Skip to main content
SpringerLink
Log in

Therapeutic implications of sentinel lymph node biopsy in the staging of oral cancer

  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

The most powerful prognostic factor in patients with oral cancer is the presence of lymph node metastases. The management of the neck at diagnosis in the absence of adenopathy is still controversial, but sentinel lymph node biopsy (SLB) may help resolve this issue. At the National Cancer Institute in Naples, we performed SLB in 41 patients with T1 to T2 oral cancer. All patients underwent lymphoscintigraphy. Intraoperative blue dye and gamma probe examination identified a sentinel node (SN) in 39 patients. Four patients (10%) had double drainage, and 7 (18%) had drainage beyond the expected anatomical site. Complete concordance between the pathology of the SN and nodes obtained from radical dissection confirmed SLB as a reliable staging procedure. Since January 2001, seven patients with T1 to T2 oral cancers have been staged with SLB only; modified radical neck dissection was carried out only in cases with a positive SN. The rate of SN identification was 100%, and all five cases with negative SNs were free of disease after a median follow-up of 10 months. Lymphoscintigraphy plus SLB seems to be a good staging system for guiding neck management in patients with oral cancer. A larger number of patients and a longer follow-up in a randomized trial will confirm the potential staging value of this procedure and determine which patients might benefit from a conservative approach that avoids radical neck dissection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Woolgar JA, Vaughan ED, Scott J, Brown JS. Pathological findings in clinically false-negative neck dissections for oral carcinoma.Ann R Coll Surg Engl 1994;76:237–44.

    PubMed  CAS  Google Scholar 

  2. Kowalski LP, Medina JE. Nodal metastases: predictive factors.Otolaryngol Clin North Am 1998;31:621–37.

    Article  PubMed  CAS  Google Scholar 

  3. Mozzillo N, Chiesa F, Botti G, et al. Sentinel node biopsy in head and neck cancer.Ann Surg Oncol 2001;8:103S-5S.

    PubMed  CAS  Google Scholar 

  4. Byers RM, Weber RS, Andrews T, McGill D, Kare R, Wolf P. Frequency and therapeutic implications of “skip metastases” in the neck from squamous carcinoma of the oral tongue.Head Neck 1997;9:14–9.

    Article  Google Scholar 

  5. Braams JW, Pruim J, Freling NJ, et al. Detection of lymph node metastases of squamous-cell cancer of the head and neck with FDG-PET and MRI.J Nucl Med 1995;36:211–6.

    PubMed  CAS  Google Scholar 

  6. Bilchik AJ, Giuliano A, Essner R, et al. Universal application of intraoperative lymphatic mapping and sentinel lymphadenectomy in solid neoplasm.Cancer J Sci Am 1998;4:251–8.

    Google Scholar 

  7. Chiesa F, Mauri S, Grana C, et al. Is there a role for sentinel node biopsy in early N0 tongue tumors?Surgery 2000;128:16–21.

    Article  PubMed  CAS  Google Scholar 

  8. Shoaib T, Soutar DS, MacDonald G, et al. The accuracy of head and neck carcinoma sentinel lymph node biopsy in the clinically N0 neck.Cancer 2001;91:2077–83.

    Article  PubMed  CAS  Google Scholar 

  9. Pitman KT, Johnson JT, Myers EN. Effectiveness of selective neck dissection for management of the clinically negative neck.Arch Otolaryngol Head Neck Surg 1997;123:917–22.

    PubMed  CAS  Google Scholar 

  10. Ross GL, Shoaib T, Soutar DS, et al. The use of sentinel node biopsy to upstage the clinically N0 neck in head and neck cancer.Arch Otolaryngol Head Neck Surg 2002;128:1287–91.

    PubMed  Google Scholar 

  11. Alex JC, Sasaki CT, Krag DN, et al. Sentinel lymph node radiolocalization in head and neck squamous cell carcinoma,Laryngoscope 2000;110:198–203.

    Article  PubMed  CAS  Google Scholar 

  12. Molinari R, Zingo L. Patogenesi delle recidive di metastasi sul campo di svuotamento laterocervicale per carcinomi orofaringei.Tumori 1969;55:371–85.

    PubMed  CAS  Google Scholar 

  13. Leemans CR, Tiwari R, Nauta JJ, Snow GB. Discontinuous vs in-continuity neck dissection in carcinoma of the oral cavity.Arch Otolaryngol Head Neck Surg 1991;117:1003–6.

    PubMed  CAS  Google Scholar 

  14. Kowalski LP, Bagietto R, Lara LRL, et al. Factors influencing contralateral lymph node metastasis from oral carcinoma.Head Neck 1999;21:104–10.

    Article  PubMed  CAS  Google Scholar 

  15. Morton DL, Thompson JF, Essner R, et al. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymph-adenectomy for early-stage melanoma: a multicenter trial. Multicenter Selective Lymphadenectomy Trial Group.Ann Surg 1999; 230:453–63.

    Article  PubMed  CAS  Google Scholar 

  16. Giuliano AE. Current status of sentinel lymphadenectomy in breast cancer.Ann Surg Oncol 2001;8:52S-5S.

    PubMed  CAS  Google Scholar 

  17. Ionna F, Chiesa F, Longo F, et al. Prognostic value of sentinel node in oral cancer.Tumori 2002;88:S18–9.

    Google Scholar 

  18. Brazilian Head and Neck Cancer Study Group, Results of a prospective trial on elective modified radical classical versus suprao-mohyoid neck dissection in the management of oral squamous carcinoma.Am J Surg 1998;176:422–7.

    Article  Google Scholar 

  19. Carvalho AL, Kowalski LP, Borges JA, et al. Ipsilateral cancer recurrences after elective supra-omohyoid neck dissection.Arch Otolaryngol Head Neck Surg 2000;126:410–2.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. National Cancer Institute, Via Orazio 31, 80122, Naples, Italy

    Nicola Mozzillo MD, Corrado Caracò MD, Gerardo Botti MD, Secondo Lastoria MD, Francesco Longo MD & Franco Ionna MD

  2. European Institute of Oncology, Milan, Italy

    Fausto Chiesa MD

Authors
  1. Nicola Mozzillo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fausto Chiesa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Corrado Caracò MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gerardo Botti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Secondo Lastoria MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Francesco Longo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Franco Ionna MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Corrado Caracò MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mozzillo, N., Chiesa, F., Caracò, C. et al. Therapeutic implications of sentinel lymph node biopsy in the staging of oral cancer. Annals of Surgical Oncology 11 (Suppl 3), 263S–266S (2004). https://doi.org/10.1007/BF02523642

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02523642

Key Words

Search

Navigation