Hanyang Med Rev.  2009 Aug;29(3):255-264. 10.7599/hmr.2009.29.3.255.

Sentinel Lymph Node Biopsy in the Oral Cavity Cancer

• Baek CH

• KMID: 1505102
• DOI: http://doi.org/10.7599/hmr.2009.29.3.255

Abstract

Elective neck dissection for the clinically node-negative neck is targeted to diagnose and eradicate the occult lymph node metastasis. However, this elective neck dissection gives unnecessary risk of complication and morbidity. Therefore, the extent of the elective neck dissection tends to be reduced to minimize the postoperative morbidity. The sentinel lymph node biopsy has been developed for this purpose. Sentinel lymph node is the first lymph node that gets lymphatic drainage from the tumor. Evaluation of this sentinel lymph node enables the prediction of the presence of occult lymph node metastasis. If the biopsy of the sentinel lymph node shows no metastasis, additional neck dissection can be avoided, which reduces the postoperative morbidity. There have been clinical studies on the sentinel lymph node biopsy for the head and neck squamous cell carcinoma, in which the diagnostic accuracy has been reported to be 95-100%. We started sentinel lymph node biopsy for the clinically node-negative, early-staged oral cavity cancer in December 2002. From 2002 to 2004, we evaluated its diagnostic accuracy. The positive predictive value and the negative predictive value were 100% and 98.5%, respectively. We currently determine the elective neck dissection according to the result of the sentinel lymph node biopsy.

Keyword

Sentinel lymph node; Oral cavity cancer; Neck dissection; Occult metastasis

MeSH Terms

Biopsy
Carcinoma, Squamous Cell
Drainage
Head
Lymph Nodes
Mouth*
Neck
Neck Dissection
Neoplasm Metastasis
Sentinel Lymph Node Biopsy*

Figure

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  Fig. 1 Diagram presenting the concept of sentinel lymph node. Sentinel lymph node biopsy lead us to know whether metastases are present in the first echelon of draining lymph nodes.

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  Fig. 2 The peritumoral injection of the radioacitive tracer.

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  Fig. 3 Lymphoscintigraphy of a 56 year-old male patient with tongue cancer (pT1N1M0). (A) Early dynamic imaging presented sentinel lymph node at right level II immediately after the injection of radioactive tracer. Sentinel lymph node was visualized as late as 4 hours after the injection (arrowhead. C-D. A 72 year-old male patient with tongue cancer (pT2N0M0). (C) Preoperative MRI showed well-enhancing lesion at the left tongue. (D) At early dynamic lymphoscintigraphy revealed sentinel lymph nodes at right level II as well as left level II and III.

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  Fig. 4 Distribution of sentinel lymph nodes according to the time in lymphoscintigraphy.

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  Fig. 5 The handheld gamma probe (Navigator GPS, Tyco Health Care, USA).

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  Fig. 6 Pathology of a sentinel lymph node. (A) In frozen biopsy, no tumor cell was found. Magnification ×40. (B) But, in permanent biopsy, small tumor cell nest was detected (arrow). Magnification ×400.

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