Fluorescence-guided lymphatic mapping in patients with differentiated thyroid cancer

The role of prophylactic central neck dissection in patients with differentiated thyroid cancer without clinically evident lymph node involvement remains controversial despite its importance for staging and risk stratification. In this context, intraoperative lymphatic mapping may provide an opportunity to reduce the extent of surgical intervention.

The study included 125 patients with cN0 differentiated thyroid cancer who underwent thyroidectomy or hemityroidectomy. Central neck dissection was performed in 98 patients, while 27 patients underwent fluorescence-guided lymphatic mapping using indocyanine green with selective lymph node removal. The mean number of removed lymph nodes was significantly lower in the ICG group (3.67 vs 10.3; p < 0.001), while the rate of metastatic node detection did not differ between groups (33.3% vs 34.7%; p = 0.62). The incidence of transient hypoparathyroidism was comparable (14.8% vs 13.3%; p = 0.74), whereas permanent hypoparathyroidism was observed only in the central neck dissection group (17.3% vs 0%; p = 0.02). However, in the subgroup of patients undergoing thyroidectomy, no difference in transient hypoparathyroidism was found (15.5% vs 15.4%; p = 1.00). Permanent recurrent laryngeal nerve palsy occurred in 4.1% of patients in the control group and was not observed in the ICG group.

These findings suggest that fluorescence-guided lymphatic mapping allows selective lymph node removal with a reduced extent of dissection while maintaining a comparable rate of metastatic detection. The differences in postoperative complications appear to be primarily related to the extent of surgery. Further studies are required to evaluate the diagnostic accuracy and long-term outcomes of this approach.

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