The accuracy of head and neck carcinoma sentinel lymph node biopsy in the clinically N0 neck

Abstract

BACKGROUND Sentinel lymph node (SLN) biopsy originally was described as a means of identifying lymph node metastases in malignant melanoma and breast carcinoma. The use of SLN biopsy in patients with oral and oropharyngeal squamous cell carcinoma and clinically N0 necks was investigated to determine whether the pathology of the SLN reflected that of the neck. METHODS Patients undergoing elective neck dissections for head and neck squamous cell carcinoma accessible to injection were enrolled into our study. Sentinel lymph node biopsy was performed after blue dye and radiocolloid injection. Preoperative lymphoscintigraphy and the perioperative use of a gamma probe identified radioactive SLNs; visualization of blue stained lymphatics identified blue SLNs. A neck dissection completed the surgical procedure, and the pathology of the SLN was compared with that of the remaining neck dissection. RESULTS Sentinel lymph node biopsy was performed on 40 cases with clinically N0 necks. Twenty were pathologically clear of tumor and 20 contained subclinical metastases. SLNs were found in 17 necks with pathologic disease and contained metastases in 16. The sentinel lymph node was the only lymph node containing tumor in 12 of 16. CONCLUSIONS The SLN, in head and neck carcinomas accessible to injection without anesthesia, is an accurate reflector of the status of the regional lymph nodes, when found in patients with early tumors. Sentinel lymph nodes may be found in clinically unpredictable sites, and SLN biopsy may aid in identifying the clinically N0 patient with early lymph node disease. If SLNs cannot be located in the neck, an elective lymph node dissection should be considered. Cancer 2001;91:2077–83. © 2001 American Cancer Society.

Sentinel Lymph Node Localization Using 1 % Isosulfan Blue Dye in Cases of Early Oral Cavity and Oropharyngeal Squamous Cell Carcinoma

“…They identified sentinel node in 17 of 21 cases (sensitivity 80.95 %) and it accurately predicted the metastasis in 16 cases (specificity 94 %). Shoaib et al performed SLNB in six patients of oral cavity and oropharyngeal SCC with N0 neck using Patent blue V dye alone [1]. Sentinel lymph node was identified in four of the six cases (67 %) and they correctly predicted the pathologic status of the neck in only two of the four cases (50 %).…”

“…The presence of a single positive lymph node can reduce the disease free survival at 5 years by 50 % [1][2][3][4][5].…”

“…Although there are no universally accepted guidelines, still all patients with clinically N0 neck should undergo neck dissection if risk of occult metastasis is 15-20 %. But up to 80 % of these cN0 patients on histopathology are pN0 and are theoretically over treated [1].…”

Sentinel lymph-node biopsy in head and neck cancer

“…Studies applying a radiolabelled tracer with or without additional blue dye, however, were promising. The majority of the studies reported results favouring the sentinel lymph-node concept (Koch et al, 1998;Shoaib et al, 1999Shoaib et al, , 2001Alex et al, 2000;Zitsch et al, 2000;Mozzillo et al, 2001;Stoeckli et al, 2001Stoeckli et al, , 2002Barzan et al, 2002;Werner et al, 2002a, b). Groups who worked with blue dye report of an extravasation of the blue dye into the tissue (Pitman et al, 2002).…”

“…A high number of nodes accumulating activity poses a problem as the aim of the sentinel node concept is to keep the surgical morbidity to a minimum. Yet, also in other studies up to nine nodes accumulating tracer have been detected (Alex et al, 2000;Shoaib et al, 2001). There have been different approaches to limit the number of nodes to be biopsied by defining the sentinel lymph node by its activity.…”