Stoeckli Sandro J, Alkureishi Lee W T, Ross Gary L
Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
Eur Arch Otorhinolaryngol. 2009 Jun;266(6):787-93. doi: 10.1007/s00405-009-0955-2. Epub 2009 Mar 21.
The appearance of lymph node metastases represents the most important adverse prognostic factor in head and neck squamous cell carcinoma. Therefore, accurate staging of the cervical nodes is crucial in these patients. The management of the clinically and radiologically negative neck in patients with early oral and oropharyngeal squamous cell carcinoma is still controversial, though most centers favor elective neck dissection for staging of the neck and removal of occult disease. As only approximately 30% of patients harbor occult disease in the neck, most of the patients have to undergo elective neck dissection with no benefit. The sentinel node biopsy concept has been adopted from the treatment of melanoma and breast cancer to early oral and oropharyngeal squamous cell carcinoma during the last decade with great success. Multiple validation studies in the context of elective neck dissections revealed sentinel node detection rates above 95% and negative predictive values for negative sentinel nodes of 95%. Sentinel node biopsy has proven its ability to select patients with occult lymphatic disease for elective neck dissection, and to spare the costs and morbidity to patients with negative necks. Many centers meanwhile have abandoned routine elective neck dissection and entered in observational trials. These trials so far were able to confirm the high accuracy of the validation trials with less than 5% of the patients with negative sentinel nodes developing lymph node metastases during observation. In conclusion, sentinel node biopsy for early oral and oropharyngeal squamous cell carcinoma can be considered as safe and accurate, with success rates in controlling the neck comparable to elective neck dissection. This concept has the potential to become the new standard of care in the near future.
淋巴结转移的出现是头颈部鳞状细胞癌最重要的不良预后因素。因此，准确对颈部淋巴结进行分期对这些患者至关重要。对于早期口腔和口咽鳞状细胞癌患者，临床上和放射学检查颈部阴性的处理仍存在争议，尽管大多数中心倾向于进行选择性颈清扫术以对颈部进行分期并清除隐匿性疾病。由于只有约30%的患者颈部存在隐匿性疾病，大多数患者不得不接受无获益的选择性颈清扫术。在前十年中，前哨淋巴结活检概念已从黑色素瘤和乳腺癌的治疗应用于早期口腔和口咽鳞状细胞癌，并取得了巨大成功。在选择性颈清扫术背景下的多项验证研究显示，前哨淋巴结检出率高于95%，前哨淋巴结阴性的阴性预测值为95%。前哨淋巴结活检已证明其能够选择有隐匿性淋巴疾病的患者进行选择性颈清扫术，并使颈部阴性的患者免于费用和并发症。与此同时，许多中心已放弃常规选择性颈清扫术并进入观察性试验。到目前为止，这些试验能够证实验证试验的高准确性，在观察期间前哨淋巴结阴性的患者中不到5%发生淋巴结转移。总之，早期口腔和口咽鳞状细胞癌的前哨淋巴结活检可被认为是安全且准确的，控制颈部的成功率与选择性颈清扫术相当。这一概念有可能在不久的将来成为新的治疗标准。
