Lymphatic mapping for staging of head and neck cancer
Section snippets
Preoperative lymphoscintigraphy
Use of preoperative lymphoscintigraphy has greatly improved our ability not only to identify all the nodal basins at risk but also to identify multiple SLNs and their location within each nodal basin (Table 2). Preoperative lymphoscintigraphy of the head and neck shows between one and three lymph node basins and one to five SLNs per patient. Balkissoon (unpublished data, 2002) has reported visualizing 1.31 nodal basins and 1.75 SLNs per patient with melanoma of the head and neck area. Rasgon4
Intraoperative lymphatic mapping and SLN biopsy
The surgeon and the nuclear medicine physician must both review lymphoscintigrams before beginning the planned surgery. This procedure enables the surgeon to discuss with the patient any additional findings that could affect informed consent (eg, if an SLN is located over the parotid or submandibular area and thus increases the risk of facial nerve injury). Another example is drainage to parotid lymph nodes, an event that can occur in 30% to 50% of cases: Being aware of this finding would lead
Discordant rates for lymphatic mapping
Lymphatic mapping in the head and neck is technically challenging and can show many unusual and unexpected drainage patterns. The highest rates of discordance are seen in the head and neck area9 and can range from 34% to 84%.8, 18 Balkissoon (unpublished data, 2002) found discordance in 44% of patients. O’Brien et al8 reported that 22% of patients had SLNs in other anatomic sites than the parotid area or in the five standard neck levels. That most of these SLNs were located in the posterior
Sentinel lymph node biopsy for squamous cell carcinoma of the oral cavity
Squamous cell carcinoma (SCC) is the most common cancer of the oral cavity, where the condition most often affects the tongue. The most important prognostic factor in SCC of the oral cavity is the status of regional lymph nodes. In cases where these nodes test positive, the cure rate is decreased by half.
Management of the neck that is clinically negative for SCC of the oral cavity continues to evolve. In the past, the main treatment was radical neck dissection, as first described by Crile in
Lymphatic mapping and SLN biopsy for thyroid cancer
The utility of SLN biopsy for treating well-differentiated thyroid cancer has yet to be determined. At present, thyroidectomy without lymph node dissection is the standard treatment for papillary thyroid cancer in a patient whose neck is clinically negative for pathology. However, 82% of patients may have occult metastasis.46
Using blue dye only, Dixon et al47 found SLNs in 65% of patients with thyroid neoplasms. The series included two SLNs that yielded false-negative results. Other
Lymphatic mapping and SLN biopsy for merkel cell cancer
Merkel cell cancer is an uncommon, highly malignant neuroendocrine tumor of the skin. Treatment for this neoplasm is controversial and has included surgery with wide excision alone or combined with elective lymph node dissection. Radiation therapy and chemotherapy also have been used. Despite our best efforts at treatment, overall survival has not improved, and recurrence rates remain clinically significant. Most surgeons would agree that Merkel cell cancer in the head and neck must be treated
Conclusions
SLN biopsy remains an evolving treatment for melanoma of the head and neck. Clinicians should present all treatment options to patients diagnosed with intermediate-thickness melanoma in the head and neck. To reduce operative morbidity, lymphatic mapping and SLN biopsy using a combined technique can be offered as an alternative to elective lymph node dissection in patients with clinically negative nodes. However, close follow-up is necessary. Patients must be informed that this technique is not
Acknowledgements
The Medical Editing Department, Kaiser Foundation Hospitals, Inc, provided editorial assistance.
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Cited by (18)
Head and neck merkel cell carcinoma: a retrospective case series and critical literature review with emphasis on treatment and prognosis.
2018, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyCitation Excerpt :On the other hand, a positive SLNB result increases the risk of early recurrence84 and should be followed by lymph node dissection (or RT alternatively) to reduce this risk.85 Lymph node dissection after a positive result on SLNB has been connected with significant improvement of DSS.64 In cases of HN-MCC, levels I-III or I-V should be treated with neck dissection after positive SLNB result to control regional recurrences from micrometastases and/or in-transit metastases.76
Whole-neck imaging for the screening of metastatic nodes
2010, Japanese Dental Science ReviewMerkel cell carcinoma, role of radiotherapy and literature review
2009, Cancer/RadiotherapieOptimized coverage of high-risk adjuvant lymph node areas in prostate cancer using a sentinel node-based, intensity-modulated radiation therapy technique
2007, International Journal of Radiation Oncology Biology PhysicsSpecial Considerations with Floor of Mouth and Tongue Cancer
2006, Oral and Maxillofacial Surgery Clinics of North AmericaCitation Excerpt :This difficulty in identifying the sentinel node in floor of mouth cancers may relate to the fact that the first echelon nodes for malignancies in this area may be within the submandibular or submental spaces and are difficult to distinguish from the primary tumor using lymphoscintigraphy or the gamma probe intraoperatively because of shine artifact [33,94]. The feasibility of sentinel node biopsy for oral cavity malignancies has been proved, but large, multi-institutional studies are needed to standardize and refine the technique of lymphatic mapping [94]. In patients with metastatic disease to the regional lymph nodes, extracapsular spread has been shown to reduce survival significantly [78,99,100].
Tumours of the external ear and temporal bone
2005, Lancet OncologyCitation Excerpt :Conventional treatment includes wide surgical excision (or, in some centres, Mohs' micrographic surgery) and regional node dissection because half of patients have nodal metastases at the time of diagnosis. However, in the ear proper variable lymphatic-drainage patterns pose much the same difficulty with these tumours, and sentinel-node sampling could play a part in the treatment of these patients.25–27 Addition of radiotherapy and chemotherapy is increasingly advocated in the treatment of these aggressive malignant diseases.28