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 microalbumine 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 No 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.