Selective neck dissection and sentinel node biopsy in head and neck squamous cell carcinomas.

The Sentinel Node concept is now well established for HNSCC and gives us a strong basis to treat patients with N0 neck where the rate of occult node metastasis is high. At the present time, the most accurate method for staging N0 neck is pathologic examination of the neck content. In this way, sentinel node dissection (SND) and sentinel node biopsy (SNB) are complementary surgical procedures. SNB has limited indications in HNSCC because of the inaccessibility of most of the primary sites to local injection of Tc99m colloid. However it seems to be an encouraging approach for small tumors of the oral cavity. In other primary sites, except for small glottic tumors, patients must undergo an SND. Supraomohyoid neck dissection which removes levels I, II and III, is performed in oral cavity tumors. Lateral neck dissection which removes levels II, III and IV, is used by many authors for laryngeal, oropharyngeal and hypopharyngeal tumors. In our experience, SND could be limited to levels II and III for laryngeal and oropharyngeal tumors without more neck failures. SND is a reliable procedure, we report only 1.5% of skip nodal metastases in 464 patients who had this staging procedure.