2014 Volume 40 Issue 4 Pages 397-401
In the management of the neck for early tongue cancer, the ‘wait and see’ policy is not recommended, because of high occult cervical metastasis, which has an occurrence rate of more than 20%, and poor survival rates. Sentinel node navigation surgery (SNNS) has been decided upon for neck dissection for early stage tongue cancer.
In our department, SNNS was performed on 29 patients (stage I: 14, stage II: 15) from 2000 to 2007. Tc-labeled phytate was injected as a radiotracer a day before SNNS. The sentinel node (SN) was then examined pathologically during surgery. Six cases (21%) were proven metastatic SNs and neck dissections were performed. For the prevention of postoperative submandible node metastasis, the lead plate technique was effective. Nineteen (65.5%) patients could avoid unnecessary neck dissection. In our cases, the 5-year overall survival rate of patients with SNNS tended to be better than that of the 52 patients with the ‘wait and see’ policy (96% vs. 84%, p < 0.05).
Although SNNS provides useful information to make decisions about neck dissection in early stage tongue cancer, the current methods still involve some drawbacks. Indocyanine green (ICG) fluorescence, CT Lymphography and superparamagnetic iron oxide-enhanced MRI lymphography could become useful tracers for predicting lymph node metastasis without using a radioisotope. The conventional intraoperative pathological examination for SNNS has been controversial. One step nucleic acid amplification could become useful in intraoperative cervical lymph node diagnosis.
