Abstract
Background: Detecting metastases to the cervical lymph nodes is the main problem in
the management of squamous cell carcinoma of the tongue. We investigated the ability
of sentinel node (SN) biopsy to predict neck status in 11 patients with lateral T1-T2,
N0, and M0 squamous cell carcinoma of the tongue who underwent ipsilateral neck dissection
30 to 40 days after primary surgery. Methods: In 5 patients, technetium 99m-labeled
particles were injected close to the operation scar on the day before neck dissection,
and the labeled neck nodes were revealed by lymphoscintigraphy. The next 6 patients
underwent lymphoscintigraphy both before surgery and before neck dissection. During
neck dissection, the ipsilateral SNs were identified by using a hand-held probe and
removed separately. Results: Three patients (27%) had metastatic neck nodes. In all
cases, labeled nodes were revealed by scintigraphy. Ipsilateral SNs were removed from
8 patients and correctly predicted the state of the neck (6 negatives and 2 positives).
Lymphoscintigraphy before and after surgery revealed that drainage was modified after
surgery in 5 of 6 patients; the pre-surgery drainage pattern varied markedly among
the 5 pN0 patients. Conclusions: The technique allows easy and safe identification
of SNs and shows promise in guiding selective neck dissection. Surgery on the primary
tumor often modifies lymphatic drainage, so that SN biopsy may only be useful if the
primary operation and neck dissection are performed at the same time. (Surgery 2000;128:16-21)
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Article info
Publication history
Accepted:
February 26,
2000
Pavia and Milan, Italy 0039-6060/2000/$12.00 + 0 11/56/106809Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
