José Francisco Gallegos-Hernández1. 1. Departamento de Tumores de Cabeza y Cuello, Hospital de Oncología, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc 330, Col. Doctores, 06725 México, D.F. gal61@prodigy.net.mx
Abstract
BACKGROUND: Lymphatic mapping with sentinel node biopsy (LMSNB) is a staging alternative in melanoma and breast cancer. In oral cavity cancer (OCC) without palpable nodes, the recommended surgical treatment is elective-selective neck dissection; nevertheless, 70% will not show metastasis. LMSNB might be a staging alternative. Our objective was to determine if this technique allows the identification of sentinel node. METHODS: Characteristics were T1-2, N0, OCC patients >4 mm of tumor thickness. We injected 3 mCi of rhenium and 2 cc of blue dye around the tumor and performed a lymphogammagraphy. Sentinel node (SN) was identified by color and radioactivity, and all patients were submitted to suprahyoid dissection. Index of success, false negative, and negative predictive values were calculated. RESULTS: Of 41 patients, there were 20 females and 21 males. Lymphogammagraphy showed a SN in each patient. SN was identified in all patients during surgery: in 10 patients the SN was "hot" (24%) and in 31 (75%) "hot and blue"; 13/41 (31.7%) showed metastasis, 4 had negative SN (false negative); in 3/13 metastatic SN. Diagnosis was made by definite analysis. All patients with false negative had tumors >2 cm. CONCLUSIONS: LMSNB in oral cavity cancer has a high index of success and radical neck dissection could be avoided in 80% of patients with T1-2 tumors.
BACKGROUND: Lymphatic mapping with sentinel node biopsy (LMSNB) is a staging alternative in melanoma and breast cancer. In oral cavity cancer (OCC) without palpable nodes, the recommended surgical treatment is elective-selective neck dissection; nevertheless, 70% will not show metastasis. LMSNB might be a staging alternative. Our objective was to determine if this technique allows the identification of sentinel node. METHODS: Characteristics were T1-2, N0, OCC patients >4 mm of tumor thickness. We injected 3 mCi of rhenium and 2 cc of blue dye around the tumor and performed a lymphogammagraphy. Sentinel node (SN) was identified by color and radioactivity, and all patients were submitted to suprahyoid dissection. Index of success, false negative, and negative predictive values were calculated. RESULTS: Of 41 patients, there were 20 females and 21 males. Lymphogammagraphy showed a SN in each patient. SN was identified in all patients during surgery: in 10 patients the SN was "hot" (24%) and in 31 (75%) "hot and blue"; 13/41 (31.7%) showed metastasis, 4 had negative SN (false negative); in 3/13 metastatic SN. Diagnosis was made by definite analysis. All patients with false negative had tumors >2 cm. CONCLUSIONS: LMSNB in oral cavity cancer has a high index of success and radical neck dissection could be avoided in 80% of patients with T1-2 tumors.