Potential utility of sentinel node biopsy in the original surgical assessment of H rthle cell tumors of the thyroid: 23-year institutional review of H rthle cell neoplasms

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Abstract
Great difficulty still exists in determining the potential malignancy of Hürthle cell tumors of the thyroid gland. Indications for the extent of resection vary greatly in the reported literature. Sentinel node biopsy has shown its usefulness as a prognostic indicator in both melanoma and breast cancer. The feasibility of using it as an integral part of Hürthle cell tumor surgery was investigated and is discussed. Eleven patients diagnosed with Hürthle cell tumors between the years of 1975 and 1998 were reviewed. The last three patients had sentinel node biopsy with isosulfan blue dye as an integral part of their procedure. Sentinel node biopsy was accomplished without difficulty or complication in our last three patients. Two patients were considered to be benign by frozen section and final pathology. Their sentinel nodes were benign. One patient was considered malignant on both frozen and final pathology. His sentinel nodes as well as central node dissection revealed no lymphatic spread. Malignancy of Hürthle cell tumors of the thyroid is difficult to determine even on final pathological examination. The addition of nodal sampling may add valuable prognostic information. Sentinel node biopsy with isosulfan blue dye, although not previously reported for these tumors, appears to be a logical next step in the evolution of surgical management.