The use of radiolocalisation of the sentinel lymph node in head and neck squamous cell carcinoma


Introduction: In cases of squamous cell carcinomas of the oral cavity, oropharynx or supraglottis region, ocult metastases have a relative high incidence, varying between 15% and 60%, according to some authors. [1] Management of patients with N0 has been intensely studied, because of the risk of occult metastases. [2,3] Therapeutic methods include the use of radiotherapy and selective neck dissection. Detection methods of the first lymph node station invaded in the metastasation process are especially important in elaborating a therapeutic protocol for the cancer patient. Techniques for this are intravital colorations, lymphography and radioactive isotope radio-localisation. Materials and

Methods: Repetead tries resulted in the formulation of 6 types of elective neck dissections which have evolved themselves from en-bloc resection to the excision of only the at-risk lymph node stations. The percentage of micro-metastases present in cases of patients with a negative sentinel lymph node is considered to be under 5% [8,9,10]. Thus the key to proper surgical treatment became the histological exam of the first lymph node station. As a response to this, Alex et. al. has developed and published in 1993 a minimally invasive technique of localising the “sentinel” lymph node in the head and neck region, using a γ probe for transcutaneous radiolocalisation of sentinel nodes and thus facilitating the biopsy through a small incision. [11,12] Results and Discussion: Radiolocalisation of the sentinel node has identified at least 2 sentinel lymph nodes in all 8 of the cases studied. In one of the cases, 2 out of 3 nodes in which micrometastases were found were classified as sentinel nodes. There wasn’t any case of false positive results. Thus, skip-metastases may represent a non-standard variant of lymph drainage or even an abberration in anatomical pathways which run in parallel with standard, classical ones.

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