Sentinel lymph-node biopsy in head and neck cancer

Abstract

The aim of the study was to assess the diagnostic value of the sentinel node method in patients suffering from squamous cell carcinoma of the upper aerodigestive tract. In 50 patients with oral, pharyngeal or laryngeal carcinomas staged N0 up to 50 MBq technetium-99m colloid were injected peritumorally. Sentinel nodes were localised using a g-probe in the setting of an elective neck dissection. Pathological findings of sentinel nodes and corresponding neck specimens were compared. In 46 patients sentinel nodes were detected. Of these 34 patients were free of metastatic disease in the sentinel nodes and in the neck specimens. In 12 patients clinically occult metastases were found in the sentinel nodes. Three metastases were detected only after additional sectioning of the sentinel nodes. In four patients, a sentinel lymph node could not be localised. Our results support the sentinel node concept in head and neck cancer and a definition of the sentinel nodes as the three nodes with the highest activity. Careful clinical staging of the neck and thorough pathological evaluation of the sentinel nodes are necessary to avoid false-negative results.

Sentinel node biopsy for early‐stage oral cavity cancer: the VU University Medical Center experience

“…Sentinel node biopsy (SNB) is a reliable diagnostic procedure for staging of the cN0 neck and identifying patients with nodal metastatic disease . First, studies analyzed the value of SNB‐assisted neck dissection, considering a neck dissection as the reference (gold) standard . However, follow‐up (no neck dissection if SNB is negative) is a more representative reference standard than (routine) histopathologic examination of (elective) neck dissections …”

Reply: Remarks on sentinel node biopsy in head and neck cancer

“…He compares four publications (Kovacs et al, 2001(Kovacs et al, , 2004aRoss et al, 2004) to our present publication in the British Journal of Cancer (Höft et al, 2004). One of the four studies was published after ours (Ross et al, 2004).…”

“…In our group of patients, this is due to the fact that it was difficult to perform an endoscopic peritumoral injection on large tumours located in the pharynx and the larynx (Höft et al, 2004). Dr Kovacs adds that large tumours pose problems due to destruction of the lymphatic drainage, but he fails to provide data or literature on which his opinion is based.…”

“…However, the rate of positive sentinel lymph nodes is not only influenced by the staging procedure but also by the pathohistologic work-up. The more the intensive sentinel lymph nodes are examined, the more the occult metastases will be detected, raising the percentage of patients with occult disease (Höft et al, 2002;Höft et al, 2004). In our study, we applied ultrasound examinations for staging of the neck as a radiological method and also performed fine-needle aspiration cytologies.…”

Sentinel Lymph Node Biopsy: A new approach in the management of head and neck cancers

“…The use of a SLN biopsy allows adjuvant or elective chemoradiation to be avoided, as well as the associated morbidities of these treatment options. 53 For example, HNSCC patients receiving chemoradiation are more likely to develop acute mucositis, oral pain, dysphagia and xerostomia; in addition, they are more frequently hospitalised. 45,54 Patients with a negative SLN biopsy can therefore Tc and indocyanine green dye.…”