Soliter ve Dominant Nonfonksiyonel Tiroid Nodüllerinde İntraoperatif Sentinel Lenf Nodunun Bulunması

Year 2020, Volume: 42 Issue: 2, 148 - 154, 17.03.2020

Serkan Sarıkaya Feridun Suat Gokce

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

Abstract

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.  

Keywords

Tiroid, tiroid nodülü, sentinel lenf nodu, tiroid kanseri

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

Abstract

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.

Keywords

Thyroid, thyroid nodule, sentinel lymph node, thyroid cancer

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