Two procedures are currently available for identifying the SLN. The first step is localization of the SLN. The purpose of this study was to review what the procedure involves, to assess its advantages and disadvantages and, finally, to establish potential lines of work which in the future will be able to answer the multiple questions still pending regarding the use of SLNB in PTC. 8–10 Although it has been suggested that a prospective, randomized study on this subject is unfeasible, 11 SLNB may possibly contribute to clarification on this subject in the future. 6,7 This has led to another of the most controversial subjects of recent years, the need for prophylactic lymphadenectomy of the central compartment. In this type of tumor, the first controversial subject is the prognostic significance of nodal involvement and, thus, the value of accurate staging during surgery. SLNB is of particular value in papillary thyroid carcinoma (PTC) because while follicular carcinoma tends to hematogenous dissemination, PTC usually metastasizes by the lymphatic route. 5 Since then, its indications, benefits, and limitations have been controversial. The use of SLNB in DTC was proposed 15 years ago by Kelemen et al. SLNB is well standardized in some tumors, particularly melanoma 3 and breast cancer, 4 and has provided undeniable benefits in their treatment. SLN location and analysis indicate whether the tumor has nodal dissemination, which is essential when deciding the type of intervention to be performed. The concept of the sentinel lymph node (SLN) refers to the first lymph node draining a tumor. One of the few contributions with an impact on thyroid surgery is probably the procedure of selective sentinel lymph node biopsy (SLNB). 2 The practical value of these approaches is however very limited. Thus, robot-assisted cervicoscopic techniques or procedures using approaches different from the conventional transverse cervicotomy have been developed. 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.
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