Lymphatic drainage patterns in oral squamous cell carcinoma: findings of the ACOSOG Z0360 (Alliance) study.
OBJECTIVE
The purpose of our study was to correlate sentinel lymph nodes (SLN) found on planar lymphoscintigraphy (LS) to SLN found with gamma probe-directed sentinel lymph node biopsy (SLNB) for T1/T2 N0 oral cavity cancer.


METHODS
Prospective cooperative group trial.


METHODS
Academic medical centers.


METHODS
One hundred forty adults with untreated T1/T2 N0 squamous cell carcinoma (SCC) of the oral cavity underwent planar LS, resection, SLNB, and neck dissection. Location of SLN by planar LS and SLNB and of metastases were compared to each other and historical data of regional metastases.


RESULTS
SLNs located by planar LS and SLNB were predominantly in levels I through IV. There was heterogeneity in the number of SLNs found at planar LS and at SLNB, which was significantly different in levels II and III (P < .0001). In 14 of 33 cases with bilateral drainage on planar LS, SLNB detected only unilateral SLN. Sensitivity of planar LS in predicting the level of SLN was 41% to 63%, and specificity was 68% to 95%. Comparison of locations of the metastases to historical data showed fewer metastases to level I in our study (P = .03). Metastases occurred predominantly in levels I through III. In 1 case of a lateral tongue cancer, a contralateral SLN was the only positive node.


CONCLUSIONS
Lymphatic drainage patterns and metastases involved predominantly levels I through III. Planar LS is not sensitive for predicting the levels of SLN, and in levels II and III, the rate of detection of SLN between the 2 modalities is significantly different.
Department of Otolaryngology and Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, West Virginia, USA rwfarmer@hsc.wvu.edu.
Roger W
RW
Farmer
Alliance Statistics and Data Center, Duke University, Durham, North Carolina, USA.
Linda
L
McCall
Department of Otolaryngology-Head and Neck Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA.
Francisco J
FJ
Civantos
Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.
Jeffrey N
JN
Myers
Department of Surgery, Section of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA.
Wendell G
WG
Yarbrough
Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee, USA.
Barbara
B
Murphy
Department of Otolaryngology, Tufts Medical Center, Boston, Massachusetts, USA.
Miriam
M
O'Leary
Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA.
Robert
R
Zitsch
Division of Nuclear Medicine, Mallinckrodt Institute of Radiology and the Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA.
Barry A
BA
Siegel
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D000077195:Squamous Cell Carcinoma of Head and Neck; D055815:Young Adult
lymphoscintigraphy; oral squamous cell carcinoma; sentinel lymph node