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

作者：Paek Se Hyun; Yi Ka Hee; Kim Su Jin; Choi June Young; Lee Kyu Eun^*; Park Young Joo; Park Do Joon; Kang Keon Wook; Chung June Key

来源：Annals of Surgical Treatment and Research, 2017, 93(5): 240-245.

DOI：10.4174/astr.2017.93.5240

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

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 (SPECTj 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.

• 出版日期2017-11