Den Toom Inne J, Heuveling Derrek A, Flach Géke B, van Weert Stijn, Karagozoglu K Hakki, van Schie Annelies, Bloemena Elisabeth, Leemans C René, de Bree Remco
Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
Head Neck. 2015 Apr;37(4):573-8. doi: 10.1002/hed.23632. Epub 2014 May 27.
Sentinel node biopsy (SNB) in head and neck cancer is recently introduced as the staging technique of oral squamous cell carcinoma. We report the results of SNB in patients diagnosed with a T1-T2 oral squamous cell carcinoma and clinically negative (N0) neck in a single center.
A retrospective analysis of 90 previously untreated patients who underwent SNB between 2007 and 2012 was performed. The SNB procedure consisted of preoperatively performed lymphoscintigraphy, intraoperative detection using blue dye, and gamma probe guidance and histopathologic examination including step-serial sectioning (SSS) and immunohistochemical (IHC) staining. A positive SNB was followed by neck dissection, whereas regular follow-up with ultrasound-guided fine-needle aspiration cytology (FNAC) was done in case of a negative SNB.
The lymphoscintigraphic identification rate was 98% (88 of 90 patients) and the surgical detection rate was 99% (87 of 88 patients). The upstaging rate was 30%. Sensitivity of SNB was 93% and the negative predictive value was 97%. The median follow-up was 18 months (range, 2-62 months). Overall survival (OS) and disease-free survival (DFS) for SNB negative were 100% and 84% and for SNB positive patients 73% and 88%, respectively.
SNB is a reliable diagnostic staging technique for the clinically negative neck in patients with early-stage (T1-T2, cN0) oral squamous cell carcinoma.
前哨淋巴结活检（SNB）最近被引入作为口腔鳞状细胞癌的分期技术用于头颈癌。我们报告了在单一中心对诊断为T1-T2期口腔鳞状细胞癌且临床颈部阴性（N0）的患者进行前哨淋巴结活检的结果。
对2007年至2012年间接受前哨淋巴结活检的90例未经治疗的患者进行回顾性分析。前哨淋巴结活检程序包括术前淋巴闪烁显像、术中使用蓝色染料检测、γ探针引导以及组织病理学检查，包括连续切片（SSS）和免疫组织化学（IHC）染色。前哨淋巴结活检阳性后行颈部清扫术，而前哨淋巴结活检阴性则进行超声引导下细针穿刺细胞学检查（FNAC）的定期随访。
淋巴闪烁显像识别率为98%（90例患者中的88例），手术检出率为99%（88例患者中的87例）。分期上调率为30%。前哨淋巴结活检的敏感性为93%，阴性预测值为97%。中位随访时间为18个月（范围2-62个月）。前哨淋巴结活检阴性患者的总生存率（OS）和无病生存率（DFS）分别为100%和84%，前哨淋巴结活检阳性患者分别为73%和88%。
对于早期（T1-T2，cN0）口腔鳞状细胞癌且临床颈部阴性的患者，前哨淋巴结活检是一种可靠的诊断分期技术。
