Role of intraoperative sentinel node imaging in head and neck cancer

Abstract

At the present time, there is a dilemma concerning the best management of the neck in patients presenting with early head and neck squamous cell carcinoma (HNSCC). Occult cervical metastasis is found in up to a quarter of HNSCC patients with radiologically N0 necks, and for this reason, conventional treatment includes elective neck dissection (END) alongside tumour excision. Sentinel node biopsy (SNB) offers an alternative accurate and minimally invasive method of staging the neck, which has been safely applied to oral cancer. SNB is a patientspecific procedure which has an enhanced recovery compared to END but is currently not widely offered to patients. There are exciting developments in the technology supporting SNB, improving the accuracy and ease of the procedure and opening up the technique to new tumour types. We describe our experiences in using a novel intraoperative navigation device for sentinel node retrieval and review other advances in SNB practice which have the potential to change the standard management for patients with early HNSCC.Keywords Sentinel node biopsy Á Freehand SPECT Á Head and neck squamous cell carcinoma Á Cervical metastasis Á Guided intraoperative scintigraphic tumour targeting (GOSTT)

Surgical consensus guidelines on sentinel node biopsy (SNB) in patients with oral cancer

“…It is tempting to offer frail patients SNB to avoid risks associated with END. However, 20%‐30% of patients will have a positive SNB (SNB+) and will require staged completion (therapeutic) neck dissection (CND). Frail patients who have undergone SNB can sometimes deteriorate after initial surgery and may not recover sufficiently to undergo CND.…”

“…A number of studies have confirmed that 2‐3 sentinel nodes normally are removed per patient. Occasionally just one sentinel node is identified; rarely more than five are encountered, usually in patients with bilateral drainage . It is appreciated that the economic advantage of SNB is reduced when multiple nodes are sent for serial sectioning.…”