Sentinel node radioguided biopsy in surgical management of the medullary thyroid Carcinoma. A case report


COD: 2196_21_01_2014 Categorie: ,

Giuseppe Boni, Sara Mazzarri, Mariano Grosso, Giampiero Manca, Marco Biricotti, Carlo Enrico Ambrosini, Lorenzo Fregoli, Marco Puccini, Claudio Caldarelli, Roberto Spisni

Published online (EP) 21 January 2014

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INTRODUCTION: Medullary thyroid cancer is a rare carcinoma. Surgery is the only curative treatment and since cervicallymphnodes metastases are frequent and can occur at an early stage, a standardized central lymphnode dissection is asso-ciated to total thyroidectomy. However, the extent of lymphadenectomy to the lateral neck lynphnodes remains debated.To reduce the extent of lymphnode excision, the sentinel node biopsy has been used as an accurate technique to assessthe status of the lymphnodes in the regional drainage basin in solid tumors, and more recently, in thyroid carcinoma.In this case report, we show the utility of the radioguided biopsy of the sentinel lymphnode in the surgical managementof the medullary thyrod cancer.
CASEREPORT:We present the case of a 24-year-old Caucasian, Italian woman with a sporadic medullary thyroid micro-carcinoma occasionally detected by neck ultrasound and diagnosed by high serum calcitonin level and fine needle aspi-ration cytology. There was no ultrasound evidence of lymphnode involvement both in central and lateral compartmentof the neck. We performed a preoperative mapping of the the sentinel lymphnodes by the injection of technetium-99mradiolabelled albumin nanocolloids in the thyroid nodule. Then our patient underwent total thyroidectomy combinedwith radioguided biopsy of the sentinel lymphnodes. Histology confirmed the presence of the medullary thyroid cancerand revealed micrometastases only in two sentinel lymphnodes detected in right lateral compartment of the neck so anipsilateral lateral neck dissection besides the central neck dissection was performed at the end of operation. Basal andpentagastrin-stimulated serum calcitonin level was undetectable during the follow-up investigations.
CONCLUSION: This is the first reported case that shows the utility of the radioguided SLN biopsy for the accurate stag-ing of the cervical lymphnode involvement in patient with sporadic medullary thyroid microcarcinoma. Total thyrodec-tomy and central neck dissection is recommended for all patients with medullary thyroid carcinoma, but the indicationfor the lateral neck dissection is still controversial. The radioguided SLN biopsy technique could be a useful tool to per-form the dissection only in those patients with proven lateral neck lymphnode involvement and reduce the extention ofthe lateral lymphnode excision and the incidence of related complications.