinel node localization in breast cancer. European journal of nuclear medicine and molecular imaging. 2013; 40(12):1932-47.
3. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Taskforce. Thyroid. 2006; 16(2):109-42.
4. Barczyński M, Konturek A, Stopa M, Nowak W. Prophylactic central neck dissection for papillary thyroid cancer. British Journal of Surgery. 2013; 100(3):410-8.
5. Chisholm EJ, Kulinskaya E, Tolley NS. Systematic review and meta‐analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. The Laryngoscope. 2009; 119(6):1135-9.
6. Mazzaferri EL, Doherty GM, Steward DL. The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. Thyroid. 2009; 19(7):683-9.
7. Alvarado R, Sywak MS, Delbridge L, Sidhu SB. Central lymph node dissection as a secondary procedure for papillary thyroid cancer: is there added morbidity? Surgery. 2009; 145(5):514-8.
8. Giordano D, Valcavi R, Thompson GB, Pedroni C, Renna L, Gradoni P, 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):911-7.
9. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, 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.
10. Portinari M, Carcoforo P. Radioguided sentinel lymph node biopsy in patients with papillary thyroid carcinoma. Gland surgery. 2016; 5(6):591.
11. Sterpetti AV. Optimization of staging of the neck with prophylactic central and lateral neck dissection for papillary thyroid carcinoma. Annals of surgery. 2015; 261(1):e30.
12. Mazzaferri EL, Kloos RT. Is diagnostic iodine- 131 scanning with recombinant human TSH useful in the follow-up of differentiated thyroid cancer after thyroid ablation? The Journal of Clinical Endocrinology & Metabolism. 2002; 87(4):1490-8.
13. Covens A, Vella ET, Kennedy EB, Reade CJ, Jimenez W, Le T. Sentinel lymph node biopsy in vulvar cancer: systematic review, metaanalysis and guideline recommendations. Gynecologic Oncology. 2015; 137(2):351-61.
14. Papathomas D, Andrade FF, Estape RE, Nasseri-Nik N, Schroeder E, Diaz JP. Sentinel Lymph Node Biopsy in Endometrial and Cervical Cancer [336]. Obstetrics & Gynecology. 2015; 125:106S.
15. Thompson C, John MS, Lawson G, Grogan T, Elashoff D, Mendelsohn A. Diagnostic value of sentinel lymph node biopsy in head and neck cancer: a meta-analysis. European Archives of Oto-Rhino-Laryngology. 2013;270(7):2115-22.
16. Dubecz A, Solymosi N, Schweigert M, Stadlhuber R, Peters J, Ofner D, et al. Time trends and disparities in lymphadenectomy for gastrointestinal cancer in the United States: a population-based analysis of 326,243 patients. Journal of Gastrointestinal Surgery. 2013; 17(4):611-9.
17. Sadeghi R, Gholami H, Zakavi SR, Kakhki VRD, Tabasi KT, Horenblas S. Accuracy of sentinel lymph node biopsy for inguinal lymph node staging of penile squamous cell carcinoma: systematic review and meta-analysis of the literature. The Journal of urology. 2012; 187(1):25-31.
18. Pelizzo M, Toniato A, Sorgato N, Losi A, Torresan F, Boschin IM. 99Tc nanocolloid sentinel node procedure in papillary thyroid carcinoma: our mono-institutional experience on a large series of patients. Acta Otorhinolaryngologica Italica. 2009; 29(6):321.
19. Carcoforo P, Feggi L, Trasforini G, Lanzara S, Sortini D, Zulian V, et al. Use of preoperative lymphoscintigraphy and intraoperative gamma-probe detection for identification of the sentinel lymph node in patients with papillary thyroid carcinoma. European Journal of Surgical Oncology (EJSO). 2007; 33(9):1075-80.
20. Lee S, Choi J, Lim H, Kim W, Kim S, Choe J, et al. Sentinel lymph node biopsy in papillary thyroid cancer: comparison study of blue dye method and combined radioisotope and blue dye method in papillary thyroid cancer. European Journal of Surgical Oncology (EJSO). 2009; 35(9):974-9.
21. Kaczka K, Celnik A, Luks B, Jasion J, Pomorski L. Sentinel lymph node biopsy techniques in thyroid pathologies—a meta-analysis. Endokrynologia Polska. 2012; 63(3):222-31.
 22. Jozaghi Y, Richardson K, Anand S, Mlynarek A, Hier MP, Forest V-I, et al. Frozen sectionanalysis and sentinel lymph node biopsy in well differentiated thyroid cancer. Journal of Otolaryngology-Head & Neck Surgery. 2013; 42(1):48.
23. Assadi M, Yarani M, Zakavi SR, Jangjoo A, Memar B, Treglia G, et al. Sentinel node mapping in papillary thyroid carcinoma using combined radiotracer and blue dye methods. Endokrynologia Polska. 2014; 65(4):281-6.
24. Alavi A, Staum MM, Shesol BF, Bloch P. Technetium-99m stannous phytate as an imaging agent for lymph nodes. J Nucl Med. 1978; 19(4):422-6.
25. Sadri K, Ayati NK, Shabani G, Zakavi SR, Sadeghi R. Sentinel node detection failure due to defective labeling and large particle size of Tc-99m antimony sulfide colloid. Iranian Journal of Nuclear Medicine. 2011; 19(1):6-11.
26. Henze E, Schelbert H, Collins J, Najafi A, Barrio J, Bennett L. Lymphoscintigraphy with Tc- 99m-labeled dextran. Journal of nuclear medicine: official publication, Society of Nuclear Medicine. 1982; 23(10):923.
27. Tavares MG, Sapienza MT, Galeb NA, Belfort FA, Costa RR, Osório CA, et al. The use of 99m Tc-phytate for sentinel node mapping in melanoma, breast cancer and vulvar cancer: a study of 100 cases. European journal of nuclear medicine. 2001; 28(11):1597-604.
28. Seok JW, Choi YS, Chong S, Kwon GY, Chung YJ, Kim BG, et al. Sentinel lymph node identification with radiopharmaceuticals in patients with breast cancer: a comparison of 99mTc-tin colloid and 99m Tc-phytate efficiency. Breast cancer research and treatment. 2010; 122(2):453-7.
29. Mota LG, de Barros AL, Fuscaldi LL, de Souza CM, Cassali GD, Moghbel M, et al. Evolving role of radiolabeled particles in detecting infection and inflammation, preliminary data with 99mTc-phytate in rats. Nuclear medicine communications. 2015; 36(11):1113-9.
30. Aliakbarian M, Memar B, Jangjoo A, Zakavi SR, Kakhki VRD, Aryana K, et al. Factors influencing the time of sentinel node visualization in breast cancer patients using intradermal injection of the radiotracer. The American journal of surgery. 2011; 202(2):199-202.
31. Paek SH, Yi KH, Kim S-J, Choi JY, Lee KE, Park YJ, et al. Feasibility of sentinel lymph node dissection using Tc-99m phytate in papillary thyroid carcinoma. Annals of Surgical Treatment and Research. 2017; 93(5):240-5.
32. Stoeckli SJ, Pfaltz M, Steinert H, Schmid S. Sentinel lymph node biopsy in thyroid tumors: a pilot study. European archives of oto-rhino-laryngology. 2003; 260(7):364-8.
33. Pelizzo MR, Rubello D, Boschin IM, Piotto A, Paggetta C, Toniato A, et al. Contribution of SLN investigation with 99mTc-nanocolloid in clinical staging of thyroid cancer: technical feasibility. European journal of nuclear medicine and molecular imaging. 2007; 34(6):934-8.
34. Boschin IM, Toniato A, Piotto A, Ide EC, Casara D, Guolo A, et al. 99Tc Nanocolloid sentinel node procedure in thyroid carcinoma. Langenbeck's Archives of Surgery. 2008; 393(5):705.
35. Eftekhari M, Beyki D, Fallahi B, Arabi M, Memari F, Gholam RA, et al. Assessment the diagnostic accuracy of sentinel lymph nodes lymphoscintigraphy using Technetium-99m phytate in breast cancer. Daru Journal of Pharmaceutical Science. 2009. 17(2): 83 -87.
36. Ege GN, Warbick A. Lymphoscintigraphy: a comparison of 99Tcm antimony sulphide colloid and 99Tcm stannous phytate. The British Journal of Radiology. 1979; 52(614):124-9.
37. Lee DY, Oh KH, Cho J-G, Kwon S-Y, Woo J-S, Baek S-K, et al. The benefits and risks of prophylactic central neck dissection for papillary thyroid carcinoma: prospective cohort study. International journal of endocrinology. 2015. Article ID 571480.
38. Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, et al. Guidelines for the management of thyroid cancer. Clinical endocrinology. 2014; 81:1-122.
39. Javadi H, Pashazadeh AM, Mogharrabi M, Asli IN, Tabei F, Parach AA, et al. Radiation exposure from diagnostic nuclear medicine examinations in Golestan province. Iranian Journal of Nuclear Medicine. 2013; 21(2):65-9.
40. Paek SH, Yi KH, Kim S-J, Choi JY, Lee KE, Park YJ, et al. Feasibility of sentinel lymph node dissection using Tc-99m phytate in papillary thyroid carcinoma. Annals of Surgical Treatment and Research. 2017; 93(5):240-5.
Asia Oceania Journal of Nuclear Medicine and Biology
Volume 9, Issue 1
January 2021
Pages 9-14

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