Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
Oral Oncol. 2013 Feb;49(2):165-8. doi: 10.1016/j.oraloncology.2012.09.002. Epub 2012 Oct 1.
With the current diagnostic techniques a considerable percentage of occult lymph node metastases are missed in the clinically negative (cN0) neck. Therefore, in patients with laryngeal cancer and cN0 neck a total laryngectomy is usually combined with elective neck dissection. Based on the risk of occult lymph node metastases the decision whether to perform a neck dissection or not is difficult. In recurrent laryngeal cancer or second primary tumors previous treatment possibly influences lymphatics and metastatic behavior. In this pilot study we investigated the feasibility of sentinel node (SN) identification and potential accuracy of sentinel node biopsy (SNB) in laryngeal cancer patients undergoing total laryngectomy with elective neck dissection.
Patients with cN0 laryngeal cancer were included. During surgery 40MBq (99m)Technetium labeled Nanocolloid was endoscopically injected around the tumor. Lymphoscintigraphy was not performed. We identified the sentinel node (SN) ex vivo in the neck dissection specimen with a gammaprobe. Histopathological examination of the neck dissection specimen served as reference test.
We included 19 patients, 13 patients with untreated necks and six with prior neck treatment. SN identification was successful in 68.4% (13/19) of patients, and significantly higher in patients with untreated necks (92.3% versus 16.7%, p<0.01). Four of 13 (30.7%) patients would potentially be upstaged by SNB. Sensitivity and negative predictive value would have been 80.0% and 87.5%, respectively.
With the current methodology, SN identification in laryngeal cancer patients undergoing total laryngectomy is feasible in patients with untreated necks. Further studies are needed to determine the exact accuracy of SNB in total laryngectomy patients.
目前的诊断技术在临床上检测为阴性（cN0）的颈部仍会遗漏相当比例的隐匿性淋巴结转移。因此，对于喉癌且颈部 cN0 的患者，通常会将全喉切除术与选择性颈部清扫术联合进行。由于隐匿性淋巴结转移的风险，是否进行颈部清扫术的决策具有一定难度。对于复发性喉癌或第二原发肿瘤，先前的治疗可能会影响淋巴系统和转移行为。在这项初步研究中，我们调查了在接受全喉切除术和选择性颈部清扫术的喉癌患者中，前哨淋巴结（SN）识别的可行性和前哨淋巴结活检（SNB）的潜在准确性。
纳入 cN0 喉癌患者。手术过程中，将 40MBq（99m）锝标记的纳米胶体经内镜注射到肿瘤周围。未进行淋巴闪烁显像。我们使用伽马探针在颈部清扫标本中体外识别前哨淋巴结（SN）。对颈部清扫标本进行组织病理学检查作为参考测试。
我们纳入了 19 名患者，其中 13 名患者为初治，6 名患者为颈部先前接受过治疗。68.4%（13/19）的患者成功识别出 SN，初治患者的成功率显著更高（92.3%比 16.7%，p<0.01）。4 名（30.7%）患者通过 SNB 可能会被升级分期。敏感性和阴性预测值分别为 80.0%和 87.5%。
在当前的方法学下，对于接受全喉切除术的喉癌患者，在未接受治疗的颈部中，SN 的识别是可行的。需要进一步的研究来确定 SNB 在全喉切除术患者中的准确准确性。
