Sentinel lymph node biopsy in SCC of the head and neck: A major advance in staging the N0 neck

Abstract

The management of the N0 neck in patients with head and neck cancer is controversial. Neck dissection provides important staging information that guides patient treatment. We examined the feasibility of using a dye technique for staging patients by sentinel lymph node biopsy (SLNBX). We studied seven patients with previously untreated early-stage squamous cell carcinoma of the oral cavity and N0 necks. Each patient underwent SLNBX guided by an intraoperative injection of 1% isosulfan blue dye. An open biopsy of the sentinel node was followed by neck dissection. We identified the sentinel node in four of the seven patients (57%). The sentinel node accurately predicted the pathologic status of the neck in three of thesefourpatients (75%). In one of the three patients, the sentinel node was one of four histopathologically positive nodes, whereas in two others, the neck was free of disease. One patient had a histopathologically negative sentinel node and tumor metastasis present in the neck. Of the four patients in whom a sentinel node was identified, the negative predictive value for the absence of cervical metastases was 67%. Based on our findings and those of other authors, we conclude that the use of blue dye in lymphatic mapping for SLNBX in head and neck cancer patients is technically feasible but of limited clinical utility. Our literature review also suggests that performing SLNBX with a radiotracer technique or a combination of a radiotracer and blue dye is a promising method of staging the N0 neck in head and neck cancer patients and warrants further clinical study.