Sentinel Node Biopsy in Oral Cancer

  • L. W. T. Alkureishi
  • G. L. Ross
  • S. J. Stoeckli


In patients with cT1-T2 oral/oropharyngeal squamous cell cancer, involve­ment of the cervical lymph nodes is associated with a 50% decrease in 5-year survival and represents the most important prognostic factor in this patient group. Precise staging of the cervical nodes is therefore of utmost importance, to ensure an accurate prognosis and provision of the most appropriate treatment.

The gold standard for staging the cervical nodes is elective neck dissection, providing both diagnostic and therapeutic measures. However, only one-fourth of cT1-T2 patients are found to harbor occult nodal disease, and the remainder of patients may be unnecessarily exposed to the considerable morbidity associated with neck dissection.

The sentinel node biopsy procedure provides a means of obtaining tissue for pathological staging of the cervical lymph node basin, while potentially avoiding the morbidity of an elective neck dissection. This chapter describes the technique, its accuracy and current applications, and its potential role in the management of patients with early oral/oropharyngeal squamous cell cancer.


Sentinel Node Sentinel Node Biopsy Neck Dissection Lymphatic Mapping Positive Sentinel Lymph Node 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Alex JC, Krag DN (1993) Gamma probe guided lymph node localization in malignant melanoma. Surg Oncol 2:137–143CrossRefPubMedGoogle Scholar
  2. Alex JC, Krag DN (1996) The gamma-probe-guided resection of radiolabeled primary lymph nodes. Surg Oncol Clin N Am 5(1):33–41 ReviewPubMedGoogle Scholar
  3. Alex JC, Sasaki CT, Krag DN, Wenig B, Pyle PB (2000) Sentinel lymph node radiolocalization in head and neck squamous cell carcinoma. Laryngoscope 110:198–203CrossRefPubMedGoogle Scholar
  4. Alkureishi LW, Ross GL, MacDonald DG, Shoaib T, Gray H, Robertson G, Soutar DS (2007) Sentinel node in head and neck cancer: use of size criterion to upstage the N0 neck in head and neck squamous cell carcinoma. Head Neck 29(2):95–103CrossRefPubMedGoogle Scholar
  5. Alkureishi LWT, Ross GL, Shoaib T, Sorensen J, Alvarez J, Poli T, Kovacs A, Alberti F, Soutar DS (2008) Sentinel node biopsy in oral/oropharyngeal squamous cell cancer: five year follow-up. Presented at the Annual Meeting of the American Head and Neck Society (AHNS), San Francisco, July 2008Google Scholar
  6. Alvi A, Johnson JT (1996) Extracapsular spread in the clinically negative neck (N0): implications and outcome. Otolaryngol Head Neck Surg 114:65–70CrossRefPubMedGoogle Scholar
  7. Ambrosch P, Brinck U (1996) Detection of nodal micrometastases in head and neck cancer by serial sectioning and immunostaining. Oncology 10:1221–1226PubMedGoogle Scholar
  8. Asthana S, Deo SVS, Shukla NK, Jain P, Anand M, Kumar R (2003) Intraoperative neck staging using sentinel node biopsy and imprint cytology in oral cancer. Head Neck 25:368–372CrossRefPubMedGoogle Scholar
  9. Barzan L, Sulfaro S, Alberti F, Politi D, Pin M, Savignano MG, Marus W, Zarcone O, Spaziante R (2004) An extended use of the sentinel node in head and neck squamous cell carcinoma: results of a prospective study of 100 patients. Acta Otorhinolaryngol Ital 24(3):145–149PubMedGoogle Scholar
  10. Bilchik AJ, Giuliano A, Essner R, Bostick P, Kelemen P, Foshag LJ, Sostrin S, Turner RR, Morton DL (1998) Universal application of intraoperative lymphatic mapping and sentinel lymphadenectomy in solid neoplasms. Cancer J Sci Am 4:351–358PubMedGoogle Scholar
  11. Bilde A, Von Buchwald C, Mortensen J et al (2006) The role of SPECT-CT in the lymphoscintigraphic identification of sentinel nodes in patients with oral cancer. Acta Otolaryngol 126(10):1096–1103CrossRefPubMedGoogle Scholar
  12. Bocca E, Pignataro O, Oldini C, Cappa C (1984) Functional neck dissection: an evaluation and review of 843 cases. Laryngoscope 94(7):942–945CrossRefPubMedGoogle Scholar
  13. Brobeil A, Cruse CW, Messina JL, Glass LF, Haddad FF, Berman CG, Marshburn J, Reintgen DS (1999) Cost analysis of sentinel lymph node biopsy as an alternative to elective lymph node dissection in patients with malignant melanoma. Surg Oncol Clin N Am 8(3):435–445 viiiPubMedGoogle Scholar
  14. Cabanas RM (1977) An approach for the treatment of penile carcinoma. Cancer 39(2):456–466CrossRefPubMedGoogle Scholar
  15. Chepeha DB, Hoff PT, Taylor RJ, Bradford CR, Teknos TN, Esclamado RM (2002) Selective neck dissection for the treatment of neck metastasis from squamous cell carcinoma of the head and neck. Laryngoscope 112(3):434–438CrossRefPubMedGoogle Scholar
  16. Chiesa F, Mauri S, Grana C, Tradati N, Calabrese L, Ansarin M, Mazzarol G, Paganelli G (2000) Is there a role for sentinel node biopsy in early N0 tongue tumors? Surgery 128:16–21CrossRefPubMedGoogle Scholar
  17. Civantos FJ, Werner JA, Bared A (2005) Sentinel node biopsy in cancer of the oral cavity. Oper Tech Otolaringol Head Neck Surg 16(4):275–285. American College of Surgeons Oncology Group trial Z0360, Google Scholar
  18. Cody HS III (1999) Sentinel lymph node mapping breast cancer. Oncology 13:25–34PubMedGoogle Scholar
  19. Dünne AA, Külkens C, Ramaswamy A, Folz BJ, Brandt D, Lippert BM, Behr T, Moll R, Werner JA (2001) Value of sentinel lymphonodectomy in head and neck cancer patients without evidence of lymphogenic metastatic disease. Auris Nasus Larynx 28(4):339–344CrossRefPubMedGoogle Scholar
  20. Ferlito A, Rinaldo A, Robbins KT, Leemans CR, Shah JP, Shaha AR, Andersen PE, Kowalski LP, Pellitteri PK, Clayman GL, Rogers SN, Medina JE, Byers RM (2003) Changing concepts in the surgical management of the cervical node metastasis. Oral Oncol 39(5):429–435CrossRefPubMedGoogle Scholar
  21. Fisch UP, Sigel ME (1964) Cervical lymphatic system as visualized by lymphography. Ann Otol Rhinol Laryngol 73:870–882PubMedGoogle Scholar
  22. Gallegos-Hernández JF, Hernández-Hernández DM, Flores-Díaz R, Sierra-Santiesteban I, Pichardo-Romero P, Arias-Ceballos H, Minauro-Muñoz G, Alvarado-Cabrero I (2005) The number of sentinel nodes identified as prognostic factor in oral epidermoid cancer. Oral Oncol 41(9):947–952CrossRefPubMedGoogle Scholar
  23. Garzom OL, Palcos MC, Radicella R (1965) Technetium-99 m labelled colloid. Int J Appl Radiat Isotopes 16:613CrossRefGoogle Scholar
  24. Genta F, Zanon E, Camanni M, Deltetto F, Drogo M, Gallo R, Gilardi C (2007) Cost/accuracy ratio analysis in breast cancer patients undergoing ultrasound-guided fine-needle aspiration cytology, sentinel node biopsy, and frozen section of node. World J Surg 31(6):1155–1163CrossRefPubMedGoogle Scholar
  25. Gould EA, Winship T, Philbin PH, Kerr HH (1960) Observations on a ‘sentinel node’ in cancer of the parotid. Cancer 13:77–78CrossRefPubMedGoogle Scholar
  26. Haerle SK, Hany TF, Strobel K, Sidler D, Stoeckli SJ (in press) Is there an additional value of SPECT/CT over lymphoscintigraphy for sentinel node mapping in oral/oropharyngeal squamous cell carcinoma? J Nucl MedGoogle Scholar
  27. Hamakawa H, Onishi A, Sumida T, Terakado N, Hino S, Nakashiro KI, Shintani S (2004) Intraoperative real-time genetic diagnosis for sentinel node navigation surgery. Int J Oral Maxillofac Surg 33:670–675CrossRefPubMedGoogle Scholar
  28. Hart RD, Nasser JG, Trites JR, Taylor SM, Bullock M, Barnes D (2005) Sentinel lymph node biopsy in N0 squamous cell carcinoma of the oral cavity and oropharynx. Arch Otolaryngol Head Neck Surg 131(1):34–38CrossRefPubMedGoogle Scholar
  29. Hermanek P, Hutter RV, Sobin LH, Wittekind C (1999) International Union Against Cancer. Classification of isolated tumor cells and micrometastasis. Cancer 86(12):2668–2673CrossRefPubMedGoogle Scholar
  30. Höft S, Maune S, Muhle C, Brenner W, Czech N, Kampen WU, Jänig U, Laudien M, Gottschlich S, Ambrosch P (2004) Sentinel lymph-node biopsy in head and neck cancer. Br J Cancer 91(1):124–128CrossRefPubMedGoogle Scholar
  31. Holmes EC, Moseley HS, Morton DL, Clark W, Robinson D, Urist MM (1977) A rational approach to the surgical management of melanoma. Ann Surg 186(4):481–490CrossRefPubMedGoogle Scholar
  32. Kaufman G, Guth AA, Pachter HL, Roses DF (2008) A cautionary tale: anaphylaxis to isosulfan blue dye after 12 years and 3339 cases of lymphatic mapping. Am Surg 74(2):152–155 ReviewPubMedGoogle Scholar
  33. Keski-Säntti H, Mätzke S, Kauppinen T, Törnwall J, Atula T (2006) Sentinel lymph node mapping using SPECT-CT fusion imaging in patients with oral cavity squamous cell carcinoma. Eur Arch Otorhinolaryngol 263(11):1008–1012CrossRefPubMedGoogle Scholar
  34. Kligerman J, Lima RA, Soares JR, Prado L, Dias FL, Freitas EQ, Olivatto LO (1994) Supraomohyoid neck dissection in the treatment of T1/T2 squamous cell carcinoma of oral cavity. Am J Surg 168(5):391–394CrossRefPubMedGoogle Scholar
  35. Koch WM, Choti MA, Civelek AC, Eisele DW, Saunders JR (1998) Gamma probe-directed biopsy of the sentinel node in oral squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 124:455–459PubMedGoogle Scholar
  36. Kosuda S, Kusano S, Kohno N, Ohno Y, Tanabe T, Kitahara S, Tamai S (2003) Feasibility and cost-effectiveness of sentinel lymph node radiolocalization in stage N0 head and neck cancer. Arch Otolaryngol Head Neck Surg 129(10):1105–1109 Erratum in: Arch Otolaryngol Head Neck Surg 2003;129(11):1229CrossRefPubMedGoogle Scholar
  37. Liang MI, Carson WE III (2008) Biphasic anaphylactic reaction to blue dye during sentinel lymph node biopsy. World J Surg Oncol 6:79CrossRefPubMedGoogle Scholar
  38. Mamelle G, Temam S, Casiraghi O, Lumbroso J, Laplanche A, Bourhis J (2006) Role and perspectives of sentinel node biopsy in head and neck tumors. Cancer Radiother 10(6–7):349–353PubMedGoogle Scholar
  39. McMasters KM, Noyes RD, Reintgen DS, Goydos JS, Beitsch PD, Davidson BS, Sussman JJ, Gershenwald JE, Ross MI, Sunbelt Melanoma Trial (2004) Lessons learned from the Sunbelt Melanoma Trial. J Surg Oncol 86(4):212–223CrossRefPubMedGoogle Scholar
  40. Morton DL, Bostick PJ (1999) Will the true sentinel node please stand? Ann Surg Oncol 6:12–14CrossRefPubMedGoogle Scholar
  41. Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, Foshag LJ, Cochran AJ (1992) Technical details of introperative lymphatic mapping for early stage melanoma. Arch Surg 127:392–399PubMedGoogle Scholar
  42. Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Elashoff R, Essner R, Nieweg OE, Roses DF, Hoekstra HJ, Karakousis CP, Reintgen DS, Coventry BJ, Glass EC, Wang HJ, MSLT Group (2006) Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med 355(13):1307–1317 Erratum in: N Engl J Med 2006;355(18):1944CrossRefPubMedGoogle Scholar
  43. Mozzillo N, Chiesa F, Botti G, Caraco C, Lastoria S, Giugliano G, Mazzarol G, Paganelli G, Ionna F (2001) Sentinel node biopsy in head and neck cancer. Ann Surg Oncol 8:103S–105SPubMedGoogle Scholar
  44. Nieuwenhuis EJ, Castelijns JA, Pijpers R, van den Brekel MW, Brakenhoff RH, van der Waal I, Snow GB, Leemans CR (2002) 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 24(3):282–289CrossRefPubMedGoogle Scholar
  45. Nieuwenhuis EJ, van der Waal I, Leemans CR, Kummer A, Pijpers R, Castelijns JA, Brakenhoff RH, Snow GB (2005) Histopathologic validation of the sentinel node concept in oral and oropharyngeal squamous cell carcinoma. Head Neck 27(2):150–158CrossRefPubMedGoogle Scholar
  46. O’Brien CJ, Traynor SJ, McNeil E, McMahon JD, Chaplin JM (2000) 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 126(3):360–365PubMedGoogle Scholar
  47. Payoux P, Dekeister C, Lopez R, Lauwers F, Esquerré JP, Paoli JR (2005) Effectiveness of lymphoscintigraphic sentinel node detection for cervical staging of patients with squamous cell carcinoma of the head and neck. J Oral Maxillofac Surg 63(8):1091–1095CrossRefPubMedGoogle Scholar
  48. Persky MS, Lagmay VM (1999) Treatment of the clinically negative neck in oral squamous cell carcinoma. Laryngoscope 109(7 Pt 1):1160–1164CrossRefPubMedGoogle Scholar
  49. Pitman KT, Johnson JT, Myers EN (1997) Effectiveness of selective neck dissection for management of the clinically negative neck. Arch Otolaryngol Head Neck Surg 123(9):917–922PubMedGoogle Scholar
  50. Pitman KT, Johnson JT, Edington H, Barnes EL, Day R, Wagner RL, Myers EN (1998) Lymphatic mapping with isosulfan blue dye in squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg 124(7):790–793PubMedGoogle Scholar
  51. Razack MS, Baffi R, Sako K (1981) Bilateral radical neck dissection. Cancer 47(1):197–199CrossRefPubMedGoogle Scholar
  52. Ries LAG, Melbert D, Krapcho M, Stinchcomb DG, Howlader N, Horner MJ, Mariotto A, Miller BA, Feuer EJ, Altekruse SF, Lewis DR, Clegg L, Eisner MP, Reichman M, Edwards BK (eds) (2008) SEER Cancer Statistics Review, 1975–2005. National Cancer Institute, Bethesda, MDGoogle Scholar
  53. Rigual N, Douglas W, Lamonica D, Wiseman S, Cheney R, Hicks W Jr, Loree T (2005) Sentinel lymph node biopsy: a rational approach for staging T2N0 oral cancer. Laryngoscope 115(12):2217–2220CrossRefPubMedGoogle Scholar
  54. Ross GL, Shoaib T, Soutar DS, MacDonald DG, Camilleri IG, Bessent RG, Gray HW (2002a) The first international conference on sentinel node biopsy in mucosal head and neck cancer and adoption of a multicenter trial protocol. Ann Surg Oncol 9(4):406–410CrossRefPubMedGoogle Scholar
  55. Ross GL, Soutar DS, Shoaib T, Camilleri IG, MacDonald DG, Robertson AG, Bessent RG, Gray HW (2002b) 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 75:950–958PubMedGoogle Scholar
  56. Ross GL, Soutar DS, MacDonald DG, Shoaib T, Camilleri IG, Robertson AG (2004a) Improved staging of cervical metastases in clinically node-negative patients with head and neck squamous cell carcinoma. Ann Surg Oncol 11(2):213–218CrossRefPubMedGoogle Scholar
  57. Ross GL, Soutar DS, Gordon MacDonald D, Shoaib T, Camilleri I, Roberton AG, Sorensen JA, Thomsen J, Grupe P, Alvarez J, Barbier L, Santamaria J, Poli T, Massarelli O, Sesenna E, Kovács AF, Grünwald F, Barzan L, Sulfaro S, Alberti F (2004b) Sentinel node biopsy in head and neck cancer: preliminary results of a multicenter trial. Ann Surg Oncol 11(7):690–696CrossRefPubMedGoogle Scholar
  58. Ross GL, on behalf of the Sentinel European Node Trial (SENT) organising committee. Sentinel Node Biopsy for Squamous Cell Carcinoma of the Oral Cavity: Preliminary results of the SENT Trial. Presented at the Annual Meeting of the American Head and Neck Society (AHNS), San Francisco, July 2008Google Scholar
  59. Scherer K, Studer W, Figueiredo V, Bircher AJ (2006) Anaphylaxis to isosulfan blue and cross-reactivity to patent blue V: case report and review of the nomenclature of vital blue dyes. Ann Allergy Asthma Immunol 96(3):497–500 ReviewCrossRefPubMedGoogle Scholar
  60. Shah JP, Andersen PE (1994) The impact of patterns of nodal metastasis on modifications of neck dissection. Ann Surg Oncol 1(6):521–532CrossRefPubMedGoogle Scholar
  61. Shoaib T, Soutar DS, Prosser JE et al (1999) A suggested method for sentinel node biopsy in squamous cell carcinoma of the head and neck. Head Neck 21(8):728–733CrossRefPubMedGoogle Scholar
  62. Shoaib T, Soutar DS, MacDonald DG, Camilleri IG, Dunaway DJ, Gray HW, McCurrach GM, Bessent RG, MacLeod TI, Robertson AG (2001) The accuracy of head and neck carcinoma sentinel lymph node biopsy in the clinically N0 neck. Cancer 91(11):2077–2083CrossRefPubMedGoogle Scholar
  63. Sobin LH, Wittekind Ch (eds) (2002) TNM classification of malignant tumors, 6th edn. Wiley, New YorkGoogle Scholar
  64. Sobol S, Jensen C, Sawyer W II, Costiloe P, Thong N (1985) Objective comparison of physical dysfunction after neck dissection. Am J Surg 150(4):503–509CrossRefPubMedGoogle Scholar
  65. Stoeckli SJ (2007) Sentinel node biopsy for oral and orophayrngeal squamous cell carcinoma of the head and neck. Candidate’s thesis. Laryngoscope 117:1539–1551CrossRefPubMedGoogle Scholar
  66. Stoeckli SJ, Schuknecht B, Strobel K (in press) Initial Staging of the Neck in HNSCC: Is PET/CT the best? Head NeckGoogle Scholar
  67. Stoeckli SJ, Steinert H, Pfaltz M, Schmid S (2001) Sentinel lymph node evaluation in squamous cell carcinoma of the head and neck. Otolaryngol Head Neck Surg 125:221–226CrossRefPubMedGoogle Scholar
  68. Stoeckli SJ, Steinert H, Pfaltz M, Schmid S (2002a) 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 24:345–349CrossRefPubMedGoogle Scholar
  69. Stoeckli SJ, Pfaltz M, Steinert H, Schmid S (2002b) Histopathological features of occult metastasis detected by sentinel lymph node biopsy in oral and oropharyngeal squamous cell carcinoma. Laryngoscope 112(1):111–115CrossRefPubMedGoogle Scholar
  70. Stoeckli SJ, Pfaltz M, Ross GL, Steiner HC, MacDonald DG, Wittekind C, Soutar D (2005) The second international conference on sentinel node biopsy in mucosal head and neck cancer. Ann Surg Oncol 12:919–924CrossRefPubMedGoogle Scholar
  71. Tafra L, Chua AN, Ng PC, Aycock D, Swanson M, Lannin D (1999) Filtered versus unfiltered technetium sulfur colloid in lymphatic mapping: a significant variable in a pig model. Ann Surg Oncol 6(1):83–87CrossRefPubMedGoogle Scholar
  72. Taylor RJ, Wahl RL, Sharma PK, Bradford CR, Terrell JE, Teknos TN, Heard EM, Wolf GT, Chepeha DB (2001) Sentinel node localization in oral cavity and oropharynx squamous cell cancer. Arch Otolaryngol Head Neck Surg 127(8):970–974PubMedGoogle Scholar
  73. Terada A, Hasegawa Y, Goto M, Sato E, Hyodo I, Ogawa T, Nakashima T, Yatabe Y (2005) Sentinel lymph node radiolocalization in clinically negative neck oral cancer. Head Neck 28:114–120CrossRefGoogle Scholar
  74. Thomsen JB, Sørensen JA, Grupe P, Karstoft J, Krogdahl A (2005) Staging N0 oral cancer: lymphoscintigraphy and conventional imaging. Acta Radiol 46(5):492–496CrossRefPubMedGoogle Scholar
  75. Tschopp L, Nuyens M, Stauffer E, Krause T, Zbären P (2005) The value of frozen section analysis of the sentinel lymph node in clinically N0 squamous cell carcinoma of the oral cavity and oropharynx. Otolaryngol Head Neck Surg 132:99–102CrossRefPubMedGoogle Scholar
  76. van den Brekel MW, Stel HV, Castelijns JA, Nauta JJ, van der Waal I, Valk J, Meyer CJ, Snow GB (1990) Cervical lymph node metastasis: assessment of radiologic criteria. Radiology 177(2):379–384PubMedGoogle Scholar
  77. van den Brekel MW, Stel HV, van der Valk P, van der Waal I, Meyer CJ, Snow GB (1992) Micrometastases from squamous cell carcinoma in neck dissection specimens. Eur Arch Otorhinolaryngol 249(6):349–353CrossRefPubMedGoogle Scholar
  78. van der Veen H, Hoekstra OS, Paul MA, Cuesta MA, Meijer S (1994) Gamma probe-guided sentinel node biopsy to select patients with melanoma for lymphadenectomy. Br J Surg 81(12):1769–1770CrossRefPubMedGoogle Scholar
  79. van Diest PJ, Torrenga H, Meijer S, Meijer CJ (2001) Pathologic analysis of sentinel lymph nodes. Semin Surg Oncol 20(3):238–245CrossRefPubMedGoogle Scholar
  80. Weissbach L, Boedefeld EA (1987) Localization of solitary and multiple metastases in stage II nonseminomatous testis tumor as basis for a modified staging lymph node dissection in stage I. J Urol 138:77–82PubMedGoogle Scholar
  81. Werner JA, Dunne AA, Brandt D, Ramaswamy A, Kulkens C, Lippert BM, Folz BJ, Joseph K, Moll R (1999) Studies on significance of sentinel lymphadenectomy in pharyngeal and laryngeal carcinoma. Laryngorhinootologie 78:663–670CrossRefPubMedGoogle Scholar
  82. Werner JA, Dünne AA, Myers JN (2003) Functional anatomy of the lymphatic drainage system of the upper aerodigestive tract and its role in metastasis of squamous cell carcinoma. Head Neck 25(4):322–332CrossRefPubMedGoogle Scholar
  83. Werner JA, Dünne AA, Ramaswamy A, Dalchow C, Behr T, Moll R, Folz BJ, Davis RK (2004) The sentinel node concept in head and neck cancer: solution for the controversies in the N0 neck? Head Neck 26(7):603–611CrossRefPubMedGoogle Scholar
  84. Wilke LG, Giuliano A (2003) Sentinel lymph node biopsy in patients with early-stage breast cancer: status of the National Clinical Trials. Surg Clin North Am 83(4):901–910CrossRefPubMedGoogle Scholar
  85. Woolgar JA, Beirne JC, Vaughan ED, Lewis-Jones HG, Scott J, Brown JS (1995) Correlation of histopathologic findings with clinical and radiologic assessments of cervical lymph-node metastases in oral cancer. Int J Oral Maxillofac Surg 24(1 Pt 1):30–37CrossRefPubMedGoogle Scholar
  86. Wrightson WR, Wong SL, Edwards MJ, Chao C, Reintgen DS, Ross MI, Noyes RD, Viar V, Cerrito PB, McMasters KM, Sunbelt Melanoma Trial Study Group (2003) Complications associated with sentinel lymph node biopsy for melanoma. Ann Surg Oncol 10(6):676–680CrossRefPubMedGoogle Scholar
  87. Yuen AP, Lam KY, Chan AC, Wei WI, Lam LK, Ho WK, Ho CM (1999) Clinicopathological analysis of elective neck dissection for N0 neck of early oral tongue carcinoma. Am J Surg 177(1):90–92CrossRefPubMedGoogle Scholar
  88. Zitsch RP, Todd DW, Renner GJ, Singh A (2000) Intraoperative radiolymphoscintigraphy for detection of occult nodal metastasis in patients with head and neck squamous cell carcinoma. Otolaryngol Head Neck Surg 122:662–666CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • L. W. T. Alkureishi
  • G. L. Ross
    • 1
  • S. J. Stoeckli
  1. 1.Plastic Surgery departmentChristie HospitalWilmslowUK

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