The sentinel node concept in head and neck cancer: solution for the controversies in the n0 neck?

Background. The majority of patients with head and neck squamous cell carcinoma (HNSCC) who have a clinical N0 neck undergo neck dissection (ND) even though no lymph node metastases may be detected. With this background, our investigation critically analyzes the value of sentinel lymphadenectomy. Me...

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Bibliographic Details
Published in:Head & neck 2004-07, Vol.26 (7), p.603-611
Main Authors: Werner, Jochen A., Dünne, Anja A., Ramaswamy, Anette, Dalchow, Carsten, Behr, Thomas, Moll, Roland, Folz, Benedikt J., Davis, R. Kim
Format: Article
Language:English
Subjects:
Carcinoma, Squamous Cell - pathology
Carcinoma, Squamous Cell - surgery
Head and Neck Neoplasms - pathology
Head and Neck Neoplasms - surgery
Humans
Hypopharyngeal Neoplasms - pathology
Hypopharyngeal Neoplasms - surgery
Intraoperative Period
Laryngeal Neoplasms - pathology
Laryngeal Neoplasms - surgery
Lymph Node Excision - methods
Lymphatic Metastasis
N0 neck
neck dissection
occult lymph node metastases
Oropharyngeal Neoplasms - pathology
Oropharyngeal Neoplasms - surgery
Radiopharmaceuticals
Sentinel Lymph Node Biopsy
sentinel node
Technetium Tc 99m Aggregated Albumin
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Summary:Background. The majority of patients with head and neck squamous cell carcinoma (HNSCC) who have a clinical N0 neck undergo neck dissection (ND) even though no lymph node metastases may be detected. With this background, our investigation critically analyzes the value of sentinel lymphadenectomy. Methods. Ninety patients with HNSCC, all staged with an N0 neck, underwent intraoperative 99mTc‐radiolabeled detection of up to three hot nodes (SN1–3) during elective ND and primary site resection. Results. Sentinel lymphadenectomy (SN1–3) detected occult metastatic spread in 20 (22%) of 90 patients, whereas failure occurred in three of 90 patients. Metastatic spread was directed to level II in the majority (66.7%) of cases. If only the SN1 had been examined, the procedure would have failed in nine (39%) of 23 patients. Conclusion. Sentinel lymphadenectomy correctly identified the stage of metastatic disease in 97% of patients in cases in which up to three sentinel nodes were identified. If only the lymph node with the highest tracer activity had been excised, 39% of cancer‐positive necks would have been missed. Selective ND identified metastatic disease in the additional 3% of patients. © 2004 Wiley Periodicals, Inc. Head Neck 26: 603–611, 2004
ISSN:1043-3074
1097-0347
DOI:10.1002/hed.20062