Soliter ve Dominant Nonfonksiyonel Tiroid Nodüllerinde İntraoperatif Sentinel Lenf Nodunun Bulunması

Öz

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.  

Anahtar Kelimeler

• Tiroid,tiroid nodülü,sentinel lenf nodu,tiroid kanseri

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

Öz

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.

Anahtar Kelimeler

• Thyroid,thyroid nodule,sentinel lymph node,thyroid cancer

Kaynakça

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