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Innovation in surgical technique
Detection of the Sentinel Node Using a Magnetic Tracer in Thyroid Cancer. A Technical Pilot Study
Detección del ganglio centinela mediante trazador paramagnético en el cáncer de tiroides. Estudio piloto técnico
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Antonio Ríosa,b,c,
Corresponding author
arzrios@um.es
arzrios4@gmail.com

Corresponding author.
, Jose Manuel Rodrígueza,b,c, Noelia Ibañezb,c, Antonio Piñeroa,b,c, Pascual Parrillaa,b,c
a Departamento de Cirugía, Pediatría y Obstetricia y Ginecología, Universidad de Murcia, Murcia, Spain
b Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Servicio Murciano de Salud, Murcia, Spain
c Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
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Tables (5)
Table 1. Preoperative Data of the Patients Undergoing Sentinel Node Identification.
Table 2. Location and Histology Data of the Sentinel Lymph Node.
Table 3. Surgery Performed and Histology Results.
Table 4. Final Staging of the Papillary Carcinoma.
Table 5. Follow-up of Patients With Papillary Carcinoma.
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Abstract
Introduction

There is no standard procedure for the detection of the sentinel node (SN) in thyroid disease. However, the recent detection of the SN using a paramagnetic tracer is proving to be useful in breast cancer and melanoma. The objective was to assess the utility of super paramagnetic iron oxide tracer for the intraoperative detection of the SN in patients with papillary thyroid cancer without nodal involvement in the preoperative study.

Method

A single center, prospective pilot study of a class IIa medical device (a paramagnetic tracer). The study included thyroid cancers which were T1–T2 tumors in the cytohistological analysis with a negative preoperative nodal assessment, operated on consecutively during scheduled treatment. For the localization of the SN, an interlesional injection of 2mL of super paramagnetic iron oxide was administered. After 10min, ferromagnetic activity was detected in the adjacent nodes. Once the node had been detected, we proceeded by extracting it for intraoperative analysis. The effectiveness of the procedure for detecting the SN was assessed, with the main variable being whether it was detected or not.

Results

The project was assessed after the first cases had been carried out. The SN was located in all cases, which was done easily in the first four, but in the fifth case the SN detection was complicated by the interference of the reusable neurostimulation electrodes with the ferromagnetic signal. Intraoperative histology revealed the SN was positive in 80% (n=4) of cases (20% [n=1] were macrometastases and 60% [n=3] micrometastases). Total thyroidectomies were carried out, with central lymph node dissection in 4 of the patients and lateral in one due to the result of the detected SN. The histology showed the carcinoma was papillary, a classic type, in 80% (n=4) and a follicular variant in 20% (n=1). Forty percent (n=2) were multifocal, 40% (n=2) had vascular infiltration, and 60% (n=3) had extrathyroidal extension. Staging determined the application of radioactive iodine therapy (150mCi) in 80% of cases (n=4).

Conclusions

A paramagnetic tracer can be useful for detecting the SN and correctly staging papillary carcinoma.

Keywords:
Thyroid carcinoma
Sentinel node
Paramagnetic tracer
Resumen
Introducción

La detección del ganglio centinela (GC) no se ha generalizado en la enfermedad tiroidea. Sin embargo, la recientemente detección del GC mediante trazador paramagnético está siendo útil en la cirugía del cáncer de mama y melanoma. El objetivo es evaluar la utilidad del trazador superparamagnetic iron oxide para la detección intraoperatoria del GC en el cáncer papilar de tiroides sin afectación ganglionar en el estudio preoperatorio.

Método

Estudio piloto unicéntrico y prospectivo con un producto sanitario de clase IIa (trazador paramagnético). Se incluyen cánceres de tiroides que tras el análisis cito-histológico son tumores T1-T2 con resultado negativo en la evaluación ganglionar preoperatoria, intervenidos de forma programada y consecutiva. Para la localización del GC se realiza una inyección intralesional de 2ml de superparamagnetic iron oxide. A los 10minutos se procede a detectar actividad ferromagnética en los ganglios adyacentes. Una vez detectado el ganglio se procede a su extracción y análisis intraoperatorio. Se evalúa la efectividad del procedimiento con la detección de GC, siendo la variable principal la detección o no de mismo.

Resultados

Se evalúa el proyecto realizados los 5 primeros casos. Se localiza el CG en todos ellos, en los 4 primeros fácilmente, pero en el quinto fue dificultosa por su localización paratraqueal, que dio interferencias con el tubo endotraqueal con electrodos de neuroestimulación recurrencial. La histología intraoperatoria informó de GC positivo en el 80% (n=4) de los casos (20% [n=1] macrometástasis y 60% [n=3] micrometástasis). Se realizó una tiroidectomía total y el GC condicionó la realización de vaciamientos centrales (n=4) y un vaciamiento lateral. La histología informa de carcinoma papilar, tipo clásico en el 80% (n=4) y en el 20% (n=1) variante folicular. El 40% (n=2) eran multifocales, el 40% (n=2) presentaban afectación vascular y el 60% (n=3) extensión extratiroidea. La estadificación condicionó la aplicación de yodoterapia (150mCi) en el 80% de los casos (n=4).

Conclusiones

El tratador paramagnético puede ser útil para detectar el GC y estadificar correctamente el carcinoma papilar.

Palabras clave:
Carcinoma tiroideo
Ganglio centinela
Trazador paramagnético

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