Sentinel node localization in oral cavity and oropharynx squamous cell cancer

objective: To evaluate the feasibility and predictive ability of the sentin el node localization technique for patients with squamous cell carcinoma of the oral cavity or oropharynx and clinically negative necks. Design: Prospective, efficacy study comparing the histopathologic status of the sentinel node with that of the remaining neck dissection specimen. Setting: Tertiary referral center. Patients: Patients with T1 or T2 disease and clinically negative necks were eligible for the study. Nine previously untreated patients with oral cavit y or oropharyngeal squamous cell carcinoma were enrolled in the study. Interventions: Ulfiltered technetium Tc99m. sulfur colloid injections of th e primary tumor and lymphoscintigraphy were performed on the day before sur gery. Intraoperatively, the sentinel node(s) was localized with a gamma pro be and removed after tumor resection and before neck dissection. Main Outcome Measures: The primary outcome was the negative predictive valu e of the histopathologic status of the sentinel node for predicting cervica l metastases. Results: Sentinel nodes were identified in 9 previously untreated patients. In 5 patients, there were no positive nodes. In 4 patients, the sentinel n odes were the only histopathologically positive nodes. In previously untrea ted patients, the sentinel node technique had a negative predictive value o f 100% for cervical metastasis. Conclusions: Our preliminary investigation shows,that sentinel node localiz ation is technically feasible in head and neck surgery and is predictive of cervical metastasis. The sentinel node technique has the potential to decr ease the number of neck dissections performed in clinically negative necks, thus reducing the associated morbidity for patients in this group.