Gamma Probe–Directed Biopsy of the Sentinel Node in Oral Squamous Cell Carcinoma

• Published in: Archives of otolaryngology, head & neck surgery Vol. 124; no. 4; pp. 455 - 459
• Main Authors: Koch, Wayne M, Choti, Michael A, Civelek, A. Cahid, Eisele, David W, Saunders, John R
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Chicago, IL American Medical Association 01-04-1998
• Subjects: Adult; Aged; Biological and medical sciences; Biopsy; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - pathology; Feasibility Studies; Female; Gamma Rays; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymphatic Metastasis; Male; Medical sciences; Middle Aged; Mouth Neoplasms - diagnostic imaging; Mouth Neoplasms - pathology; Neck Dissection; Neoplasm Staging; Oropharyngeal Neoplasms - diagnostic imaging; Oropharyngeal Neoplasms - pathology; Radionuclide Imaging; Sensitivity and Specificity; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the upper aerodigestive tract; Technetium Tc 99m Sulfur Colloid; Human; Surgical biopsy; Squamous cell carcinoma; Lymph node; Radiolabelling; Stomatology; Male; Identification; Malignant tumor; Metastasis; Case study; Oral cavity; Treatment; Surgery; Adult; Female; Oral cavity disease; Technique; Dissection; Elderly
• ISSN: 0886-4470; 2168-6181; 1538-361X; 2168-619X
• DOI: 10.1001/archotol.124.4.455

OBJECTIVE Management of the N0 neck in head and neck squamous cell carcinoma is an important issue for the head and neck surgeon. Experience with radionuclide-labeled colloid injection to identify a sentinel node in malignant melanoma suggests a high level of accuracy for this approach to identify microscopic metastasis when present. We set out to explore the feasibility of using the handheld gamma probe to identify radiolabeled sentinel nodes in oral squamous cell carcinoma. PATIENT POPULATION Five individuals with N0 necks and accessible oral or oropharyngeal primary sites from a major tertiary referral center. METHODS Radiolabel with unfiltered technetium Tc 99m sulfur colloid was injected in quadrants around the primary site followed by immediate dynamic lymphoscintigraphy. Open biopsy of the sentinel node was accomplished within 2 hours of injection after extirpation of the primary site. Regional or complete neck dissection was performed after sentinel node biopsy. RESULTS Sentinel node biopsy accurately identified one or several nodes in 2 cases, including nodes containing metastatic cancer in 1. In the other 3 cases, the radiolabel failed to identify the sentinel node despite the presence of metastatic disease in the nodes at final pathologic study in 2. CONCLUSIONS Detection and biopsy of the sentinel node are feasible for selected patients with oral head and neck squamous cell carcinoma with N0 necks. There is a potential savings of time, cost, and morbidity with this approach. However, several substantial problems were encountered with the technique in this limited series of patients. Establishing the reliability of lymphoscintigraphy in this setting would require testing in a much larger patient cohort. Our experience suggests that such an investment may not be warranted.Arch Otolaryngol Head Neck Surg. 1998;124:455-459-->