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Effect of Sentinel Node Biopsy in Clinically N0, BRAF V600E–Mutated, Small Papillary Thyroid Carcinoma

A Pilot Study

Puccini, Marco, MD*†; Manca, Gianpiero, MD; Neri, Carlo Maria, MD; Boni, Giuseppe, MD; Coli, Virginia, MD*; Garau, Ludovico Maria, MD; Colletti, Patrick M., MD§; Rubello, Domenico, MD; Buccianti, Piero, MD

doi: 10.1097/RLU.0000000000002465
Original Articles
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Purpose BRAF V600E mutation papillary thyroid cancer (PTC) is more aggressive with a higher risk of lymph node involvement and a poorer prognosis. Prior studies failed to demonstrate the superiority of prophylactic lymphadenectomy. We investigated the utility of additional radio-guided sentinel node biopsy (SNB).

Methods We analyzed 15 patients with N0 PTC by ultrasound and BRAF mutation on preoperative biopsy treated with total thyroidectomy (TT) or TT + prophylactic central neck dissection (PCND) alone or with SNB. Conventional surgery was performed before SNB. We recorded primary tumor diameter, multifocality, extrathyroid infiltration, neoplastic emboli, and tall cell variant. At follow-up, we evaluated basal and stimulated thyroglobulin and ultrasound or radioiodine scintigraphy.

Results Of 15 consecutive patients, 5 received conventional surgery alone, and 10 had SNB. For the first group, 4 underwent TT, and 1 had TT + PCND. Among the SNB group, 1 had no sentinel node detected and underwent a simple TT, 2 had TT + PCND+ SNB in the lateral compartment, and 7 had TT + SNB in 1 to 3 neck compartments. Micrometastases were found in 1 of 3 PCND specimens. Sentinel node biopsy revealed metastasis in 3 of 6 central compartment biopsies, in 2 of 6 biopsies in the ipsilateral lateral compartment, and in none of 2 biopsies in the contralateral compartment. Sentinel node biopsy allowed the removal of micrometastases in 4 of 10 patients. At 53 months' (mean) follow-up, no relapse was documented.

Conclusions Radio-guided SNB correctly and efficiently stages cN0 BRAF–mutated PTC patients. Sentinel node biopsy could limit time-consuming, risk-exposing compartmental prophylactic dissections.

From the *Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa;

General Surgery Unit, Azienda Ospedaliera Universitaria Pisana;

Regional Center of Nuclear Medicine, Hospital University of Pisa, Pisa, Italy;

§Department of Radiology, University of Southern California, Los Angeles, CA; and

Department of Nuclear Medicine and PET Center, Radiology, Medical Physics, Clinical Pathology, S. Maria della Misericordia Hospital, Rovigo, Italy.

Received for publication November 14, 2018; revision accepted December 6, 2018.

Conflicts of interest and sources of funding: none declared.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional, the national research committee, and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Correspondence to: Marco Puccini, MD, Department of Surgery, Pisa University, Pisa 36100, Italy. E-mail: marco.puccini@med.unipi.it; or Patrick M. Colletti, MD, Department of Radiology, Southern California University, 90033 Los Angeles, CA. E-mail: colletti@med.usc.edu.

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