Abstract
Background : Sentinel lymph node (SLN) radiolocalization has become one of the most interesting topics in head and neck surgery. We started SLN radiolocalization in N0 neck oral cancer patients in November 2000. Method : Fifteen individuals with previously untreated N0 neck oral cancer participated in the study. The radioactive tracer used was 99mTc phytate. It was injected submucosally around the primary tumor, the day before an operation. Using a hand-held gamma probe on the table, we identified and extracted radiolabeled SLNs before starting a planned surgery. The level of SLN and its count of the gamma probe were recorded. After finishing the planned surgery, we extracted residual radiolabeled SLNs in the dissected specimen again. The SLNs and all other lymph nodes were examined for pathology. Results : Occult metastases to SLNs were found in five patients. In four patients, we found it in SLN with the highest count of radioactivity, and in one patient in SLN with the second highest count. In the case with two positive SLNs, one had the highest count and one the third highest. These SLNs were the only nodes affected. SLNs reflected the patients' neck status accurately. Four of the six positive SLNs in those five patients were micrometastases. Conclusion : We concluded that the sentinel node concept can be applied to the head and neck region. Careful investigation of the highest count SLN to the third is necessary for accurate prediction of the patients' neck status. Considering intraoperative diagnosis of SLN biopsy, a sensitive method which can detect micrometastasis should be established.
