Is there a role for sentinel node biopsy in early N0 tongue tumors?

Background. Detecting metastases to the cervical lymph nodes is the main pr oblem in the management of squamous cell carcinoma of the tongue. We invest igated the ability of sentinel node (SN) biopsy to predict neck status in 1 1 patients wit lateral T1-T2, N0 and M0 squamous cell carcinoma of the tong ue who underwent ipsilateral neck dissection 30 to 40 days after primary su rgery Methods. In 5 patients, technetium 99m-labeled particles were injected clos e to the operation scar on the day before neck dissection, and the labeled neck nodes were revealed by lymphoscintigraphy. The next 6 patients underwe nt lymphoscintigraphy both before surgery and before neck dissection. durin g neck dissection. the ipsilateral SNs were identified by using a hand-held probe and removed separately. Results. Three patients (27%) had metastatic neck nodes. In all cases, labe led nodes were revealed by scintigraphy. Ipsilateral SNs were removed from 8 patients and correctly predicted the state of the neck (6 negatives and 2 positives). Lymphoscintigraphy before and after surgery revealed that drai nage was modified after surgery in 5 of 6 patients; the peg-surgery drainag e pattern varied markedly among the 5 pN0 patients. Conclusions. The technique allows easy and safe identification of SNs and s hows promise in guiding selective neck dissection. Surgery on the primary t umor often modifies lymphatic drainage, so that SN biopsy may only be usefu l if the primary operation and neck dissection are performed at the same ti me.