The nodal neck level of sentinel lymph nodes in mucosal head and neck cancer

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Summary

Sentinel node biopsy is emerging as a successful means of identifying subclinical lymph node disease in mucosal head and neck cancer. Sentinel node studies in melanoma and breast cancer have identified sentinel nodes at unusual sites and the technique is redefining our understanding of dynamic lymphatic flow. In this study, the sentinel nodes in mucosal head and neck malignancies were mapped according to their site within the neck and this was correlated with tumour site within the oral cavity. Fifty-two necks were explored for sentinel nodes from tumours located in the tongue (23 cases), floor of mouth (12 cases), palate (six cases), retromolar trigone (five cases), alveolus (three cases), buccal mucosa (two cases), tonsil (two cases) and lip (one case). In total, 124 sentinel nodes were found in levels I–V. Two hot spots were found in the tonsils and were not excised, two nodes were located in level IIB, four nodes were found in level IV, three in the contralateral neck and one in level V. The sentinel nodes located at unusual sites would not have been excised in a supraomohyoid neck dissection and the study has improved our understanding of dynamic lymph flow from tumours.

Section snippets

Methods

Patients included in this study were those who had sentinel node biopsy performed using a combination of radiocolloid and blue dye for primary intraoral mucosal malignancies. Ethical approval for this study was granted by the local research ethics committee. The technique for sentinel node biopsy has been described previously.18

Only those cases where the sentinel node pathology was a true indicator of the neck pathology were included. Thus, all true positive and true negative sentinel node

Results

One hundred and twenty-four sentinel nodes were harvested from 52 necks. The distribution of primary tumours is shown in Table 1. Results were considered by tumour site.

Discussion

This study was performed to map the spread of colloid and blue dye from primary site to sentinel node in 52 cases of true positive or true negative sentinel node biopsy. Although there were some unexpected sites of first echelon nodes most sentinel nodes were found as clinically expected in levels I–III. Of the 124 sentinel nodes that were harvested, 113 (91%) were found in the ipsilateral levels I–III.

Sentinel nodes were found in level IIb. Although level IIb is part of a neck dissection in

References (20)

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