Sentinel node biopsy as staging tool in a multimodality treatment approach to cancer of the oral cavity and the oropharynx.

Abstract

Feasibility of sentinel lymph node (SLN) biopsy in head and neck cancer as a staging tool embedded in a multimodality regimen including neoadjuvant intraarterial chemotherapy. 39 patients with oral and anterior oropharyngeal cancer classified N0 by [18 F]FDG-PET underwent SLN scintigraphy. Selective SLN biopsy without elective neck dissection (ND) was performed, immediately followed by radical resection of the primary tumor. Histopathology included step-serial sections and immunocytochemistry. Lymphoscintigraphy detected 104 spots. In 15 patients there was bilateral drainage. 114 SLN were excised due to additional intraoperative discrimination. 95% of visualised SLN could be removed. Histology was positive in 3 patients (8%), all underwent ND which yielded another positive node in 2 cases. Median observation time was 30 months. Two patients (5%) had a neck relapse in combination with a second primary. SLN biopsy as only surgical staging tool seems to be feasible. Method promises reduction of elective ND and morbidity in N0 patients.