Sentinel node biopsy for deciding neck dissection for early-stage tongue cancer

Abstract

In the management of the neck for early-stage tongue cancer, the wait-and-see policy is not recommended because of high occult cervical metastasis, which occurs in more than 20%, and poor survival rates. Sentinel node (SN) biopsy has been used for deciding neck dissection for early-stage tongue cancer since 2000 in our department. A series of 25 cases of stage I and II carcinoma of the tongue was analyzed prospectively. SN was detected in all 25 cases. In frozen pathological diagnosis, five cases were upstaged as a result of a positive sentinel node, of which neck dissection was performed in four cases. In 20 cases, there were no metastases in sentinel nodes. Because two cases were staged as late T2, they underwent the pull-through method to manage the primary tumor, and then underwent neck dissection. Eighteen cases were observed without neck dissection, of which 16 cases did not show evidence of metastasis. Although they were salvaged, post-operative submandible node metastasis (POSNM) occurred in two of 20 cases with negative SN. As a countermeasure to avoid POSNM, we use a lead plate to separate the cervical area from the injected oral area, and POSNM did not occur in 12 cases. The sentinel node strategy provided a favorable outcome, as good as routinely performing neck dissection for early-stage tongue cancer.