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Originally published as Ann Surg Oncol Early Release 10.1245/ASO.2004.09.001 on June 14, 2004

Annals of Surgical Oncology 11:690-696 (2004)
© 2004 Society of Surgical Oncology
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ORIGINAL ARTICLES

Sentinel Node Biopsy in Head and Neck Cancer: Preliminary Results of a Multicenter Trial

Gary L. Ross, MD, David S. Soutar, ChM, D. Gordon MacDonald, FRCPath, Taimur Shoaib, FRCSEd, Ivan Camilleri, FRCS(plast), Andrew G. Roberton, PhD, Jens A. Sorensen, PhD, Jorn Thomsen, MD, Peter Grupe, MD, Julio Alvarez, MBBS, L. Barbier, MD, J. Santamaria, MD, Tito Poli, MD, Olindo Massarelli, MD, Enrico Sesenna, ChM, Adorján F. Kovács, PhD, Frank Grünwald, MD, Luigi Barzan, MD, Sandro Sulfaro, MD and Franco Alberti, MD

From the Plastic Surgery Unit, Canniesburn Hospital (GLR, DSS, TS, IC), Bearsden, Glasgow, UK; Department of Oral Pathology, Glasgow Royal Infirmary (DGM), Glasgow, UK; Beatson Oncology Centre (AGR), Glasgow, UK; Departments of Plastic and Reconstructive Surgery (JAS, JT) and Nuclear Medicine (PG), Odense University Hospital, Odense, Denmark; Servicio de C. Maxilofacial, Hospital de Cruces (JA, LB, JS), Cruces, Spain; Sezione di Chirurgia Maxillo-Faciale, Dipartmento di Scienze Otorino-Odonto-Oftalmologiche e Cervico Facciali (TP, OM, ES), University Hospital of Parma, Parma, Italy; Clinic for Maxillofacial Plastic Surgery (AFK) and Department of Nuclear Medicine (FG), Johann Wolfgang Goethe University Medical School, Frankfurt am Main, Germany; and Operative Units of Otolaryngology (LB), Department of Pathology (SS), and Department of Nuclear Medicine (FA), Azienda Ospedaliera "S. Maria degli Angeli," Pordenone, Italy.

Correspondence: Address correspondence and reprint requests to: Gary Ross, MD, 14 Northern Grove, Didsbury, Manchester, M202WL, UK; Fax: 44-1612916381; E-mail: gary.ross{at}canniesburn.org

Background: The aim was to determine the reliability and reproducibility of sentinel node biopsy (SNB) as a staging tool in head and neck squamous cell carcinoma (HNSCC) for T1/2 clinically N0 patients by means of a standardized technique.

Methods: Between June 1998 and June 2002, 227 SNB procedures have been performed in HNSCC cases at six centers. One hundred thirty-four T1/2 tumors of the oral cavity/oropharynx in clinically N0 patients were investigated with preoperative lymphoscintigraphy (LSG), intraoperative use of blue dye/gamma probe, and pathological evaluation with step serial sectioning and immunohistochemistry, with a follow-up of at least 12 months. In 79 cases SNB alone was used to stage the neck carcinoma, and in 55 cases SNB was used in combination with an elective neck dissection (END).

Results: In 125/134 cases (93%) a sentinel node was identified. Of 59 positive nodes, 57 were identified with the intraoperative gamma probe and 44 with blue dye. Upstaging of disease occurred in 42/125 cases (34%): with hematoxylin-eosin in 32/125 (26%) and with additional pathological staging in 10/93 (11%). The sensitivity of the technique with a mean follow-up of 24 months was 42/45 (93%). The identification of SNB for floor of mouth (FOM) tumors was 37/43 (86%), compared with 88/91 (97%) for other tumors. The sensitivity for FOM tumors was 12/15 (80%), compared with 30/30 (100%) for other tumor groups.

Conclusion: SNB can be successfully applied to early T1/2 tumors of the oral cavity/oropharynx in a standardized fashion by centers worldwide. For the majority of these tumors the SNB technique can be used alone as a staging tool.

Key Words: Cervical metastases • Elective neck dissection • Head and neck • Neoplasms • Sentinel node biopsy




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