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Sentinel Lymph Node Biopsy in Small Papillary Thyroid Cancer

A Meta-analysis

Garau, Ludovico M., MD*; Rubello, Domenico, MD; Morganti, Riccardo, SCD, PhD; Boni, Giuseppe, MD*; Volterrani, Duccio, MD*; Colletti, Patrick M., MD§; Manca, Gianpiero, MD, PhD*

doi: 10.1097/RLU.0000000000002378
Original Articles

Purpose The aim of this study was to compare reported results on available techniques for sentinel lymph node detection rate (SDR) in papillary thyroid cancer (PTC).

Methods The MEDLINE database was searched via a PubMed interface to identify original articles regarding sentinel lymph node biopsy (SNB) in thyroid cancer. Studies were stratified according to the sentinel lymph node (SLN) detection technique: vital-dye (VD), 99mTc-nanocolloid planar lymphoscintigraphy with the use of intraoperative hand-held gamma probes (LS), both 99mTc-nanocolloid planar lymphoscintigraphy with intraoperative use of hand-held gamma probe and VD (LS + VD), 99mTc-nanocolloid planar lymphoscintigraphy with the additional contribution of preoperative SPECT/CT, and intraoperative use of hand-held gamma probe (LS-SPECT/CT). Pooled SDR values were presented with a 95% confidence interval (CI) for each SLN detection techniques. A Z-test was used to compare pooled SDR estimates. False-negative rates were summarized for each method.

Results Forty-five studies were included. Overall SDRs for the VD, LS, LS + VD, and LS-SPECT/CT techniques were 83% (95% CI, 77%–88%; I 2 = 78%), 96% (95% CI, 90%–98%; I 2 = 68%), 87% (95% CI, 65%–96%; I 2 = 75%), and 93% (95% CI, 86%–97%; I 2 = 0%), respectively. False-negative rates were 0% to 38%, 0% to 40%, 0% to 17%, and 7% to 8%, respectively.

Conclusions In patients with PTC, 99mTc-nanocolloids offer a higher SDR than that of the VD technique. The addition of SPECT/CT improved identification of metastatic SLNs outside the central neck compartment.

From the *Regional Center of Nuclear Medicine, Hospital University of Pisa, Pisa;

Department of Nuclear Medicine and PET Center, Radiology, Medical Physics, Clinical Pathology, Santa Maria della Misericordia Hospital, Rovigo;

Section of Statistics, University of Pisa, Pisa, Italy; and

§Department of Radiology, Keck School of Medicine of USC, Los Angeles, CA.

Received for publication September 13, 2018; revision accepted October 4, 2018.

Conflicts of interest and sources of funding: none declared.

Correspondence to: Ludovico Maria Garau, MD, Regional Center of Nuclear Medicine, Hospital University of Pisa, Via Roma 67, 56126 Pisa, Italy. E-mail: ludovico.garau@gmail.com; and Domenico Rubello, MD, Head Nuclear Medicine and PET Center, Department of Nuclear Medicine and PET Center, Radiology, Medical Physics, Clinical Pathology, Santa Maria della Misericordia Hospital, Via Tre Martiri, 89, 45100 Rovigo, Italy. E-mail: domenico.rubello@libero.it.

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