Original Articles

Annals of Surgical Oncology

, Volume 11, Issue 7, pp 690-696

Sentinel Node Biopsy in Head and Neck Cancer: Preliminary Results of a Multicenter Trial

  • Gary L. RossAffiliated withPlastic Surgery Unit, Canniesburn Hospital Email author 
  • , David S. SoutarAffiliated withPlastic Surgery Unit, Canniesburn Hospital
  • , D. Gordon MacDonaldAffiliated withDepartment of Oral Pathology, Glasgow Royal Infirmary
  • , Taimur ShoaibAffiliated withPlastic Surgery Unit, Canniesburn Hospital
  • , Ivan CamilleriAffiliated withPlastic Surgery Unit, Canniesburn Hospital
  • , Andrew G. RobertonAffiliated withBeatson Oncology Centre
  • , Jens A. SorensenAffiliated withDepartments of Plastic and Reconstructive Surgery, Odense University Hospital
  • , Jorn ThomsenAffiliated withDepartments of Plastic and Reconstructive Surgery, Odense University Hospital
  • , Peter GrupeAffiliated withDepartments of Nuclear Medicine, Odense University Hospital
    • , Julio AlvarezAffiliated withServicio de C. Maxilofacial, Hospital de Cruces
    • , L. BarbierAffiliated withServicio de C. Maxilofacial, Hospital de Cruces
    • , J. SantamariaAffiliated withServicio de C. Maxilofacial, Hospital de Cruces
    • , Tito PoliAffiliated withSezione di Chirurgia Maxillo-Faciale, Dipartmento di Scienze Otorino-Odonto-Oftalmologiche e Cervico Facciali, University Hospital of Parma
    • , Olindo MassarelliAffiliated withSezione di Chirurgia Maxillo-Faciale, Dipartmento di Scienze Otorino-Odonto-Oftalmologiche e Cervico Facciali, University Hospital of Parma
    • , Enrico SesennaAffiliated withSezione di Chirurgia Maxillo-Faciale, Dipartmento di Scienze Otorino-Odonto-Oftalmologiche e Cervico Facciali, University Hospital of Parma
    • , Adorján F. KovácsAffiliated withClinic for Maxillofacial Plastic Surgery, Johann Wolfgang Goethe University Medical School, Frankfurt am Main
    • , Frank GrünwaldAffiliated withDepartment of Nuclear Medicine, Johann Wolfgang Goethe University Medical School, Frankfurt am Main
    • , Luigi BarzanAffiliated withPlastic Surgery Unit, Canniesburn HospitalOperative Units of Otolaryngology, Azienda Ospedaliera “S. Maria degli Angeli,”
    • , Sandro SulfaroAffiliated withPlastic Surgery Unit, Canniesburn HospitalDepartment of Pathology, Azienda Ospedaliera “S. Maria degli Angeli,”
    • , Franco AlbertiAffiliated withPlastic Surgery Unit, Canniesburn HospitalDepartment of Nuclear Medicine, Azienda Ospedaliera “S. Maria degli Angeli,”

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Abstract

Background: The aim was to determine the reliability and reproducibility of sentinel node biopsy (SNB) as a staging tool in head and neck squamous cell carcinoma (HNSCC) for T1/2 clinically N0 patients by means of a standardized technique.

Methods: Between June 1998 and June 2002, 227 SNB procedures have been performed in HNSCC cases at six centers. One hundred thirty-four T1/2 tumors of the oral cavity/oropharynx in clinically N0 patients were investigated with preoperative lymphoscintigraphy (LSG), intraoperative use of blue dye/gamma probe, and pathological evaluation with step serial sectioning and immunohistochemistry, with a follow-up of at least 12 months. In 79 cases SNB alone was used to stage the neck carcinoma, and in 55 cases SNB was used in combination with an elective neck dissection (END).

Results: In 125/134 cases (93%) a sentinel node was identified. Of 59 positive nodes, 57 were identified with the intraoperative gamma probe and 44 with blue dye. Upstaging of disease occurred in 42/125 cases (34%): with hematoxylin-eosin in 32/125 (26%) and with additional pathological staging in 10/93 (11%). The sensitivity of the technique with a mean follow-up of 24 months was 42/45 (93%). The identification of SNB for floor of mouth (FOM) tumors was 37/43 (86%), compared with 88/91 (97%) for other tumors. The sensitivity for FOM tumors was 12/15 (80%), compared with 30/30 (100%) for other tumor groups.

Conclusion: SNB can be successfully applied to early T1/2 tumors of the oral cavity/oropharynx in a standardized fashion by centers worldwide. For the majority of these tumors the SNB technique can be used alone as a staging tool.

Key Words:

Cervical metastases Elective neck dissection Head and neck Neoplasms Sentinel node biopsy