Predictive value of sentinel node biopsy in head and neck cancer

CONCLUSIONS: The negative predictive value (NPV) of sentinel lymph node biopsy (SNB) in this study was 95%. The accuracy of SNB compared to histopathologic evaluation of surgical specimen of subsequent neck dissection (ND) was 96%. OBJECTIVE: To evaluate NPV of SNB in head and neck cancer. PATIENTS AND METHODS: This was a prospective clinical study comprising 35 patients (50 necks) with squamous cell carcinoma (SCC) of head and neck with clinically (cN0) and radiologically negative necks, without previous treatment, who underwent SNB with gamma probe and subsequent ND. The NPV, accuracy, sensitivity, and specificity of SNB were compared to histopathologic assessment of surgical specimens from NDs. Negative sentinel lymph nodes (SLNs) on histopathology were evaluated with step serial section (SSS) and immunohistochemistry (IHC). When a neck had a positive SLN, all lymph nodes of subsequent NDs were studied with SSS and IHC. RESULTS: There were primaries of the oral cavity (n=24), lip (n=3), oropharynx (n=3), and larynx (n=5). All patients had detected SLNs. In all, 41 necks were SLN-negative on histopathologic evaluation but 2 (5%) had metastases in non-SLNs after ND. Of these 41 necks, SLNs were level Ib (26%), IIa (45%), III (21%), and IV (8%). Nine necks presented positive SLN on histopathologic evaluation, level Ib (n=3), IIa (n=5), and III (n=2), and subsequent NDs were negative on conventional histopathologic analysis, but after SSS and IHC, two presented micrometastases.     

Predictive value of sentinel node biopsy in head and neck cancer

Conclusions. The negative predictive value (NPV) of sentinel lymph node biopsy (SNB) in this study was 95%. The accuracy of SNB compared to histopathologic evaluation of surgical specimen of subsequent neck dissection (ND) was 96%. Objective. To evaluate NPV of SNB in head and neck cancer. Patients and methods. This was a prospective clinical study comprising 35 patients (50 necks) with squamous cell carcinoma (SCC) of head and neck with clinically (cN0) and radiologically negative necks, without previous treatment, who underwent SNB with gamma probe and subsequent ND. The NPV, accuracy, sensitivity, and specificity of SNB were compared to histopathologic assessment of surgical specimens from NDs. Negative sentinel lymph nodes (SLNs) on histopathology were evaluated with step serial section (SSS) and immunohistochemistry (IHC). When a neck had a positive SLN, all lymph nodes of subsequent NDs were studied with SSS and IHC. Results. There were primaries of the oral cavity (n=24), lip (n=3), oropharynx (n=3), and larynx (n=5). All patients had detected SLNs. In all, 41 necks were SLN-negative on histopathologic evaluation but 2 (5%) had metastases in non-SLNs after ND. Of these 41 necks, SLNs were level Ib (26%), IIa (45%), III (21%), and IV (8%). Nine necks presented positive SLN on histopathologic evaluation, level Ib (n=3), IIa (n=5), and III (n=2), and subsequent NDs were negative on conventional histopathologic analysis, but after SSS and IHC, two presented micrometastases.     

Sentinel lymph node biopsy as an alternative to wait and see policy in patients with small T1 oral cavity squamous cell carcinoma

CONCLUSION: Although sentinel lymph node (SLN) biopsy is not yet validated for clinical use to replace elective neck dissection in patients with oral squamous cell carcinoma, it can be recommended for patients who do not fulfil the criteria for elective neck treatment according to current treatment protocols. OBJECTIVE: To examine the benefits of SLN biopsy in oral cancer patients who have a small risk for occult metastasis and therefore are not considered candidates for elective neck treatment. PATIENTS AND METHODS: Thirteen consecutive patients with a small T1 oral cavity squamous cell carcinoma, clinically staged NO, and who did not meet the indications for elective neck treatment, underwent SLN biopsy. The SLNs were cut at 1-2 mm intervals and stained with haematoxylin and eosin and cytokeratin AE1/AE3. RESULTS: Histopathological examination of SLNs revealed micrometastases in two patients. A selective neck dissection was performed on these patients and no further metastases were encountered. All patients had a minimum follow-up of 12 months and no cervical or other recurrences were encountered.     

Sentinel lymph node biopsy or elective neck dissection for patients with oral squamous cell carcinoma?

Sentinel lymph node biopsy (SNB) seems to be a promising method for staging clinically N0 neck in patients with oral squamous cell carcinoma (OSCC). In the present study, SNB was performed on 46 patients having elective neck dissection (END; six bilateral dissections) for T1–T3N0 OSCC. Sentinel lymph nodes (SLN) were first examined according to only slightly modified standard histopathologic protocol including sections at 1–2 mm intervals and H&E staining. SLN that appeared false negative (i.e. metastatic non-SLN without metastasis in a SLN) after the initial histopathologic examination were further assessed by step sectioning at 150 μm intervals and immunohistochemistry. Of the 47 neck sides with at least one SLN identified, nine contained metastasis in nine patients. After the initial histopathologic examination, SLNs were negative for malignant cells in four out of the nine metastatic neck sides. In one neck side, two metastatic SLNs were detected after the additional meticulous histopathologic work-up of the initially false negative SLNs. Therefore, in three neck sides the SLN did not contain metastasis although there was a metastasis in a non-SLN. In all these three cases with a false negative SLN, only one SLN had been identified. The sensitivity of the method (employing extensive histopathologic work-up) for detection of occult cervical metastasis was 67% (6/9 neck sides). The sensitivity of SNB for detection of occult metastasis seems to be poor in cases where only one SLN can be identified. The results of this study do not entitle us to entirely replace END by SNB in patients with OSCC.     

High sensitivity and negative predictive value of sentinel lymph node biopsy in a retrospective early stage oral cavity cancer cohort in the Northern Netherlands

Objectives

In cT1‐2N0, oral squamous cell carcinoma (OSCC) occult metastases are detected in 23%‐37% of cases. Sentinel lymph node biopsy (SLNB) was introduced in head and neck cancer as a minimally invasive alternative for an elective neck dissection in neck staging. Meta‐analyses of SLNB accuracy show heterogeneity in the existing studies for reference standards, imaging techniques and pathological examination. The aim of this study was to assess the sensitivity and negative predictive value (NPV) of the SLNB in detecting occult metastases in cT1‐2N0 OSCC in a well‐defined cohort.

Design

Retrospective study. The SLNB procedure consisted of lymphoscintigraphy, SPECT/CT‐scanning and gamma probe detection. Routine follow‐up was the reference standard for the SLNB negative neck. Histopathological examination of sentinel lymph nodes (SLN) consisted of step serial sectioning, haematoxylin‐eosin and cytokeratin AE1/3 staining.

Setting

Two comprehensive oncology centres.

Participants

A total of 91 consecutive patients with primary cT1‐2N0 OSCC treated by primary resection and neck staging by SLNB procedure between 2008 and 2016.

Main outcome measures

Sensitivity and negative predictive value.

Results

In all cases, SLNs were harvested. A total of 25 (27%) patients had tumour‐positive SLNs. The median follow‐up was 32 months (range 2‐104). Four patients were diagnosed with an isolated regional recurrence in the SLNB negative neck side resulting in an 85% sensitivity and a 94% NPV.

Conclusion

In our cohort, the SLNB detected occult metastases in early OSCC with 85% sensitivity and 94% NPV. This supports that SLNB is a reliable procedure for surgical staging of the neck in case of oral cT1‐2N0 SCC.     

Sentinel node biopsy in N0 squamous cell carcinoma of the oral cavity and oropharynx in patients previously treated with surgery or radiation therapy: a pilot study

OBJECTIVES: To assess the feasibility of sentinel lymph node (SLN) localization and to determine the predictive value of SLN biopsy for occult neck metastases in patients previously treated with surgery or radiation therapy and with N0 squamous cell carcinoma of the oral cavity or oropharynx. DESIGN: Prospective case series. SETTING: Tertiary academic hospital. PATIENTS: Eleven patients with T1 to T4 N0 squamous cell carcinoma of the oral cavity or oropharynx. INTERVENTIONS: Patients underwent preoperative peritumoral injection of technetium Tc 99m sulfur colloid followed by dynamic lymphoscintigraphy and operative localization of the SLN(s) with the use of a handheld gamma probe. MAIN OUTCOME MEASURES: The presence or absence of metastatic disease in N0 squamous cell carcinoma of the oral cavity and oropharynx in patients previously treated with surgery or radiation therapy as identified by SLN biopsy findings. RESULTS: In each of the 11 patients, 1 to 3 SLNs were identified by lymphoscintigraphy. All SLNs identified by lymphoscintigraphy were successfully identified and removed with the use of an intraoperative gamma probe. In 10 of the 11 patients, the biopsy findings from the SLN(s) accurately predicted the presence or absence of occult neck metastasis. There was 1 instance of a negative SLN with a positive neck dissection. The overall negative predictive value of the study was 91%. No aberrant lymphatic drainage patterns were observed in this study. CONCLUSION: In patients previously treated with surgery or radiation therapy, SLN biopsy was as effective as in previously untreated patients according to published reports and warrants inclusion of this patient group into larger studies.     

前哨淋巴结检测在头颈部鳞状细胞癌中的应用

目的　评价前哨淋巴结 (sentinellymphnode ,SLN)检测在N0头颈鳞状细胞癌 (简称鳞癌 )中的可行性以及SLN对微小转移灶的诊断价值。方法　分析研究中国医学科学院肿瘤医院头颈外科 2 0 0 1年 8月～ 2 0 0 2年 2月收治的 10例头颈鳞癌患者 ,为未经治疗临床诊断为N0的患者。所有患者术前均在肿瘤周围的黏膜下注射锝标记的右旋糖酐胶体 (technetium 99m preparedwithdextrancolloid ,99mTc DX) ,约 30min后行单光子发射计算机断层显像术扫描 ,在相应的颈部皮肤上标记显像“热点” ;术中翻开皮瓣后用手提探测仪探测术野 ,以高于背景计数 4倍以上确定为SLN。将确定的SLN送病理学检查 ,并借助淋巴结连续切片和免疫组化法检测微小转移灶。结果　术前淋巴结显像及术中探测仪探测所识别的SLN行病理学检查 ,10例N0患者有 3例发现隐性转移 ,其隐性转移率为 30 % (3/ 10 ) ,SLN的阳性率为 2 2 .7% (5 / 2 2 ) ,非SLN的阳性率为 0 .4 % (1/ 2 4 7)。经病理证实为SLN阴性的患者的非SLN无阳性发现。结论　头颈鳞癌颈部N0的SLN检测对发现临床隐性转移灶是可行的。SLN检测技术可缩小手术范围 ,减少手术的创伤及并发症 ,该技术的进一步推广还需更多的研究。     

Sentinel node mapping in head and neck squamous cell carcinoma

BACKGROUND: Commonly used staging procedures often cannot predict the absence of lymphatic micro- metastases in squamous cell carcinoma (SCC) of the head and neck. Therefore in many cases an elective neck dissection (ND) is necessary. In the surgical therapy of melanoma or breast cancer the presence of metastases can be evaluated securely by identification and examination of the sentinel lymph node (SLN). The type of surgical procedure is usually chosen in regard to the histopathological result. The present study evaluates the applicability of this concept for SCC of the head and neck. METHODS: Radioactive labeled micro-albumin particles were injected preoperatively around the tumor in 38 patients without proven metastases. Following the excision of the primary tumor the sentinel lymph node/s were detected and dissected and ND was completed. Histological examination of the tissue was performed to evaluate whether the SLN reflected the lymphatic status. RESULTS: In two cases (5.1 %) no SLN were detected. ND was completed in 32 cases. In nine cases (28.1 %) the SLN were infiltrated by the primary tumor. In 22 cases (68.8 %) SLN and ND revealed a N(0) stage. In one case (3.1 %) we could not identify a metastasis because of the anatomical closeness of the SLN to the primary. The negative predictive value was 96 %. CONCLUSION: Predictive value regarding metastases to the neck was higher with the detection of SLN than with conventional staging procedures. Whether the detection of a tumor-free SLN is an indication not to perform an elective neck dissection is a matter of discussion, especially under the aspect of the effective reduction of postoperative morbidity.     

前哨淋巴结检测在头颈部鳞状细胞癌中的应用

目的 评价前哨淋巴结(sentinel lymph node，SLN)检测在NO头颈鳞状细胞癌(简称鳞癌)中的可行性以及SLN对微小转移灶的诊断价值。方法 分析研究中国医学科学院肿瘤医院头颈外科2001年8月～2002年2月收治的10例头颈鳞癌患者，为未经治疗临床诊断为NO的患者。所有患者术前均在肿瘤周围的黏膜下注射锝标记的右旋糖酐胶体(technetium 99m prepared with dextran colloid，^99mTc-DX)，约30min后行单光子发射计算机断层显像术扫描，在相应的颈部皮肤上标记显像“热点”；术中翻开皮瓣后用手提探测仪探测术野，以高于背景计数4倍以上确定为SLN。将确定的SLN送病理学检查，并借助淋巴结连续切片和免疫组化法检测微小转移灶。结果术前淋巴结显像及术中探测仪探测所识别的SLN行病理学检查，10例NO患者有3例发现隐性转移，其隐性转移率为30％(3／10)，SLN的阳性率为22．7％(5／22)，非SLN的阳性率为0．4％(1／247)。经病理证实为SLN阴性的患者的非SLN无阳性发现。结论 头颈鳞癌颈部NO的SLN检测对发现临床隐性转移灶是可行的。SLN检测技术可缩小手术范围，减少手术的创伤及并发症，该技术的进一步推广还需更多的研究。     

Sentinel lymph node biopsy in N0 squamous cell carcinoma of the oral cavity and oropharynx

OBJECTIVES: To ascertain the feasibility of sentinel lymph node (SLN) localization by preoperative lymphoscintigraphy and intraoperative gamma probe radiolocalization and to determine the predictive value of the SLN for occult metastasis of the neck in N0 squamous cell carcinoma of the oral cavity and oropharynx. DESIGN: A prospective study of 20 consecutive patients with N0 squamous cell carcinoma of the head and neck who underwent lymphoscintigraphy and SLN biopsy. INTERVENTIONS: On the day before surgery, each patient who completed the study underwent a submucosal peritumoral injection of unfiltered technetium 99m sulfur colloid followed by lymphoscintigraphy. Focal areas of radioactivity were marked on the overlying skin. The following day, the patients underwent resection of the primary tumor, elevation of subplatysmal flaps, identification and removal of the SLNs as identified by gamma probe, and complete neck dissections. RESULTS: Lymphoscintigraphy and gamma probe radiolocalization accurately identified 1 or more SLNs in all 20 patients. In 4 (20%) of the 20 patients, the SLN correctly identified metastatic disease. In no instance was the SLN negative when the lymphadenectomy specimen was positive. CONCLUSIONS: In this study, the SLN had a negative predictive value of 100%. Sentinel lymph node biopsy is feasible and appears to accurately predict the presence of occult metastatic disease. Although further study is warranted, SLN biopsy could potentially guide head and neck oncologists to the patient with N0 disease who would benefit most from selective neck dissection and prevent the morbidity of unnecessary neck dissection.     

Identification of sentinel lymph node in neck-node-negative oral and pharyngeal carcinoma study of patients, it's feasibility, and problems

We assessd the feasibility and problems associated with sentinel lymph node (SLN) study in 13 cases of oral and pharyngeal squamous cell carcinoma (SCC) that were neck-node-negative clinically. The primary sites were the tongue (n = 10), other sites in the oral cavity (n = 2), and the mesopharynx (n = 1). The day before surgery, tracer was injected into the submucosa around the tumor, and scintigraphic images were acquired 2 hours later. The SLN was identified intraoperatively with a handheld gamma probe, and neck dissection, including the SLNs, was performed. Radioactivity within the nodes was confirmed with a well type scintillation counter, and all resected lymph nodes were histologically examined for metastasis. The SLN was identified in every case. There were regional lymphnode metastases in 4 cases, and metastasis to the SLNs was present in all of 4 cases. Thus, the SLN concept was valid for head and neck SCC, sentinel node navigation surgery (SNNS) was thought to be applied in stage NO SCC of the head and neck. If SNNS is performed, about 70% of patients do not require neck dissection. SNNS is feasible and cost-effective in these cases. We used two different tracers: phytate and tin colloid, and found that phytate was more useful. To avoid the effects of the shine-through phenomenon, it was thought that some directions of lymphoscintigram should be taken. For intraoperative identification of the SLNs, care should be taken to the angle of gamma probe. SLN study leads to clarify each patient's lymphoid flow mapping, and it is also useful to determine the dissection area of selective neck dissection.     

Sentinel node biopsy for early oral and oropharyngeal squamous cell carcinoma

The appearance of lymph node metastases represents the most important adverse prognostic factor in head and neck squamous cell carcinoma. Therefore, accurate staging of the cervical nodes is crucial in these patients. The management of the clinically and radiologically negative neck in patients with early oral and oropharyngeal squamous cell carcinoma is still controversial, though most centers favor elective neck dissection for staging of the neck and removal of occult disease. As only approximately 30% of patients harbor occult disease in the neck, most of the patients have to undergo elective neck dissection with no benefit. The sentinel node biopsy concept has been adopted from the treatment of melanoma and breast cancer to early oral and oropharyngeal squamous cell carcinoma during the last decade with great success. Multiple validation studies in the context of elective neck dissections revealed sentinel node detection rates above 95% and negative predictive values for negative sentinel nodes of 95%. Sentinel node biopsy has proven its ability to select patients with occult lymphatic disease for elective neck dissection, and to spare the costs and morbidity to patients with negative necks. Many centers meanwhile have abandoned routine elective neck dissection and entered in observational trials. These trials so far were able to confirm the high accuracy of the validation trials with less than 5% of the patients with negative sentinel nodes developing lymph node metastases during observation. In conclusion, sentinel node biopsy for early oral and oropharyngeal squamous cell carcinoma can be considered as safe and accurate, with success rates in controlling the neck comparable to elective neck dissection. This concept has the potential to become the new standard of care in the near future.     

The sentinel node procedure with Patent Blue V dye in the surgical treatment of papillary thyroid carcinoma.

How far to extend the surgical treatment of papillary thyroid carcinoma (PTC) is still an open question. A contribution may come from intra-operative lymphatic mapping because, in other malignancies, the procedure has become an important aid in defining lymph node status. To assess the feasibility of using the sentinel lymph node (SLN) technique with the intratumoral injection of Patent Blue V dye to guide nodal dissection in PTC, 29 patients with a preoperative diagnosis of PTC and no clinical or ultrasonographic evidence of nodal involvement underwent cervicotomy and exposure of the thyroid gland, followed by Patent Blue V dye injection into the thyroid nodule. Total thyroidectomy was subsequently performed, resecting the lymph nodes at levels III, IV, VI and VII. The thyroid, SLN and the other lymph nodes were snap-frozen and submitted for both intra-operative and subsequent definitive pathological evaluation. Intra-operative lymphatic mapping located the SLN in 22/29 patients (75.9%) and the SLN revealed neoplastic involvement in 4/22 (18.2%); other lymph nodes were also positive in 2 cases. In the 18 patients whose SLNs were not metastatic, the other nodes were also disease-free. The SLN technique thus seems helpful in avoiding unnecessary lymph node dissection in PTC without spread to the SLN.     

Preliminary study of the lymphatic drainage system of the nose and paranasal sinuses and its role in detection of sentinel metastatic nodes

CONCLUSIONS: The normal nasal lymphatic drainage runs via the facial vessels into the neck lymphatic nodes of levels I-II and this drainage pattern was found in our patients with sinonasal tumors. We found only one true-positive sentinel lymph node (SLN). Our pathological material was very limited and so further investigations are required before any valid conclusions can be drawn concerning the clinical value of SLNs in nasal tumors. Objectives. To detect the lymph collection route of the nasal fossae and paranasal sinuses and to identify the first echelon in the tumor metastatic cascade in order to prevent the risk of occult metastases in N0 necks in patients with primary head and neck squamous cell carcinoma (SCC). MATERIAL AND METHODS: Our control group comprised 30 patients (20 females; age range 19-50 years) suffering from chronic otitis media who had an anatomically normal nose and a cNO neck on palpation. The pathological group comprised 6 patients (2 females; age range 40-85 years) suffering from sinonasal tumors: 3 SCC, 1 recurrent melanoma, 1 ameloblastoma and 1 inverted papilloma. All had a clinically staged cNO neck on palpation and CT. In the control group, lymphoscintigraphy was carried out by means of unilateral injection of radioactive gold into the head of the inferior turbinate. The tracer was identified using a gamma camera 3 and 6 h after the injection. In the pathological group the chosen tracer was technetium, which was administered 1 day prior to surgery by means of injections into the heads of the inferior and middle turbinates, into the nasal septum and into the retromaxillary gingival mucosa. The tracer was identified transcutaneously using a navigator probe in the gamma camera at 15 min, 30 min and 1 h post-injection. A mark was drawn on the skin corresponding to the hot spot of the SLN. The study was repeated 30 min before surgery. The neck incision was selected according to the location of the SLN. A hand-held gamma probe was used in the operating theatre to detect in situ the radioactivity of the surgical excisional nasal area and the cervical SLN. Once the SLN was excised its radioactivity was confirmed ex situ, taking into account that the activity counts were at least three times greater than background. Postoperatively, all SLNs were histopathologically examined and cytokeratin staining was carried out immunohistochemically using the monoclonal antibody cocktail AE1/AE3. Results. In the control group, intense activity at the injection tracer site and lower activity in the submandibular area (level I) were detected in 26.6% of cases. Nasal radioactivity persisted for 6 h post-injection and submandibular radioactivity increased, also reaching the area corresponding to neck node level II (70%). In two cases (6.6%), radioactivity was observed in the retropharyngeal nodes. In the pathological group, the SLN was found in the submandibular area (level I) in three cases, and in the ameloblastoma patient three SLNs were found at levels I-II. Three cases were false positives, and no metastases were detected using any of the histopathological procedures. The only one true positive corresponded to a female with an SCC of the maxillary infrastructure with invasion of the gingival mucosa. The histopathological code was 1 and a metastasis was detected on hematoxylin-eosin examination. In the other two cases no SLNs were detected.     

Preliminary study of the lymphatic drainage system of the nose and paranasal sinuses and its role in detection of sentinel metastatic nodes

Conclusions The normal nasal lymphatic drainage runs via the facial vessels into the neck lymphatic nodes of levels I–II and this drainage pattern was found in our patients with sinonasal tumors. We found only one true-positive sentinel lymph node (SLN). Our pathological material was very limited and so further investigations are required before any valid conclusions can be drawn concerning the clinical value of SLNs in nasal tumors.

Objectives To detect the lymph collection route of the nasal fossae and paranasal sinuses and to identify the first echelon in the tumor metastatic cascade in order to prevent the risk of occult metastases in N0 necks in patients with primary head and neck squamous cell carcinoma (SCC).

Material and methods Our control group comprised 30 patients (20 females; age range 19–50 years) suffering from chronic otitis media who had an anatomically normal nose and a cNO neck on palpation. The pathological group comprised 6 patients (2 females; age range 40–85 years) suffering from sinonasal tumors: 3 SCC, 1 recurrent melanoma, 1 ameloblastoma and 1 inverted papilloma. All had a clinically staged cNO neck on palpation and CT. In the control group, lymphoscintigraphy was carried out by means of unilateral injection of radioactive gold into the head of the inferior turbinate. The tracer was identified using a gamma camera 3 and 6 h after the injection. In the pathological group the chosen tracer was technetium, which was administered 1 day prior to surgery by means of injections into the heads of the inferior and middle turbinates, into the nasal septum and into the retromaxillary gingival mucosa. The tracer was identified transcutaneously using a navigator probe in the gamma camera at 15 min, 30 min and 1 h post-injection. A mark was drawn on the skin corresponding to the hot spot of the SLN. The study was repeated 30 min before surgery. The neck incision was selected according to the location of the SLN. A hand-held gamma probe was used in the operating theatre to detect in situ the radioactivity of the surgical excisional nasal area and the cervical SLN. Once the SLN was excised its radioactivity was confirmed ex situ, taking into account that the activity counts were at least three times greater than background. Postoperatively, all SLNs were histopathologically examined and cytokeratin staining was carried out immunohistochemically using the monoclonal antibody cocktail AE1/AE3.

Results In the control group, intense activity at the injection tracer site and lower activity in the submandibular area (level I) were detected in 26.6% of cases. Nasal radioactivity persisted for 6 h post-injection and submandibular radioactivity increased, also reaching the area corresponding to neck node level II (70%). In two cases (6.6%), radioactivity was observed in the retropharyngeal nodes. In the pathological group, the SLN was found in the submandibular area (level I) in three cases, and in the ameloblastoma patient three SLNs were found at levels I–II. Three cases were false positives, and no metastases were detected using any of the histopathological procedures. The only one true positive corresponded to a female with an SCC of the maxillary infrastructure with invasion of the gingival mucosa. The histopathological code was 1 and a metastasis was detected on hematoxylin–eosin examination. In the other two cases no SLNs were detected.     

The Sentinel Node Procedure with Patent Blue V Dye in the Surgical Treatment of Papillary Thyroid Carcinoma

How far to extend the surgical treatment of papillary thyroid carcinoma (PTC) is still an open question. A contribution may come from intra-operative lymphatic mapping because, in other malignancies, the procedure has become an important aid in defining lymph node status. To assess the feasibility of using the sentinel lymph node (SLN) technique with the intratumoral injection of Patent Blue V dye to guide nodal dissection in PTC, 29 patients with a preoperative diagnosis of PTC and no clinical or ultrasonographic evidence of nodal involvement underwent cervicotomy and exposure of the thyroid gland, followed by Patent Blue V dye injection into the thyroid nodule. Total thyroidectomy was subsequently performed, resecting the lymph nodes at levels III, IV, VI and VII. The thyroid, SLN and the other lymph nodes were snap-frozen and submitted for both intra-operative and subsequent definitive pathological evaluation. Intra-operative lymphatic mapping located the SLN in 22/29 patients (75.9%) and the SLN revealed neoplastic involvement in 4/22 (18.2%); other lymph nodes were also positive in 2 cases. In the 18 patients whose SLNs were not metastatic, the other nodes were also disease-free. The SLN technique thus seems helpful in avoiding unnecessary lymph node dissection in PTC without spread to the SLN.     

Sentinel lymph node biopsy for cutaneous head and neck melanomas

OBJECTIVE: To report the results of sentinel lymph node biopsy (SLNB) for cutaneous head and neck melanomas (CMHNs). DESIGN: Consecutive series followed for a median of 20 months. SETTING: Tertiary cancer care center. PATIENTS: Fifty-six individuals with clinically node-negative CMHN, median Breslow thickness, 2.6 mm (range, 0.2-20.0 mm). INTERVENTIONS: Preoperative technetium 99m sulfur colloid lymphoscintigraphy (PLSG) followed within 4 hours by intraoperative handheld gamma probe localization (IHGP). Intraoperative injection of 1% isosulfan blue dye (IBD) was used in 48 patients. Immediate completion nodal dissection was performed for metastatic SLNs on intraoperative frozen section analysis and monitoring for negative SLNs. MAIN OUTCOME MEASURES: Rate of SLN identification, SLN and non-SLN positivity, same-basin recurrence, and disease-specific and recurrence-free survival. RESULTS: Combination of IHGP and IBD improved SLN identification to 96% from 93% for IHGP and 73% for IBD alone. Four patients had a positive SLN on frozen section analysis. A negative SLNB correctly predicted regional nodal control in 47 of 48 patients but missed 1 of 5 patients who had regional lymphatic disease. All 4 patients who failed SLNB remain alive and free of recurrent disease. Two-year Kaplan-Meier disease-specific and relapse-free survival was 91% and 88%, respectively. Two-year disease-specific survival was 93% for SLN-negative patients and 50% for SLN-positive patients (P=.20). CONCLUSIONS: Combining PLSG with IHGP and IBD improves the success rate of SLNB. Although SLNB is a reliable indicator of the status of the draining lymphatic basins in CMHN, patients with negative SLNs must be observed for longer periods to understand the true implications of the procedure.     

Patterns of drainage and recurrence following sentinel lymph node biopsy for cutaneous melanoma of the head and neck

OBJECTIVES: To analyze lymphatic drainage patterns and recurrence patterns in patients undergoing sentinel lymph node biopsy (SLNB) for cutaneous head and neck melanoma. DESIGN: Retrospective review of a consecutive series with a mean follow-up of 35 months. SETTING: Tertiary cancer care center. PATIENTS: Fifty-one patients with clinically node-negative cutaneous melanoma of the head and neck region staged by means of SLNB. INTERVENTIONS: Sentinel lymph nodes (SLNs) were identified using preoperative lymphatic mapping along with intraoperative gamma probe evaluation and isosulfan blue dye injection. Patients with a positive SLNB finding by hematoxylin-eosin or immunohistochemical evaluation underwent completion lymphadenectomy of the affected lymphatic basin and were considered for further adjuvant treatment. Patients with a negative SLNB finding were observed clinically. MAIN OUTCOME MEASURES: Location characteristics of SLNs, incidence of positive SLNs, same-basin recurrence, and disease-free survival. RESULTS: The mean number of SLNs per patients was 2.75. The extent of SLNB included removal of 1 node (n = 11), multiple nodes from 1 basin (n = 18), 1 node in multiple basins (n = 7), and multiple nodes in multiple basins (n = 15). Drainage to unexpected basins was found in 13 of 51 patients. Parotid region drainage was identified in 18 patients. There were no same-basin recurrences in patients with a negative SLNB finding. Thirty-six-month disease-free survival was 88.9% for patients with a negative SLN and 72.9% for patients with a positive SLN (P=.17). CONCLUSIONS: The number and location of SLNs is variable and difficult to predict for head and neck cutaneous melanoma. Preoperative lymphoscintigraphy is an important planning instrument to guide complete removal of all SLNs. Based on 3-year follow-up, this procedure can be expected to provide low same-basin recurrence rates for patients with a negative SLN.     

How many sentinel nodes should be harvested in oral squamous cell carcinoma?

The number of harvested lymph nodes when performing sentinel lymph node (SLN) biopsy remains controversial. The aim of this study was to examine the maximum number of nodes to be harvested for histopathological analysis. We also wanted to determine if the level of radioactivity within a SLN or its size were indicators for the likelihood of nodal metastases. The SLNs from 34 neck dissection specimens from patients with T1/T2 N0 oral and oropharyngeal carcinomas were included. Altogether 76 SLNs were measured for radioactivity and lymph node dimensions and volume. Tumour was identified in 16 of 76 nodes (positive nodes), and the remaining 60 nodes were free from tumour (negative nodes). In 9 of 16 cases, metastases were in the hottest node. Two patients had more than one positive SLN: the first and fourth hottest in one and the second and fourth hottest nodes in another contained tumour. However, all patients would have been staged accurately if only the hottest three sentinel nodes had been retrieved. Lymph nodes that contained tumour had a greater maximum diameter than non-metastatic SLNs. To stage the neck accurately, only the three hottest lymph nodes required sampling.     

Indications and pitfalls of immunohistochemistry in head and neck cancer

Immunohistochemistry (IHC) has been employed in the differential diagnosis of tumors.ObjectiveTo assess the use of IHC in cases of head and neck tumor.MethodThis is a retrospective study of the cases included in the Cancer Registry of the institution.ResultsIHC was used in 76 (11%) of 704 pathology tests. Most cases were carcinomas (85.80%), and 83.66% of them were squamous cell carcinomas. All tests were done with diagnostic purposes. The most frequently used antibodies were 34BE12 (37.18%), AE1/AE3 (35.9%), 35BH11 (28.21%), CD45 (25.64%), CD20 (24.36%), CD30 (24.36%), CK7 (23.08%) and CD3 (23.08%).ConclusionsIHC was used in 10.67% of the head and neck tumor cases submitted to pathology testing, mostly for carcinoma (5.26%). In the determination of squamous cell carcinoma, IHC accounted for 18.42% of all tumors.