Annals of Surgical Oncology

, Volume 11, Issue 7, pp 690–696 | Cite as

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

  • Gary L. Ross
  • David S. Soutar
  • D. Gordon MacDonald
  • Taimur Shoaib
  • Ivan Camilleri
  • Andrew G. Roberton
  • Jens A. Sorensen
  • Jorn Thomsen
  • Peter Grupe
  • Julio Alvarez
  • L. Barbier
  • J. Santamaria
  • Tito Poli
  • Olindo Massarelli
  • Enrico Sesenna
  • Adorján F. Kovács
  • Frank Grünwald
  • Luigi Barzan
  • Sandro Sulfaro
  • Franco Alberti
Original Articles

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 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. 1.
    Leemans CR, Tiwari RM, Nauta JJP, van der Waal I, Snow GB. Regional lymph node involvement and its significance in the development of distant metastases in head and neck carcinoma. Cancer 1993;71:452–6.PubMedGoogle Scholar
  2. 2.
    Alvi A, Johnson JT. Extracapsular spread in the clinically negative neck (N0): implications and outcome. Otolaryngol Head Neck Surg 1996;114:65–70.Google Scholar
  3. 3.
    Sobin LH, Wittelind Ch, eds. International Union Against Cancer: TNM Classification of Malignant Tumours. 6th ed. New York: Wiley, 2002Google Scholar
  4. 4.
    O’Brien CJ, Traynor SJ, McNeil E, McMahon JD, Chaplin JM. The use of clinical criteria alone in the management of the clinically negative neck among patients with squamous cell carcinoma of the oral cavity and oropharynx. Arch Otolaryngol Head Neck Surg 2000;126:360–5.Google Scholar
  5. 5.
    Woolgar JA, Beirne JC, Vaughan ED, Lewis-Jones HG, Scott J, Brown JS. Correlation of histopathologic findings with clinical and radiologic assessments of cervical lymph-node metastases in oral cancer. Intl J Oral Maxillofac Surg 1995;24:30–7.Google Scholar
  6. 6.
    Watkinson JC, Johnston D, Jones N, Coady M, Laws D, Allen S, Hibbert J. The reliability of palpation in the assessment of tumours. Clin Otolaryngol 1990;15:405–9.Google Scholar
  7. 7.
    Friedman M, Mafee MF, Pacella, Jr BL, Strorigl TL, Dew LL, Toriumi DM. Rationale for elective neck dissection in 1990. Laryngoscope 1990;100:54–9.Google Scholar
  8. 8.
    Moreau P, Goffart Y, Collignon J. Computed tomography of metastatic cervical lymph nodes. A clinical, computed tomographic, pathologic correlative study. Arch Otolaryngol Head Neck Surg 1990;116:1190–3.Google Scholar
  9. 9.
    Stern WB, Silver CE, Zeifer BA, Persky MS, Heller KS. Computed tomography of the clinically negative neck. Head Neck 1990;12:109–13.Google Scholar
  10. 10.
    van den Brekel MW, Castelijns JA, Stel HV, Golding RP, Meyer CJ, Snow GB. Modern imaging techniques and ultrasound-guided aspiration cytology for the assessment of neck node metastases: a prospective comparative study. Eur Arch Otorhinolaryngol 1993;250:11–7.Google Scholar
  11. 11.
    John DG, Anaes FC, Williams SR, et al. Palpation compared with ultrasound in the assessment of malignant cervical lymph nodes. J Laryngol Otol 1993;107:821–3.Google Scholar
  12. 12.
    Righi PD, Kopecky KK, Caldemeyer KS, Ball VA, Weisberger EC, Radpour S. Comparison of ultrasound-fine needle aspiration and computed tomography in patients undergoing elective neck dissection. Head Neck 1997;19:604–10.Google Scholar
  13. 13.
    Takes RP, Knegt P, Manni JJ, et al. Regional metastasis in head and neck squamous cell carcinoma: revised value of US with US-guided FNAB. Radiology 1996;198:819–23.Google Scholar
  14. 14.
    Kau RJ, Alexiou C, Laubenbacher C, Werner M, Schwaiger M, Arnold W. Lymph node detection of head and neck squamous cell carcinomas by positron emission tomography with fluorodeoxyglucose F 18 in a routine clinical setting. Arch Otolaryngol Head Neck Surg 1999;125:1322–8.Google Scholar
  15. 15.
    Stokkel MP, ten Broek FW, Hordijk GJ, Koole R, van Rijk PP. Preoperative evaluation of patients with primary head and neck cancer using dual-head 18fluorodeoxyglucose positron emission tomography. Ann Surg 2000;231:229–34.Google Scholar
  16. 16.
    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.Google Scholar
  17. 17.
    Ross GL, Soutar DS, Shoaib T, et al. The ability of lymphoscintigraphy to direct sentinel node biopsy in the clinically N0 neck for patients with head and neck squamous cell carcinoma. Br J Radiol 2002;75:950–8.Google Scholar
  18. 18.
    Werner JA, Dunne AA, Ramaswamy A, et al. Sentinel node detection in N0 cancer of the pharynx and larynx. Br J Cancer 2002;87:711–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Stoeckli SJ, Steinert H, Pfaltz M, Schmid S. Is there a role for positron emission tomography with 18F-fluorodeoxyglucose in the initial staging of nodal negative oral and oropharyngeal squamous cell carcinoma. Head Neck 2002;24:345–9.Google Scholar
  20. 20.
    Stoeckli SJ, Pfaltz M, Steinert H, Schmid S. Histopathological features of occult metastasis detected by sentinel lymph node biopsy in oral and oropharyngeal squamous cell carcinoma. Laryngoscope 2002;112:111–5.Google Scholar
  21. 21.
    Civantos FJ, Gomez C, Duque C, et al. Sentinel node biopsy in oral cavity cancer: Correlation with PET scan and immunohistochemistry. Head Neck 2003;25:1–9.Google Scholar
  22. 22.
    Ferlito A, Devaney KO, Rinaldo A, Devaney SL, Carbone A. Micrometastases: have they an impact on prognosis? Ann Otol Rhinol Laryngol 1999;108:1185–9.Google Scholar
  23. 23.
    Ferlito A, Devaney KO, Devaney SL, Rinaldo A. What is the incidence of occult metastasis in patients with stage N0 cancers of the head and neck. ORL 2001;63:1–5.Google Scholar
  24. 24.
    van Diest PJ, Peterse HL, Borgstein PJ, Hoekstra O, Meijer CJ. Pathological investigation of sentinel lymph nodes. Eur J Nucl Med 1999;26:S43–9.PubMedGoogle Scholar
  25. 25.
    Ambrosch P, Brinck U. detection of nodal micrometastasis in head and neck cancer by serial sectioning and immunostaining. Oncology (Huntingt) 1996;10:1221–6.Google Scholar
  26. 26.
    Woolgar JA. Micrometastasis in oral/oropharyngeal squamous cell carcinoma: incidence, histopathological features and clinical implications. Br J Oral Maxillofac Surg 1999;37:181–6.CrossRefPubMedGoogle Scholar
  27. 27.
    van den Brekel MW, Stel HV, van der Valk P, van der Waal I, Meyer CJ, Snow GB. Micrometastases from squamous cell carcinoma in neck dissection specimens. Eur Arch Otorhinolaryngol 1992;249:349–53.Google Scholar
  28. 28.
    NCCN Practice Guidelines for Cancer of the Head and Neck, version 1.2000. Rockville, PA: The National Comprehensive Cancer Network, Inc., 2000.Google Scholar
  29. 29.
    Pillsbury HC, Clark MA. Rationale for therapy of the N0 neck. Laryngoscope 1997;107:1294–315.Google Scholar
  30. 30.
    Ross GL, Shoaib T, Soutar DS, et al. The first international conference on sentinel node biopsy in mucosal head and neck cancer and adoption of a multicenter trial protocol. Ann Surg Oncol 2002;9:406–10.Google Scholar
  31. 31.
    Robbins KT. Classification of neck dissection: current concepts and future considerations. Otolaryngol Clin North Am 1998;31:639–55.Google Scholar
  32. 32.
    Hermanek P, Hutter RVP, Sobin LH, Wittekind C. Classification of isolated tumour cells and micrometastasis. Cancer 1999;86:2668–73.CrossRefPubMedGoogle Scholar
  33. 33.
    Alex JC, Krag DN. The gamma-probe-guided resection of radiolabeled primary lymph nodes. Surg Oncol Clin N Am 1996;5:33–41.Google Scholar
  34. 34.
    Pitman KT, Johnson JT, Edington H, et al. Lymphatic mapping with isosulfan blue dye in squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg 1998;124:790–3.Google Scholar
  35. 35.
    Koch WM, Choti MA, Civelek AC, Eisele DW, Saunders JR. Gamma probe-directed biopsy of the sentinel node in oral squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 1998;124:455–9.PubMedGoogle Scholar
  36. 36.
    Shoaib T, Soutar DS, Prosser JE, et al. A suggested method for sentinel node biopsy in squamous cell carcinoma of the head and neck. Head Neck 1999;21:728–33.Google Scholar
  37. 37.
    Werner JA, Dunne AA, Brandt D, et al. Studies on significance of sentinel lymphadenectomy in pharyngeal and laryngeal carcinoma. Laryngorhinootologie 1999;78:663–70.CrossRefPubMedGoogle Scholar
  38. 38.
    Bilchik AJ, Giuliano A, Essner R, et al. Universal application of intraoperative lymphatic mapping and sentinel lymphadenectomy in solid neoplasms. Cancer J Sci Am 1998;4:351–8.PubMedGoogle Scholar
  39. 39.
    Shoaib T, Soutar DS, MacDonald DG, et al. The accuracy of head and neck carcinoma sentinel lymph node biopsy in the clinically N0 neck. Cancer 2001;91:2077–83.CrossRefPubMedGoogle Scholar
  40. 40.
    Chiesa F, Mauri S, Grana C, et al. Is there a role for sentinel node biopsy in early N0 tongue tumours? Surgery 2000;128:16–21.CrossRefPubMedGoogle Scholar
  41. 41.
    Alex JC, Sasaki CT, Krag DN, Wenig B, Pyle PB. Sentinel lymph node radiolocalization in head and neck squamous cell carcinoma. Laryngoscope 2000;110:198–203.CrossRefPubMedGoogle Scholar
  42. 42.
    Taylor RJ, Wahl RL, Sharma PK, et al. Sentinel node localization in oral cavity and oropharynx squamous cell cancer. Arch Otolaryngol Head Neck Surg 2001;127:970–4.PubMedGoogle Scholar
  43. 43.
    Zitsch RP, Todd DW, Renner GJ, Singh A. Intraoperative radiolymphoscintigraphy for detection of occult nodal metastasis in patients with head and neck squamous cell carcinoma. Otolaryngol Head Neck Surg 2000;122:662–6.PubMedGoogle Scholar
  44. 44.
    Stoeckli SJ, Steinert H, Pfaltz M, Schmid S. Sentinel lymph node evaluation in squamous cell carcinoma of the head and neck. Otolaryngol Head Neck Surg 2001;125:221–6.CrossRefPubMedGoogle Scholar
  45. 45.
    Mozzillo N, Chiesa F, Botti G, et al. Sentinel node biopsy in head and neck cancer. Ann Surg Oncol. 2001;8:103S–5S.Google Scholar
  46. 46.
    Dunne AA, Kulkens C, Ramaswamy A, et al. Value of sentinel lymphonodectomy in head and neck cancer patients without evidence of lymphogenic metastatic disease. Auris Nasus Larynx 2001;28:339–44.CrossRefPubMedGoogle Scholar
  47. 47.
    Barzan L, Sulfaro S, Alberti F, et al. Gamma probe accuracy in detecting the sentinel lymph node in clinically N0 squamous cell carcinoma of the head and neck. Ann Otol Rhinol Laryngol 2002;111:794–8.PubMedGoogle Scholar
  48. 48.
    von Buchwald C, Bilde A, Shoaib T, Ross G. Sentinel node biopsy: the technique and the feasibility in head and neck cancer. ORL J Otorhinolaryngol Relat Spec 2002;64:268–74.Google Scholar
  49. 49.
    Kovacs AF, Acker P, Berner U, Risse JH. Sentinel lymph node excision. Treatment of the N0 neck in patients with oral and oropharyngeal carcinoma. HNO 2001;49:646–53.CrossRefPubMedGoogle Scholar
  50. 50.
    Shah JP, Andersen PE. The impact of patterns of nodal metastasis on modifications of neck dissection. Ann Surg Oncol 1994;1:521–32.Google Scholar
  51. 51.
    Brazilian Head and Neck Cancer Study Group. Results of a pro-spective 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.Google Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2004

Authors and Affiliations

  • Gary L. Ross
    • 1
    • 13
  • David S. Soutar
    • 1
  • D. Gordon MacDonald
    • 2
  • Taimur Shoaib
    • 1
  • Ivan Camilleri
    • 1
  • Andrew G. Roberton
    • 3
  • Jens A. Sorensen
    • 4
  • Jorn Thomsen
    • 4
  • Peter Grupe
    • 5
  • Julio Alvarez
    • 6
  • L. Barbier
    • 6
  • J. Santamaria
    • 6
  • Tito Poli
    • 7
  • Olindo Massarelli
    • 7
  • Enrico Sesenna
    • 7
  • Adorján F. Kovács
    • 8
  • Frank Grünwald
    • 9
  • Luigi Barzan
    • 10
  • Sandro Sulfaro
    • 11
  • Franco Alberti
    • 12
  1. 1.Plastic Surgery UnitCanniesburn HospitalBearsdenUK
  2. 2.Department of Oral PathologyGlasgow Royal InfirmaryGlasgowUK
  3. 3.Beatson Oncology CentreGlasgowUK
  4. 4.Departments of Plastic and Reconstructive SurgeryOdense University HospitalOdenseDenmark
  5. 5.Departments of Nuclear MedicineOdense University HospitalOdenseDenmark
  6. 6.Servicio de C. MaxilofacialHospital de CrucesCrucesSpain
  7. 7.Sezione di Chirurgia Maxillo-Faciale, Dipartmento di Scienze Otorino-Odonto-Oftalmologiche e Cervico FaccialiUniversity Hospital of ParmaParmaItaly
  8. 8.Clinic for Maxillofacial Plastic SurgeryJohann Wolfgang Goethe University Medical School, Frankfurt am MainGermany
  9. 9.Department of Nuclear MedicineJohann Wolfgang Goethe University Medical School, Frankfurt am MainGermany
  10. 10.Operative Units of OtolaryngologyAzienda Ospedaliera “S. Maria degli Angeli,”PordenoneItaly
  11. 11.Department of PathologyAzienda Ospedaliera “S. Maria degli Angeli,”PordenoneItaly
  12. 12.Department of Nuclear MedicineAzienda Ospedaliera “S. Maria degli Angeli,”PordenoneItaly
  13. 13.DidsburyUK

Personalised recommendations