Yoshimoto Seiichi, Hasegawa Yasuhisa, Matsuzuka Takashi, Shiotani Akihiro, Takahashi Katsumasa, Kohno Naoyuki, Yoshida Tomoyuki, Kitano Hiroya
Department of Head and Neck Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
Auris Nasus Larynx. 2012 Feb;39(1):65-70. doi: 10.1016/j.anl.2011.03.002. Epub 2011 May 17.
Sentinel node (SN) biopsy in the head and neck region has not been widely used in Japan, except at a few facilities. However, almost all these facilities perform preoperative localization and intraoperative diagnosis by frozen section analysis of SN to select patients who must undergo neck dissection in a one-stage procedure. The objective of this study was to determine the actual status of SN biopsy at those facilities in Japan that have actively conducted this procedure, and to elucidate the usefulness and drawbacks of this technique in head and neck cancer.
We retrospectively reviewed 177 patients who had undergone SN biopsy at 7 facilities. The underlying pathology was laryngeal or hypopharyngeal cancer in 20 patients from one hospital, while the remaining 157 patients had oral cancer. Preoperative localization of SN was determined using conventional lymphoscintigraphy with or without single photon emission computed tomography with CT (SPECT-CT). Intraoperative localization and diagnosis of SN were performed by gamma probe and frozen section analysis.
Conventional lymphoscintigraphy detected a mean of 2.6 SNs per patient in 137 patients with oral cancer, compared to 2.7 in 71 patients using SPECT-CT and 2.9 in 154 patients using the gamma probe. No significant differences were apparent between techniques. Forty of the 520 SNs (7.7%; 33 in oral cancer and 7 in laryngeal or hypopharyngeal cancer) were pathologically positive in the final diagnosis. Of these, 3 were not processed for frozen sectioning and were diagnosed only with hematoxylin and eosin staining. Among the others, 32 (86.5%) were diagnosed intraoperatively as showing metastasis. In terms of the false-negative rate, 144 patients were determined by SN biopsy to have no positive SNs. Of these, 2 patients had non-SN metastases found in their dissected neck and 8 patients without neck dissection showed late nodal recurrence. The false-negative rate was thus 6.9%.
Frozen section analysis, particularly multislice sectioning, offers a relatively reliable intraoperative diagnostic method. We were able to perform immediate neck dissection based on the results of multislice sectioning as a single-stage procedure.
前哨淋巴结（SN）活检在日本头颈部区域尚未广泛应用，仅在少数机构开展。然而，几乎所有这些机构都通过对SN进行术前定位及术中冰冻切片分析来选择需一期行颈部清扫术的患者。本研究的目的是确定日本积极开展该手术的机构中SN活检的实际情况，并阐明该技术在头颈部癌中的实用性和缺点。
我们回顾性分析了在7家机构接受SN活检的177例患者。其中，一家医院的20例患者潜在病理为喉癌或下咽癌，其余157例患者为口腔癌。SN的术前定位采用传统淋巴闪烁显像，部分联合单光子发射计算机断层扫描与CT（SPECT-CT）。SN的术中定位及诊断通过γ探测仪和冰冻切片分析进行。
在137例口腔癌患者中，传统淋巴闪烁显像平均每例患者检测到2.6个SN，使用SPECT-CT的71例患者为2.7个，使用γ探测仪的154例患者为2.9个。不同技术之间无明显差异。最终诊断中，520个SN中有40个（7.7%；口腔癌33个，喉癌或下咽癌7个）病理检查呈阳性。其中，3个未进行冰冻切片处理，仅进行苏木精和伊红染色诊断。其余病例中，32个（86.5%）术中诊断为有转移。就假阴性率而言，144例患者经SN活检确定无阳性SN。其中，2例患者在清扫的颈部发现非SN转移，8例未行颈部清扫的患者出现晚期淋巴结复发。因此，假阴性率为6.9%。
冰冻切片分析，尤其是多层切片，提供了一种相对可靠的术中诊断方法。基于多层切片的结果，我们能够一期直接行颈部清扫术。
