Skip to main content

Advertisement

SpringerLink
Log in

Sentinel Node Concept in Clinically N0 Laryngeal and Hypopharyngeal Cancer

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

Abstract

Background

Sentinel nodes (SNs) are the lymph nodes that directly receive lymphatic flow from a primary cancer lesion. The SN concept implies that lymphatic metastasis initially occurs at SNs. SN navigation surgery can be introduced for cancers in which the SN concept is established. In SN navigation surgery, lymph node dissection beyond SNs can be omitted if SNs are metastasis free. Although the SN concept has been investigated frequently for oral and oropharyngeal cancer, it has so far been investigated less for laryngeal and hypopharyngeal cancer. In this study, we investigated whether the SN concept is applicable for laryngeal and hypopharyngeal cancer.

Methods

Twenty patients with T2–T4 and clinically N0 laryngeal and hypopharyngeal cancer were recruited. 99mTc-phytate was injected into several sites surrounding the tumor on the day before surgery. Lymphoscintigrams were acquired from at least two different viewpoints. SNs were surveyed intraoperatively, and neck dissections including at least levels II, III, and IV were performed.

Results

SNs had occult metastases in five cases. In the remaining 15 cases, neither SNs nor other lymph nodes contained metastases, consistent with the SN concept. There was one false-negative case showing delayed nodal metastasis 2 years after initial surgery. The overall accuracy of the SN concept was 95%.

Conclusion

Our study shows that SN biopsy is a reliable strategy to determine correct lymph node status in N0 laryngeal and hypopharyngeal cancer. SN detection was valuable in evaluating the need for neck dissection, whether ipsilaterally or bilaterally.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. van den Brekel MW, Stel HV, Castelijns JA, et al. Cervical lymph node metastasis: assessment of radiologic criteria. Radiology 1990;177:379–84

    PubMed  Google Scholar 

  2. Zhang B, Xu ZG, Tang PZ. Elective lateral neck dissection for laryngeal cancer in the clinically negative neck. J Surg Oncol 2006;93:464–7

    Article  PubMed  Google Scholar 

  3. Esposito ED, Motta S, Cassiano B, et al. Occult lymph node metastases in supraglottic cancers of the larynx. Otolaryngol Head Neck Surg 2001;124:253–7

    Article  PubMed  CAS  Google Scholar 

  4. Clark JR, Naranjo N, Franklin JH, et al. Established prognostic variables in N0 oral carcinoma. Otolaryngol Head Neck Surg 2006;135:748–53

    Article  PubMed  Google Scholar 

  5. Dias FL, Lima RA, Kligerman J, et al. Relevance of skip metastases for squamous cell carcinoma of the oral tongue and the floor of the mouth. Otolaryngol Head Neck Surg 2006;134:460–5

    Article  PubMed  Google Scholar 

  6. Nieuwenhuis EJ, Castelijns JA, Pijpers R, et al. Wait and see policy for the N0 neck in early-stage oral and oropharyngeal squamous cell carcinoma using ultrasonography-guided cytology: is there a role for identification of the sentinel node? Head Neck 2002;24:282–9

    Article  PubMed  Google Scholar 

  7. van den Brekel MW, Castelijns JA, Reitsma LC, et al. Outcome of observing the N0 neck using ultrasonographic-guided cytology for follow-up. Arch Otolaryngol Head Neck Surg 1999;125:153–6

    PubMed  Google Scholar 

  8. Krag DN, Anderson SJ, Julian TB, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol 2007;8:881–8

    Article  PubMed  CAS  Google Scholar 

  9. Zavagno G, De Salvo GL, Scalco G, et al. A randomized clinical trial on sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer: results of the Sentinella/GIVOM Trial. Ann Surg 2008;247:207–13

    PubMed  Google Scholar 

  10. Faries MB, Morton DL. Surgery and sentinel lymph node biopsy. Semin Oncol 2007;34:498–508

    Article  PubMed  Google Scholar 

  11. Amersi F, Morton DL. The role of sentinel lymph node biopsy in the management of melanoma. Adv Surg 2007;41:241–56

    Article  PubMed  Google Scholar 

  12. Kitagawa Y, Fujii H, Kumai K, et al. Recent advances in sentinel node navigation for gastric cancer: a paradigm shift of surgical management. J Surg Oncol 2005;90:147–51

    Article  PubMed  Google Scholar 

  13. Kitagawa Y, Fujii H, Mukai M, et al. Current status and future prospects of sentinel node navigational surgery for gastrointestinal cancers. Ann Surg Oncol 2004;11:242S–4S

    PubMed  Google Scholar 

  14. Stojadinovic A, Nissan A, Protic M, et al. Prospective randomized study comparing sentinel lymph node evaluation with standard pathologic evaluation for the staging of colon carcinoma: results from the United States Military Cancer Institute Clinical Trials Group Study GI-01. Ann Surg 2007;245:846–57

    Article  PubMed  Google Scholar 

  15. Mozzillo N, Chiesa F, Caracò C, et al. Therapeutic implications of sentinel lymph node biopsy in the staging of oral cancer. Ann Surg Oncol 2004;11(Suppl):263S–6S

    Article  PubMed  Google Scholar 

  16. Civantos F, Zitsch R, Bared A. Sentinel node biopsy in oral squamous cell carcinoma. J Surg Oncol 2007;96:330–6

    Article  PubMed  Google Scholar 

  17. Stoeckli SJ, Pfaltz M, Ross GL, et al. The second international conference on sentinel node biopsy in mucosal head and neck cancer. Ann Surg Oncol 2005;12:919–24

    Article  PubMed  Google Scholar 

  18. Terada A, Hasegawa Y, Goto M, et al. Sentinel lymph node radiolocalization in clinically negative neck oral cancer. Head Neck 2006;28:114–20

    Article  PubMed  Google Scholar 

  19. Kontio R, Leivo I, Leppänen E, et al. Sentinel lymph node biopsy in oral cavity squamous cell carcinoma without clinically evident metastasis. Head Neck 2004;26:16–21

    Article  PubMed  Google Scholar 

  20. Werner JA, Dünne AA, Ramaswamy A, et al. The sentinel node concept in head and neck cancer: solution for the controversies in the N0 neck? Head Neck 2004;26:603–11

    Article  PubMed  Google Scholar 

  21. Werner JA, Dünne AA, Ramaswamy A, et al. Sentinel node detection in N0 cancer of the pharynx and larynx. Br J Cancer 2002;87:711–5

    Article  PubMed  CAS  Google Scholar 

  22. Muhle C, Brenner W, Südmeyer M, et al. CT-guided lymphoscintigraphy in patients with squamous cell carcinoma of the head and neck: a feasibility study. Eur J Nucl Med Mol Imaging 2004;31:940–4

    Article  PubMed  Google Scholar 

  23. Fujii H, Yamashita H, Nakahara T, et al. Outlining the body contours with scattered photons in lymphoscintigraphy for sentinel nodes. Ann Nucl Med 2000;14:401–4

    Article  PubMed  CAS  Google Scholar 

  24. Fujii H, Ikeda T, Jinno H, et al. Lymphoscintigraphy for the visualization of sentinel lymph nodes and body contour. Breast Cancer 2004;11:250–5

    Article  PubMed  Google Scholar 

  25. van den Brekel MW. Lymph node metastases: CT and MRI. Eur J Radiol 2000;33:230–8

    Article  PubMed  Google Scholar 

  26. Stoeckli SJ, Steinert H, Pfaltz M, et al. 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

    Article  PubMed  Google Scholar 

  27. van den Brekel MW, Castelijns JA, Snow GB. The size of lymph nodes in the neck on sonograms as a radiologic criterion for metastasis: how reliable is it? AJNR Am J Neuroradiol 1998;19:695–700

    PubMed  Google Scholar 

  28. Morton DL, Wen DR,Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392–9

    PubMed  CAS  Google Scholar 

  29. Paganelli G, De Cicco C, Cremonesi M, et al. Optimized sentinel node scintigraphy in breast cancer. Q J Nucl Med 1998;42:49–53

    PubMed  CAS  Google Scholar 

  30. Werner JA, Dünne AA, Davis RK. Intraoperative lymphatic mapping in cases of midline squamous cell carcinoma. Acta Otolaryngol 2005;125:403–8

    PubMed  Google Scholar 

  31. Werner JA, Dünne AA, Myers JN. Functional anatomy of the lymphatic drainage system of the upper aerodigestive tract and its role in metastasis of squamous cell carcinoma. Head Neck 2003;25:322–32

    Article  PubMed  Google Scholar 

  32. Hermanek P, Hutter RVP, Sobin LH, et al. Classification of isolated tumor cells and micrometastasis. Cancer 1999;86:2668–73

    Article  PubMed  CAS  Google Scholar 

  33. Stoeckli SJ, Pfaltz M, Steinert H, et al. Histopathological features of occult metastasis detected by sentinel lymph node biopsy in oral and oropharyngeal squamous cell carcinoma. Laryngoscope 2002;112:111–5

    Article  PubMed  Google Scholar 

  34. Ferris RL, Xi L, Raja S, et al. Molecular staging of cervical lymph nodes in squamous cell carcinoma of the head and neck. Cancer Res 2005;65:2147–56

    Article  PubMed  CAS  Google Scholar 

  35. Tao L, Lefèvre M, Ricci S, et al. Detection of occult carcinomatous diffusion in lymph nodes from head and neck squamous cell carcinoma using real-time RT-PCR detection of cytokeratin 19 mRNA. Br J Cancer 2006;94:1164–9

    Article  PubMed  CAS  Google Scholar 

  36. Werner JA, Sapundzhiev NR, Teymoortash A, et al. Endoscopic sentinel lymphadenectomy as a new diagnostic approach in the N0 neck. Eur Arch Otorhinolaryngol 2004;261:463–8

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Dr. Keisuke Okubo, Dr. Kazuhisa Moro, Dr. Asako Ikeda, and Dr. Yuko Mori for recruiting patients and helping with the procedures.

Author information

Authors and Affiliations

  1. Department of Otolaryngology—Head and Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 3598513, Japan

    Masayuki Tomifuji MD & Akihiro Shiotani MD

  2. Division of Functional Imaging Division, National Cancer Center, Tokyo, Japan

    Hirofumi Fujii MD

  3. Department of Otolaryngology—Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan

    Koji Araki MD, Koichiro Saito MD, Koji Inagaki MD & Kaoru Ogawa MD

  4. Division of Surgical Pathology, Keio University School of Medicine, Tokyo, Japan

    Makio Mukai MD

  5. Department of Surgery, Keio University School of Medicine, Tokyo, Japan

    Yuko Kitagawa MD

Authors
  1. Masayuki Tomifuji MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akihiro Shiotani MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hirofumi Fujii MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Koji Araki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Koichiro Saito MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Koji Inagaki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Makio Mukai MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yuko Kitagawa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kaoru Ogawa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Akihiro Shiotani MD.

Additional information

Presented at the 2004 Annual Meeting of the American Academy of Otolaryngology, New York.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tomifuji, M., Shiotani, A., Fujii, H. et al. Sentinel Node Concept in Clinically N0 Laryngeal and Hypopharyngeal Cancer. Ann Surg Oncol 15, 2568–2575 (2008). https://doi.org/10.1245/s10434-008-0008-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-008-0008-x

Keywords

Search

Navigation