Selective sentinel lymph node biopsy in papillary thyroid carcinoma.

While significant advances have been made in the past decade in the etiopathogenesis of differentiated thyroid cancer (DTC),1 advances in surgery have not been relevant. Thus, robot-assisted cervicoscopic techniques or procedures using approaches different from the conventional transverse cervicotomy have been developed.2 The practical value of these approaches is however very limited. One of the few contributions with an impact on thyroid surgery is probably the procedure of selective sentinel lymph node biopsy (SLNB). The concept of the sentinel lymph node (SLN) refers to the first lymph node draining a tumor. SLN location and analysis indicate whether the tumor has nodal dissemination, which is essential when deciding the type of intervention to be performed. SLNB is well standardized in some tumors, particularly melanoma3 and breast cancer,4 and has provided undeniable benefits in their treatment. The use of SLNB in DTC was proposed 15 years ago by Kelemen et al.5 Since then, its indications, benefits, and limitations have been controversial. SLNB is of particular value in papillary thyroid carcinoma (PTC) because while follicular carcinoma tends to hematogenous dissemination, PTC usually metastasizes