The sentinel node concept in head and neck cancer: solution for the controversies in the N0 neck?
BACKGROUND
The majority of patients with head and neck squamous cell carcinoma (HNSCC) who have a clinical N0 neck undergo neck dissection (ND) even though no lymph node metastases may be detected. With this background, our investigation critically analyzes the value of sentinel lymphadenectomy.


METHODS
Ninety patients with HNSCC, all staged with an N0 neck, underwent intraoperative 99mTc-radiolabeled detection of up to three hot nodes (SN1-3) during elective ND and primary site resection.


RESULTS
Sentinel lymphadenectomy (SN1-3) detected occult metastatic spread in 20 (22%) of 90 patients, whereas failure occurred in three of 90 patients. Metastatic spread was directed to level II in the majority (66.7%) of cases. If only the SN1 had been examined, the procedure would have failed in nine (39%) of 23 patients.


CONCLUSIONS
Sentinel lymphadenectomy correctly identified the stage of metastatic disease in 97% of patients in cases in which up to three sentinel nodes were identified. If only the lymph node with the highest tracer activity had been excised, 39% of cancer-positive necks would have been missed. Selective ND identified metastatic disease in the additional 3% of patients.
Werner
Jochen A
JA
Department of Otolaryngology, Head and Neck Surgery, Philipps University of Marburg, Germany. wernerj@med.uni-marburg.de
Dünne
Anja A
AA
Ramaswamy
Anette
A
Dalchow
Carsten
C
Behr
Thomas
T
Moll
Roland
R
Folz
Benedikt J
BJ
Davis
R Kim
RK
D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology / Q000601:surgery; D007432:Intraoperative Period; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy; D013668:Technetium Tc 99m Aggregated Albumin
D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid