Soliter ve Dominant Nonfonksiyonel Tiroid Nodüllerinde İntraoperatif Sentinel Lenf Nodunun Bulunması

Yıl 2020, Cilt: 42 Sayı: 2, 148 - 154, 17.03.2020

Serkan Sarıkaya Feridun Suat Gokce

https://doi.org/10.20515/otd.497134

Öz

Sentinel lenf nodu tiroid
nodülünün ilk olarak drene olduğu lenf nodudur. Soliter ve dominant
nonfonksiyonel tiroid nodüllerinde intranodüler isosülfan uygulamasının
sentinel lenf nodu saptanmasında etkili bir yöntem olup olmadığını saptamayı
amaçladık Bu prospektif klinik çalışma Trakya Üniversitesi Tıp Fakültesi Genel
Cerrahi Anabilim Dalı’nda ameliyat edilen soliter ve dominant nonfonksiyonel
tiroid nodülü olan, palpabl lenfadenopatisi olmayan 25 olguda yapıldı.
İntraoperatif, intranodüler isosülfan mavisi enjeksiyonundan sonra sentinel
lenf nodlarının frozen section ve parafin kesit incelemeleri yapıldı ve
yöntemin klinik değeri incelendi. Olguların %48’inde sentinel lenf nodu  gösterildi. Lenf nodlarının büyük çoğunluğu
tiroiddeki nodülle aynı tarafta ve paratrakeal yerleşimlidir. Tiroid nodülünde
malignite saptanan 5 olgunun 4’ünde sentinel lenf nodu boyandı ve sadece 1
olguda lenfatik metastaz tespit edildi. Sentinel lenf nodları isosülfan mavisi
ile boyanan olgularda, lenf nodlarının 
frozen section ve parafin kesitlerinin sonuçları arasında anlamlı bir
fark bulunmadı. Sentinel lenf nodunda frozen section incelemenin tiroid
nodülüne oranla sensitivite ve spesifite değerlerinin oldukça yüksek olduğu
görüldü.(sensitivite, spesifite %100). Mikrometastazları ortaya çıkarmak için
yapılan immunohistokimyasal boyamanın hematoksilen eosin boyamaya bir üstünlüğü
olmadığı görüldü.  Tiroid nodülü ve
sentinel lenf nodu frozen sectıon incelemelerinin birlikte değerlendirilmesi ve
malignitenin saptanması cerraha daha küratif bir ameliyat yapma şansı
sağlayacaktır. Olgu sayısının ve cerrahi deneyiminin artması, gamma probe
eşliğinde lenfosintigrafinin de eklenmesiyle daha yüksek oranla sentinel lenf
nodunun  gösterilebileceği
düşüncesindeyiz.  

Anahtar Kelimeler

Tiroid, tiroid nodülü, sentinel lenf nodu, tiroid kanseri

The Display of Sentinel Lymph Node İntraoperative in Solitary and Dominant Non-Functional Thyroid Nodules

Öz

Sentınel lymph node in the
first lymph node that thyroid nodule drains. Our aim was to detect if isosulfan
injection was effective in detecting solitary and dominant non-functional
thyroid nodules. In this prospective study, in 25 cases who were operated
inTrakya Univercity medical faculty department of general surgery and who have
solitary and non-functional thyroid nodule and who do not have palpable
lymphadenopathy, after the intra operative intranodular injection of the
isosulfan blue-dye, the frozen section and haematoxylin eosin stained sections
investigations of sentinel lymph nodes which were stained together with the
thyroid nodule were done and the clinical significance of the method was
evaluated. In 48% of the cases, sentinel lymph node was stained. Most of the
lymph nodes were at the ipsilateral side of the nodule in thyroid and located
paratracheal. In 4 of the 5 cases, in which malignancy was determined in
thyroid nodule, sentinel lymph node was stained and only in one case, lymphatic
metastases was indicated.In cases, in which sentinel lymph nodes were stained
with the isosulfan blue-dye, there was no significant difference between the
frozen section and haematoxylin eosin stained sections results of the lymph
nodes. It has been reported that, in proportion to thyroid nodule, in the
frozen section investigation, the sensitivity and the spectifity values were
very high.(sensitivity, specificity 100%). It has been reported that,
immunohistochemistry dyeing, which is applied to reveal micrometastases, does
not have any superiority than the haematoxylin eosin dyeing.The evaluation of
the thyroid nodule investigation together with the sentinel lymph node frozen
section investigation and the identification of the malignancy, would provide
the chance of a more curative operation for the surgeon.We think that, with an
increase in the number of the cases and in the surgical experience, with the
including of the lymphoscintigraphy together with the gamma probe, in higher
numbers of sentinel lymph nodes can be displayed.

Anahtar Kelimeler

Thyroid, thyroid nodule, sentinel lymph node, thyroid cancer

Kaynakça

• 1-Xing M, Alzahrani AS, Carson KA, Shong YK, Kim TY, Viola D, et al. Association Between BRAF V600E Mutation and Recurrence of Papillary Thyroid Cancer. J Clin Oncol. 2015;33:42-50.
• 2- Sever AR, Mills P, Weeks J, Jones SE, Fish D, Jones PA, et al. Preoperative needle biopsy of sentinel lymph nodes using intradermal microbubbles and contrast-enhanced ultrasound in patients with breast cancer. Am J Roentgenol. 2012;199:465-470.
• 3-Zheng G, Zhang H, Hao S, Liu C, Xu J, Ning J, Wu G, Jiang L, Li G, Zheng H, Song X. Patterns and clinical significance of cervical lymph node metastasis in papillary thyroid cancerpatients with Delphian lymph node metastasis. Oncotarget 2017: 6;8(34):57089-57098.
• 4- Sabel MS, Staren ED, Gianakakis LM, Dwarakanatan S, Prinz RA. Use of fine-needle aspiration biopsy and frozen section in the management of the solitary thyroid nodule.Surgery 1997;122:1201-1207.
• 5-Tan Z, Ge MH, Zheng CM, Wang QL, Nie XL, Jiang LH. The significance of Delphian lymph node in papillary thyroid cancer Asia Pac J Clin Oncol. 2017 Oct;13(5):e389-e393. doi: 10.1111/ajco.12480. Epub 2016 Mar 17.
• 6- Lee YC, Shin SY, Kwon KH, Eun YG. Incidence and clinical characteristics of prelaryngeal lymph node metastasis in papillary thyroid cancer. Eur Arch Otorhinolaryngol 2013; 270: 2547–50. doi: 10.1007/s00405-013-2471-7.
• 7- Yu XM, Schneider DF, Leverson G, Chen H, Sippel RS. Follicular variant of papillary thyroid carcinoma is a unique clinical entity: a population-based study of 10,740 cases. Thyroid. 2013;23:1263-1268. doi: 10.1089/thy.2012.0453. doi:10.1007/s00405-013-2471-7
• 8- Fernandez IJ, Ottavio P, Silvia S, Cavicchi O, Repaci A, Vicennati V, et al. Clinical Significance of BRAF Mutation in Thyroid Papillary Cancer. Otolaryngol Head Neck Surg. 2013;148:919-925. doi: 10.1177/0194599813481942.
• 9- Oh EM, Chung YS, Lee YD. Clinical significance of Delphian lymph node metastasis in papillary thyroid carcinoma. World J Surg 2013; 37: 2591–9. doi: 10.1007/s00268-013-2157-8
• 10- Morton DL, Thompson JF, Essner R, Elashoff R, Stern SL, Nieweg OE, Roses DF, Karakousis CP, Mozzillo N, Reintgen D, Wang HJ, Glass EC, Cochran AJ. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomyfor early-stage melanoma: a multicenter trial. Multicenter Selective Lymphadenectomy Trial Group. Ann Surg. 1999 Oct;230(4):453-63; discussion 463-5.
• 11- Giuliano AE, Kirgen DM, Guenter JM , Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Am J Surg 1994;220:391-410.
• 12- Fang W, Ye L, Shen L, Cai J, Huang F, Wei Q, et al. Tumor-associated macrophages promote the metastatic potential of thyroid papillary cancer by releasing CXCL8. Carcinogenesis. 2014;35:1780-1787. doi: 10.1093/carcin/ bgu060. doi:10.1093/carcin/bgu060
• 13-Patwardhan N, Cataldo T, Braverman LE: Surgical management of the patient with papillary cancer. Surg Clin North Am 1995;75(3):449-464. .
• 14- Liu F, Zhu Y, Qian Y, Zhang J, Zhang Y, Zhang Y. Recognition of sentinel lymph nodes in patients with papillary thyroid cancer by nano-carbon and methylene blue. Pak J Med Sci. 2017;33(6):1485-1489.
• 15- Chang JW, Kang SU, Shin YS, Kim KI, Seo SJ, Yang SS, et al. Non-thermal atmospheric pressure plasma inhibits thyroid papillary cancer cell invasion via cytoskeletal modulation, altered MMP-2/-9/uPA activity. Plos One. 2014;9:e92198. doi:10.1371/journal.pone.0092198.
• 16- Chai YJ, Kim SJ, Choi JY et al. Papillary thyroid carcinoma located in the isthmus or upper third is associated with Delphian lymph node metastasis.World J Surg 2014; 38: 1306– 11. doi: 10.1007/s00268-013-2406-x
• 17- Sellers M,Beekend S,Blankenship A,Soong S,Herrera ET,Urist M at al. Prognostic significance of cervical lymph node metastases in differantiated thyroid cancer.Am J Surg 1992;164:578-581.
• 18- Tian W, Jiang Y, Gao B, Zhang X, Zhang S, Zhao J, et al. Application of nano-carbon in lymph node dissection for thyroid cancer and protection of parathyroid glands. Med Sci Monit. 2014;20:1925-1930.
• 19- Kelemen PR,Van Herle AJ, Giuliano AE. Sentinel Iymphadenectomy in thyroid malignant neoplasms.Arch Surg 1998;133(3):288-292.
• 20-Pelizzo MR, Boschin IM, Toniato A, Bernante P, Piotto A, Rinaldo A et al. The sentinel node procedure with patent blue V dye in the surgical treatment of papillarythyroid carcinoma. Acta Otolaryngol 2001;121:421-424.
• 21- Fukui Y, Yamakawa T, Taniki T, Numoto S, Miki H, Monden Y. Sentinel lymph node biopsy in patients with papillary thyroid carcinoma. Cancer 2001;92(11):2868-2874.
• 22- Catarci M, Zaraca F, Angeloni R, Mancini B, De Filippo MG, Massa R et al. Preoparative lymphoscintigraphy and sentinel lymph node biopsy in papillary thyroid cancer. A pilot study. J Surg Oncol 2001;77:21-24.
• 23- Rettenbacher L, Sungler P, Gmeiner D, Kassmann H,Galvan G. Detecting the sentinel lymph node in patients with differentiated thyroid carcinoma. Eur J NUCL Med 2000;27(9):1399-1401.