Broglie M A, Stoeckli S J
Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, Switzerland.
Q J Nucl Med Mol Imaging. 2011 Oct;55(5):509-20.
The management of the clinically and radiologically negative neck (cN0) in patients with early oral and oropharyngeal squamous cell carcinoma (OSCC) is still a matter of debate, though most centers favor an active policy and perform END for staging of the neck and removal of occult disease. In the past decade SNB has been successfully implemented in early stage head and neck carcinomas. A large number of validation studies have shown an excellent safety profile with good sensitivity for the identification of occult neck metastases. The status of the neck is more accurately assessed by step-serial sectioning (SSS) and immunhistochemistry (IHC) of the sentinel lymph nodes (SN) compared to routine histopathologic work up of a comprehensive lymph node dissection specimen. Gain in experience as well as technical developments have lead to a wider use of SNB even in the complex lymphatic system of the Head and Neck region. First observational trials have documented its oncological accuracy and safety with success rates in controlling the neck comparable to END. The role of small tumor deposits only detectable by the extensive histopathologic work-up of the SNB-protocol is controversial. The overview comprises an introduction of the sentinel node procedure and indications in the head and neck region. The methodology as well as the histological work up and reporting of SNB is described. Finally, the clinical application, prognostic significance and future perspectives of SNB are summarized.
早期口腔和口咽鳞状细胞癌（OSCC）患者中临床及影像学检查均为阴性的颈部（cN0）的处理仍存在争议，尽管大多数中心倾向于采取积极策略并进行择区性颈清扫术（END）以对颈部进行分期并清除隐匿性疾病。在过去十年中，前哨淋巴结活检（SNB）已成功应用于早期头颈癌。大量验证性研究表明，其安全性良好，对隐匿性颈部转移灶的识别具有较高的敏感性。与对颈淋巴结清扫标本进行常规组织病理学检查相比，通过对前哨淋巴结（SN）进行连续切片（SSS）和免疫组织化学（IHC）检查能更准确地评估颈部状况。经验的积累以及技术的发展使得SNB在头颈部复杂的淋巴系统中得到更广泛应用。首批观察性试验已证明其肿瘤学准确性和安全性，控制颈部疾病的成功率与END相当。仅通过SNB方案广泛的组织病理学检查才能检测到的微小肿瘤沉积物的作用存在争议。本综述介绍了前哨淋巴结活检程序及其在头颈部区域的适应证。描述了SNB的方法、组织学检查及报告方式。最后，总结了SNB的临床应用、预后意义及未来展望。
