The sentinel node concept in head and neck cancer: solution for the controversies in the n0 neck?
Article first published online: 14 MAY 2004
Copyright © 2004 Wiley Periodicals, Inc.
Head & Neck
Volume 26, Issue 7, pages 603–611, July 2004
How to Cite
Werner, J. A., Dünne, A. A., Ramaswamy, A., Dalchow, C., Behr, T., Moll, R., Folz, B. J. and Davis, R. K. (2004), The sentinel node concept in head and neck cancer: solution for the controversies in the n0 neck?. Head Neck, 26: 603–611. doi: 10.1002/hed.20062
- Issue published online: 23 JUN 2004
- Article first published online: 14 MAY 2004
- Manuscript Accepted: 21 JAN 2004
- sentinel node;
- occult lymph node metastases;
- N0 neck;
- neck dissection
The majority of patients with head and neck squamous cell carcinoma (HNSCC) who have a clinical N0 neck undergo neck dissection (ND) even though no lymph node metastases may be detected. With this background, our investigation critically analyzes the value of sentinel lymphadenectomy.
Ninety patients with HNSCC, all staged with an N0 neck, underwent intraoperative 99mTc-radiolabeled detection of up to three hot nodes (SN1–3) during elective ND and primary site resection.
Sentinel lymphadenectomy (SN1–3) detected occult metastatic spread in 20 (22%) of 90 patients, whereas failure occurred in three of 90 patients. Metastatic spread was directed to level II in the majority (66.7%) of cases. If only the SN1 had been examined, the procedure would have failed in nine (39%) of 23 patients.
Sentinel lymphadenectomy correctly identified the stage of metastatic disease in 97% of patients in cases in which up to three sentinel nodes were identified. If only the lymph node with the highest tracer activity had been excised, 39% of cancer-positive necks would have been missed. Selective ND identified metastatic disease in the additional 3% of patients. © 2004 Wiley Periodicals, Inc. Head Neck26: 603–611, 2004