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Sentinel Node Localization in Oral Cavity and Oropharynx Squamous Cell Cancer
Rodney J. Taylor, MSPH, MD;
Richard L. Wahl, MD;
Pramod K. Sharma, MD;
Carol R. Bradford, MD;
Jeffrey E. Terrell, MD;
Theodoros N. Teknos, MD;
Earl M. Heard, MD;
Gregory T. Wolf, MD;
Douglas B. Chepeha, MSPH, MD
Arch Otolaryngol Head Neck Surg. 2001;127:970-974.
Objective To evaluate the feasibility and predictive ability of the sentinel node
localization technique for patients with squamous cell carcinoma of the oral
cavity or oropharynx and clinically negative necks.
Design Prospective, efficacy study comparing the histopathologic status of
the sentinel node with that of the remaining neck dissection specimen.
Setting Tertiary referral center.
Patients Patients with T1 or T2 disease and clinically negative necks were eligible
for the study. Nine previously untreated patients with oral cavity or oropharyngeal
squamous cell carcinoma were enrolled in the study.
Interventions Ulfiltered technetium Tc 99m sulfur colloid injections of the primary
tumor and lymphoscintigraphy were performed on the day before surgery. Intraoperatively,
the sentinel node(s) was localized with a gamma probe and removed after tumor
resection and before neck dissection.
Main Outcome Measures The primary outcome was the negative predictive value of the histopathologic
status of the sentinel node for predicting cervical metastases.
Results Sentinel nodes were identified in 9 previously untreated patients. In
5 patients, there were no positive nodes. In 4 patients, the sentinel nodes
were the only histopathologically positive nodes. In previously untreated
patients, the sentinel node technique had a negative predictive value of 100%
for cervical metastasis.
Conclusions Our preliminary investigation shows that sentinel node localization
is technically feasible in head and neck surgery and is predictive of cervical
metastasis. The sentinel node technique has the potential to decrease the
number of neck dissections performed in clinically negative necks, thus reducing
the associated morbidity for patients in this group.
From the Department of Otolaryngology–Head and Neck Surgery (Drs
Taylor, Sharma, Bradford, Terrell, Teknos, Wolf, and Chepeha) and the Department
of Internal Medicine, Division of Nuclear Medicine (Drs Wahl and Heard), University
of Michigan, Ann Arbor.
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