Prognostic value of sentinel lymph node and local thyroid lymphocyte infiltration in differentiated thyroid carcinoma

ABSTRACT

The aim of this work is to investigate the prevalence, significance and prognostic value of lymphocytic infiltration and SLN associated to differentiated thyroid carcinoma. Our study included 50 patients with preoperative diagnosis of differentiated thyroid carcinoma by FNAC and Trucut needle biopsy, there age ranged from 17 to 55 years with mean age [36 year]. They were 35 females and 15 males. Absence of clinically palpable draining cervical lymph node was the main exclusion criterion in selection of our patients.Our patients were subjected to peroperative injection of patent blue dye intra tumoral, detection and resection of SLN and stained lymphatic channels, resection of samples from jugular lymph nodes [non stained] as NSLNs. Then total thyroidectomy was done. In our study, SLNs staining occurred in 37/50 patients with DTC [74%], 28 of which in patients with PTC 28/33 [84.8%], 5 in patients with FTC 5/13 [38.4%] and 4 in patients with follicular variants of PTC 4/4 [100%] mapping failure occurred in 13/50 patients [26%].22 patients revealed the SLN biopsy from which 18 patients show -ve NSLN and 4 patients with +ve NSLNs [false +ve]. 15 patients revealed -ve SLN biopsy from them 10 patients show -ve NSLNs and 5 patients show +ve NSLN [false -ve SLNI. The accuracy of SLN biopsy needs further investigation before it can be recommended in the routine management of the thyroid neoplasia. The onus must fall on the endocrine surgeon to define clearly the direct therapeutic relevance of occult nodal disease if SLN biopsy is to become a standard of care in thyroid cancer