Sentinel Lymph Node Biopsy in Differentiated Thyroid Cancer: A Review of its Evolving Role in Guiding Lateral Neck Dissection

Abstract

Thyroid carcinoma patients frequently have lymph node involvement, which is associated with the biology of the tumor (differentiated thyroid carcinoma/medullary thyroid carcinoma). For neck nodal dissection, it is crucial to understand surgical anatomy, classifications, and operative technique. For both central and lateral neck dissection, there are still some questions about the optimal surgical approach, extension, and criteria for lymph node dissection. The role of prophylactic central neck dissection in patients with clinically node-negative tumors is still up for debate, however in cases with differentiated thyroid carcinomas where there is macroscopic central neck nodal involvement, central neck dissection is required. Even if there is no overt involvement, central neck dissection is required during initial surgery for individuals with medullary thyroid cancer. According to guidelines, all patients with differentiated thyroid cancer or medullary thyroid carcinoma and lateral neck nodal metastases should have their lateral neck dissection done with therapeutic aim. Prophylactic lateral neck dissection indications for medullary thyroid cancer are still up for debate. The majority of endocrine surgeons do selective lateral neck dissection, including levels IIa–III–IV–Vb, while the extent of this procedure is still up for debate. In order to achieve a sufficient oncological surgical resection while lowering the risk of complications and sequelae from radical neck dissection, facial functional neck dissection has been recommended. The surgical procedure is explained, along with any potential complications.