Sentinel lymph node biopsy as adjunct to selective neck dissection for SCC oral cavity

• Published in: Otolaryngology-head and neck surgery Vol. 131; no. 2; p. P261
• Main Authors: Rasgon, Barry M, Bitgood, Mark Joseph
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA Mosby, Inc 01-08-2004; SAGE Publications
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1016/j.otohns.2004.06.539

Objectives: The current standard of care for managing the clinically negative neck (NO) in patients with squamous cell carcinoma (SCC) of the oral cavity includes a selective neck dissection (SND), levels I-III minimally, with pathological findings determining the need for postoperative radiation. This approach may present several difficulties. Limiting the dissection to levels I-III could potentially miss affected nodes in other nodal basins. If SND includes the appropriate nodal basins, metastatic disease may be missed, and micrometastases could be overlooked with current pathological analysis. The purpose of this study was to see if SLN biopsy in conjuntion with SND improved diagnostic and therapeutic outcomes.
Methods: We retrospectively reviewed 10 patients with SCC of the oral cavity and NO neck undergoing SND. Preoperative and intraoperative lymphatic mapping using low dose Technetium 99 sulfur colloid was used as an adjunct to standard SND
Results: Preoperative lymphoscintigraphy showed 1 or more SLNs in all patients. Two patients had SLNs in level IV and 1 patient had a contralateral Level I SLN. All SLNs seen on preoperative lymphoscintigraphy were identified in the SND. No SLNs were left in the nodal basins dissected after SND was completed. Micrometastases were found in SLNs of 3 patients.
Conclusion: Combined with standard SND, preoperative and intraoperative SLN mapping may improve our diagnostic and therapeutic outcomes in patients with SCCA of the oral cavity with clinically negative necks. The extent of SND can be more accurately planned, a more thorough neck dissection can be accomplished and a detailed pathological analyses of high risk nodes feasible.