[The sentinel node concept in head and neck squamous cell carcinoma--a critical analysis in 100 patients].
BACKGROUND
The value of Sentinel Node (SN) concept is a current issue in clinical oncology. Few investigations deal with SN biopsy in head and neck squamous cell carcinomas (HNSCC). For this reason the SN concept was investigated based on the results of the so far largest group of 100 patients.


METHODS
Three groups of patients were investigated. Group 1: In 30 patients (6 x oral cavity, 24 x oropharynx) a dynamic lymphoscintigraphy was performed. Group 2: 60 previously untreated patients (12 x oral cavity, 23 x oropharynx, 16 x larynx, 9 x hypopharynx); neck lymph node status on ultrasound imaging: 39 x N0, 5 x N1, 16 x N2, intraoperative identification of the SN during neck dissection (ND) accomplished according to the extent of assumed lymphogenic metastatic spread; postoperative comparison of the histological result of the SN with the neck dissection specimen. Group 3: 10 previously treated patients (1 x oral cavity, 5 x oropharynx, 1 x larynx, 3 x hypopharynx) in whom an intraoperative SN biopsy was performed.


RESULTS
Group 1: In 20/30 patients a cervical lymph drainage could be visualized on dynamic lymphscintigraphy and an activity enrichment above the mean metastatic region could be identified transcutaneously. Group 2: In 34 patients the tumorfree SN1 reflected the regional lymph node status. In 9 patients an isolated tumor metastasis (pN1) was found in the intraoperatively identified SN1 and in a further patient in the SN2 (pN1).


CONCLUSIONS
The results of SN biopsy are encouraging in cases of clinical N0-necks. Nevertheless the data demonstrates that extensive investigations followed by a critical analysis of the results are required. The presented results suggest that the value of the SN concept seems to be of minor importance in cases of advanced lymphogenic metastatic spread.
Werner
J A
JA
Klinik für Hals-, Nasen- und Ohrenheilkunde, Germany. j.a.werner@mailer.uni-marburg.de
Dünne
A-A
AA
Ramaswamy
A
A
Brandt
D
D
Külkens
C
C
Folz
B J
BJ
Moll
R
R
Lippert
B M
BM
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery; D037981:Neck Dissection; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery; D010039:Otorhinolaryngologic Neoplasms / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy