Significance of sentinel lymphonodectomy in laryngeal and pharyngeal carcinomas: A pilot study.

Background: Management of the suspected NO-neck (sonography and CT) in squa mous cell carcinoma (SCC) of the head and neck is discussed controversially . The question arrises whether the sentinel node (SN) concept as it is perf ormed in different areas of clinical oncology is applicable to ear, nose, a nd throat medicine. Methods: Nine male patients with SCC were studied (4 or opharynx, 2 hypopharynx, and 3 larynx) in whom different lymph node status was diagnosed clinically (5 x N0, 2 x N1, 2 x N2c). After intraoperative sc intillation probe detection, the histological examination of the SN with ne ck dissection (ND) specimen followed. Results: In 7 of 9 cases SN detection was successful. In 4 of 5 cases of clinical NO status, SN, and ND specimen s were free of tumor histologically, while in one patient radiolabel-identi fied SN showed tumor cells in histological examination. In 2 patients with clinical N1 neck, SN, and ND were histologically tumor-free in one patient and contained one single tumor metastasis located in the SN in the other pa tient. In 2 patients with clinically and histologically proven N2c neck, ly mph nodes located in regions II and III showed metastasis including capsula r rupture. In both cases no lymph node radioactivity was detectable during the operation. Conclusions: The results suggest that sentinel lymphonodecto my may be suited for ear, nose, and throat medicine. Before it is applied t o clinical practice, further problems must be resolved. These include the s hort distance between the primary injection side and lymph nodes and the in fluence of intranodal tumor metastasis on the uptake of the radiolabeled tr acer.