title: Sentinel node identification in laryngeal cancer: Feasible in primary cancer with previously untreated neck.
abstract: OBJECTIVE
  With the current diagnostic techniques a considerable percentage of occult lymph node metastases are missed in the clinically negative (cN0) neck. Therefore, in patients with laryngeal cancer and cN0 neck a total laryngectomy is usually combined with elective neck dissection. Based on the risk of occult lymph node metastases the decision whether to perform a neck dissection or not is difficult. In recurrent laryngeal cancer or second primary tumors previous treatment possibly influences lymphatics and metastatic behavior. In this pilot study we investigated the feasibility of sentinel node (SN) identification and potential accuracy of sentinel node biopsy (SNB) in laryngeal cancer patients undergoing total laryngectomy with elective neck dissection.
  
  
  METHODS
  Patients with cN0 laryngeal cancer were included. During surgery 40MBq (99m)Technetium labeled Nanocolloid was endoscopically injected around the tumor. Lymphoscintigraphy was not performed. We identified the sentinel node (SN) ex vivo in the neck dissection specimen with a gammaprobe. Histopathological examination of the neck dissection specimen served as reference test.
  
  
  RESULTS
  We included 19 patients, 13 patients with untreated necks and six with prior neck treatment. SN identification was successful in 68.4% (13/19) of patients, and significantly higher in patients with untreated necks (92.3% versus 16.7%, p<0.01). Four of 13 (30.7%) patients would potentially be upstaged by SNB. Sensitivity and negative predictive value would have been 80.0% and 87.5%, respectively.
  
  
  CONCLUSIONS
  With the current methodology, SN identification in laryngeal cancer patients undergoing total laryngectomy is feasible in patients with untreated necks. Further studies are needed to determine the exact accuracy of SNB in total laryngectomy patients.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Géke B
authors.initials: GB
authors.lastname: Flach
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Bloemena
authors.forename: Annelies
authors.initials: A
authors.lastname: van Schie
authors.forename: Otto S
authors.initials: OS
authors.lastname: Hoekstra
authors.forename: Stijn
authors.initials: S
authors.lastname: van Weert
authors.forename: C René
authors.initials: CR
authors.lastname: Leemans
authors.forename: Remco
authors.initials: R
authors.lastname: de Bree
mesh_terms: D000368:Aged; D005240:Feasibility Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology*; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy