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  • Title: The sentinel node concept in head and neck cancer: solution for the controversies in the N0 neck?
    Author: Werner JA, Dünne AA, Ramaswamy A, Dalchow C, Behr T, Moll R, Folz BJ, Davis RK.
    Journal: Head Neck; 2004 Jul; 26(7):603-11. PubMed ID: 15229903.
    Abstract:
    BACKGROUND: The majority of patients with head and neck squamous cell carcinoma (HNSCC) who have a clinical N0 neck undergo neck dissection (ND) even though no lymph node metastases may be detected. With this background, our investigation critically analyzes the value of sentinel lymphadenectomy. METHODS: Ninety patients with HNSCC, all staged with an N0 neck, underwent intraoperative 99mTc-radiolabeled detection of up to three hot nodes (SN1-3) during elective ND and primary site resection. RESULTS: Sentinel lymphadenectomy (SN1-3) detected occult metastatic spread in 20 (22%) of 90 patients, whereas failure occurred in three of 90 patients. Metastatic spread was directed to level II in the majority (66.7%) of cases. If only the SN1 had been examined, the procedure would have failed in nine (39%) of 23 patients. CONCLUSION: Sentinel lymphadenectomy correctly identified the stage of metastatic disease in 97% of patients in cases in which up to three sentinel nodes were identified. If only the lymph node with the highest tracer activity had been excised, 39% of cancer-positive necks would have been missed. Selective ND identified metastatic disease in the additional 3% of patients.
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