Sentinel node biopsy in head and neck cancer: preliminary results of a multicenter trial.
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.


CONCLUSIONS
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.
Ross
Gary L
GL
Plastic Surgery Unit, Canniesburn Hospital, Bearsden, Glasgow, UK. gary.ross@canniesburn.org
Soutar
David S
DS
Gordon MacDonald
D
D
Shoaib
Taimur
T
Camilleri
Ivan
I
Roberton
Andrew G
AG
Sorensen
Jens A
JA
Thomsen
Jorn
J
Grupe
Peter
P
Alvarez
Julio
J
Barbier
L
L
Santamaria
J
J
Poli
Tito
T
Massarelli
Olindo
O
Sesenna
Enrico
E
Kovács
Adorján F
AF
Grünwald
Frank
F
Barzan
Luigi
L
Sulfaro
Sandro
S
Alberti
Franco
F
D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy