Sentinel lymph node extirpation as treatment method of the NO neck in patients with oral and oropharyngeal carcinomas

Background. The clinically non-metastatic neck is an unsolved problem in th e treatment of oral and oropharyngeal squamous cell carcinomas. A rational procedure is looked for which is neither exaggerated nor neglects the neede d safety. Patients and methods. 15 patients with primary squamous cell carcinomas of the oral cavity and the oropharynx, staging T1-4N0M0 were examined. After p eritumoral intramucodermal injection of tc(99)m-labeled colloidal albumin t he lymphoscintigraphy using gamma -camera imaging prior and hand-held gamma -probe during operation were used for identification of the nodes. Selecti ve sentinel lymph node exstirpation was followed by radical tumor resection . Results. In all cases (n = 41) lymph nodes could be detected, 40 of them we re sentinel lymph nodes, distributed to all neck levels, in 5 cases bilater al drainage. 92.5% of sentinel lymph nodes could be actually removed. All b ut 1 (97.5%) were true-negative. In the positive case modified radical neck dissection harvested another affected node. Conclusions. Methodically seen, the sentinel procedure works well and might lead to reduced post-surgical morbidity in about 50% of patients with oral cancer. To date, the procedure should be confined to studies with special requirements to diagnostics and subsequent treatment.