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Gary Ross, MRCSEd; Taimur Shoaib, FRCSEd; David S. Soutar, ChM; Ivan G. Camilleri, FRCS(Plast); Henry W. Gray, FRCP; Rodney G. Bessent, DPhil; Andrew G. Robertson, PhD; D. Gordon MacDonald, FRCPath

Arch Otolaryngol Head Neck Surg. 2002;128:1287-1291.

Objective  To investigate the possible role of sentinel node biopsy (SNB) alone to upstage the clinically N0 neck in patients with oral and oropharyngeal squamous cell carcinoma.

Design  Prospective clinical study.

Setting  Head and neck referral center.

Patients  Patients with primary untreated oral and/or oropharyngeal squamous cell carcinoma accessible to injection and with clinically N0 necks were enrolled in the study.

Intervention  An SNB was performed after radiocolloid and blue dye injection. Preoperative lymphoscintigraphy and the perioperative use of a gamma probe identified radioactive sentinel nodes and visualization of blue-stained lymphatics identified blue sentinel nodes. If the sentinel node was found negative, there was no further treatment to the neck. If the sentinel node tested positive, a therapeutic neck dissection was performed. All patients underwent regular follow-up at the outpatient clinic to identify possible recurrence.

Main Outcome Measures  Upstaging of the clinically N0 neck by SNB and development of subsequent disease in SNB-negative necks.

Results  An SNB was performed on 57 clinically N0 necks in 48 patients. Sentinel nodes were harvested in 43 (90%) of 48 patients. Fifteen (35%) of 43 patients were upstaged by SNB and 28 (65%) of 43 were staged SNB negative. There was a mean follow-up of 18 months. One patient developed subsequent disease after having been staged negative with SNB. The overall sensitivity of the procedure using the full pathologic protocol was 94% (15/16).

Conclusions  Sentinel node biopsy can be used to upstage the N0 neck in patients with early subclinical nodal disease. However, before it becomes the standard of care in head and neck squamous cell carcinoma, longer follow-up observational trials are needed.

From the Plastic Surgery Unit, Canniesburn Hospital (Drs Ross, Shoaib, Soutar, and Camilleri); Departments of Nuclear Medicine (Dr Gray) and Clinical Physics and Nuclear Medicine (Dr Bessent), Royal Infirmary; Beatson Oncology Centre, Western Infirmary (Dr Robertson); and the Oral Pathology Unit, Glasgow Dental Hospital and School (Dr MacDonald), Glasgow, Scotland.

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