The potential role of carbon nanoparticles-assisted biopsy for sentinel lymph nodes of incidental thyroid carcinoma

Thyroid nodules are a common clinical finding and the increasing prevalence of differentiated thyroid carcinoma is a challenge for thyroid surgeons since they have to identify malignant nodules, which represent 5–15% of thyroid nodules. Although the majority of malignant nodules can be diagnosed by fine needle biopsy (FNA) and ultrasound examination preoperatively, incidental thyroid carcinoma (i.e., malignant finding of a nodule that was initially thought as benign) identified in specimens of thyroidectomy performed for benign nodules is quite frequent (1). Thyroid microcarcinoma represents most of the incidental carcinoma since they are difficult to be sampled adequately by FNA. Hence, the diagnosis of differentiated thyroid cancer may be missed. The majority of follicular variants of thyroid papillary carcinoma are encapsulated and the neoplastic cells do not show the nuclear features of papillary carcinoma. As a result, the diagnoses of these tumors may be missed even by experienced pathologists (2)