The accuracy of head and neck carcinoma sentinel lymph node biopsy in the clinically NO neck

BACKGROUND. Sentinel lymph node (SLN) biopsy originally was described as a means of identifying lymph node metastases in malignant melanoma and breast carcinoma. The use of SLN biopsy in patients with oral and oropharyngeal s quamous cell carcinoma and clinically N0 necks was investigated to determin e whether the pathology of the SLN reflected that of the neck. METHODS. Patients undergoing elective neck dissections for head and neck sq uamous cell carcinoma accessible to injection were enrolled into our study. Sentinel lymph node biopsy was performed after blue dye and radiocolloid i njection. Preoperative lymphoscintigraphy and the perioperative use of a ga mma probe identified radioactive SLNs; visualization of blue stained lympha tics identified blue SLNs. A neck dissection completed the surgical procedu re, and the pathology of the SLN was compared with that of the remaining ne ck dissection. RESULTS. Sentinel lymph node biopsy was performed on 40 cases with clinical ly N0 necks. Twenty were pathologically clear of tumor and 20 contained sub clinical metastases. SLNs were found in 17 necks with pathologic disease an d contained metastases in 16. The sentinel lymph node was the only lymph no de containing tumor in 12 of 16. CONCLUSIONS. The SLN, in head and neck carcinomas accessible to injection w ithout anesthesia, is an accurate reflector of the status of the regional l ymph nodes, when found in patients with early tumors. Sentinel lymph nodes may be found in clinically unpredictable sites, and SLN biopsy may aid in i dentifying the clinically NO patient with early lymph node disease. If SLNs cannot be located in the neck, an elective lymph no de dissection should b e considered. Cancer 2001;91: 2077-83. (C) 2001 American Cancer Society.