Abstract
To study the use of 1 % isosulfan blue dye in identifying sentinel node, sensitivity and specificity of frozen section and predictive value of sentinel node in predicting other nodal status in the cases of oral cavity and oropharyngeal squamous cell carcinoma. 15 patients of oral cavity and oropharyngeal SCC with clinically N0 neck, who required WLE of the primary lesion as well as neck dissection as per recommended treatment protocol, were selected from OPD. 1 % Isosulfan dye was injected peritumorally intraoperatively after the induction of general anaesthesia. Neck dissection was performed and first node taking up the blue dye was identified, dissected, removed and was sent for frozen section. In two of the 15 cases a sentinel node was identified (sensitivity of the technique—13 %). Both the sentinel nodes were positive for presence of metastasis on final histopathology (specificity—100 %). However, five cases had nodal metastasis on final histopathological examination of the neck dissection specimen (sensitivity of sentinel lymph node biopsy—40 %). Frozen section examination had a sensitivity and specificity of 100 %. All data was analyzed using SPSS 16 software. Use of 1 % Isosulfan Dye for identification of sentinel node is a simple and cheap technique, however, it has low sensitivity as compared to the use of triple diagnostic procedure consisting of lymphoscintigraphy, per op gamma probe localization and using isosulfan dye for sentinel node identification. Sentinel lymph node is representative of nodal status and correlates well with the final histopathological examination of the dissected neck nodes.
Similar content being viewed by others
References
Shoaib T, Soutar DS, Mac Donald DG, Camilleri IG, Dunaway DG, Gray HW et al (2001) The accuracy of head and neck carcinoma sentinel lymph node biopsy in the clinically N0 neck. Cancer 91(11):2077–2083
Shah JP, Anderson PE (1995) Evolving role of modifications in neck dissection for oral squamous carcinoma. Br J Oral Maxillofac Surg 33:3–8
Vartanian JG, Pontes Everton, Ivan MG, Olimpio DC, Joao GF et al (2003) Distribution of metastatic lymph nodes in oropharyngeal carcinoma and its implications for the elective treatment of the neck. Arch Otolaryngol Head Neck Surg 129:729–732
Jones AS, Phillips DE, Helliwell TR, Roland NJ (1993) Occult node metastasis in head and neck squamous carcinoma. Eur Arch Otorhinolaryngol 250:446–449
Wiseman SM, Loree TR, Hicks WL, Rigual NR (2002) Sentinel lymph node biopsy in SCC of the head and neck: a major advance in staging the N0 neck. ENT-Ear Nose Throat J 81(3):156–163
Rigual N, Douglas W, Lamonica D, Wiseman S, Cheney R, Hicks W Jr et al (2005) Sentinel lymph node biopsy: a rational approach for staging T2N0 oral cancer. Laryngoscope 115(12):2217–2220
Civantos FJ, Stoeckli SJ, Takes RP, Woolgar JA, De Bree R, Paleri V et al (2010) What is the role of sentinel node biopsy in the management of oral cancer in 2010? Eur Arch Otorhinolaryngol 267(6):839–844
Kowalski LP, Sanabria A (2007) Elective neck dissection in oral carcinoma: a critical review of the evidence. Acta Otorhinolaryngol Ital 27(3):113–117
Minamikawa T, Umeda M, Komori T (2005) Reliability of sentinel node biopsy with squamous cell carcinoma of the oral cavity. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 99(5):532–538
Cabanas RM (1977) An approach for the treatment of Penile carcinoma. Cancer 39:456–466
Alex JC, Krag DN (1996) Gamma-probe-guided resection of radiolabeled primary lymph nodes. Surg Oncol Clin North Am 5:33–41
Civantos FJ, Zitsch RP, Schuller DE, Aggarwal A, Smith RB, Nason R et al (2010) Sentinel lymph node biopsy accurately stages the regional lymph nodes for T1–T2 oral squamous cell carcinomas: result of a prospective multi institutional trial. J Clin Oncology 28(8):1395–1400
Pitman KT, Johnson JT, Brown ML, Myers EN (2002) Sentinel lymph node biopsy in head and neck squamous cell carcinoma. Laryngoscope 112:2101–2113
Pitman KT, Johnson JT, Edington H, Barnes EL, Day R, Wagner RL et al (1998) Lymphatic mapping with Isosulfan blue dye in squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg 124:790–793
Don DM, Anzai Y, Lufkin RB, Fu YS, Calcaterra TC (1995) Evaluation of cervical lymph node metastasis in squamous cell carcinoma of the head and neck. Laryngoscope 105:6669–6674
Tschopp L, Nuyens M, Stauffer E, Krause T, Zbaren P (2005) The value of frozen section analysis of the sentinel node in clinically N0 squamous cell carcinoma of the oral cavity and oropharynx. Otolaryngol Head Neck Surg 132(1):99–102
Barakat FH, Sulaiman I, Sughayer MA (2012) Reliability of frozen section in breast sentinel lymph node examination. Breast Cancer. 2012 Nov 29. [Epub ahead of print]
Kumar S, Medeiros F, Dowdy SC, Keeney GL, Bakkum-Gamez JN, Podratz KC, Cliby WA, Mariani A (2012) A prospective assessment of the reliability of frozen section to direct intraoperative decision making in endometrial cancer. Gynecol Oncol 127(3):525–531
Ross G, Shoaib T, Soutar DS, Camilleri IG, Gray HW, Bessent RG et al (2002) The use of sentinel node biopsy to upstage the clinically N0 neck in head and neck cancer. Arch Otolaryngol Head Neck Surg 128:1287–1291
Pitman KT, Ferlito A, Devaney KO, Shaha AR, Rinaldo A (2003) Sentinel lymph node biopsy in head and neck cancer. Oral Oncol 39:343–349
Calabrese L, Bruschini R, Ansarin M, Giugliano G, De Cicco C, Ionna F et al (2006) Role of sentinel node biopsy in oral cancer. Acta Otorhinolaryngol Ital 26(6):345–349
Coughlin A, Resto VA (2010) Oral cavity squamous cell carcinoma and the clinically N0 neck: the past, present and future of sentinel lymph node biopsy. Curr Oncol Rep 12(2):129–135
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sangwan, P., Nilakantan, A., Patnaik, U. et al. Sentinel Lymph Node Localization Using 1 % Isosulfan Blue Dye in Cases of Early Oral Cavity and Oropharyngeal Squamous Cell Carcinoma. Indian J Otolaryngol Head Neck Surg 67 (Suppl 1), 56–61 (2015). https://doi.org/10.1007/s12070-014-0752-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12070-014-0752-0