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Sentinel lymph node scintigraphy in head and neck tumours

Elective neck dissection and pathological examination of the lymph nodes is the most precise method for determining metastases in patients with head and neck tumours, but in general this method exposes more than 50% of stage N0 patients to lymphadenectomy that may not be necessary. The aim of this prospective study was to assess the value of sentinel lymph node (SLN) scintigraphy for the staging of clinically nodal negative necks in head and neck squamous cell carcinoma. The study included 15 male patients (six oral cavity, six laryngeal, three hypopharynx cancers ; median age 55 years, range 37-77 years) without evident neck metastases (physical examination, ultrasound, CT). On the day of the surgery we preoperatively injected 18 MBq HAS colloid (SENTI-SCINT, particle size 100-600 nm, total volume of 0.4 ml) in two to four sites around the tumour. After tracer injection a 45-minutes dynamic study on gamma camera was performed and followed with static images till the SLN visualisation. Area(s) of focal uptake were marked on patients skin. Intraoperatively gamma probe was used to detect radiotracer uptake and to guide surgeon to sentinel node. SLN dissection was followed with elective neck dissection in all patients. Sentinel nodes were examined by pathologists using frozen section and immunohistochemistry (cytokeratin). 1.7 (range 0-4) SLNs were detected in 13/15 patients (87%). They are most often detected in the first hour after injection in level II. In two patients bilateral SLNs were observed. On pathology we found metastases in four SLNs. Other lymph nodes were negative in two, and positive in other two patients. Nine SLNs were without metastases on pathology. In eight the other lymph nodes were also negative, but in one they were positive (false negative rate 11%). Our preliminary results suggest that SLN scintigraphy in head and neck cancers is technical feasible. This method may direct the surgeon to nodal levels that would not have been predicted by the site and stage of primary tumour, but further studies with more patients are needed to see is it accurate as elective neck dissection

sentinel lymph node scintigraphy; head and neck tumours

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