Koch W M, Choti M A, Civelek A C, Eisele D W, Saunders J R
Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD 21203-6402, USA.
Arch Otolaryngol Head Neck Surg. 1998 Apr;124(4):455-9. doi: 10.1001/archotol.124.4.455.
Management of the N0 neck in head and neck squamous cell carcinoma is an important issue for the head and neck surgeon. Experience with radionuclide-labeled colloid injection to identify a sentinel node in malignant melanoma suggests a high level of accuracy for this approach to identify microscopic metastasis when present. We set out to explore the feasibility of using the handheld gamma probe to identify radiolabeled sentinel nodes in oral squamous cell carcinoma.
Five individuals with N0 necks and accessible oral or oropharyngeal primary sites from a major tertiary referral center.
Radiolabel with unfiltered technetium Tc 99m sulfur colloid was injected in quadrants around the primary site followed by immediate dynamic lymphoscintigraphy. Open biopsy of the sentinel node was accomplished within 2 hours of injection after extirpation of the primary site. Regional or complete neck dissection was performed after sentinel node biopsy.
Sentinel node biopsy accurately identified one or several nodes in 2 cases, including nodes containing metastatic cancer in 1. In the other 3 cases, the radiolabel failed to identify the sentinel node despite the presence of metastatic disease in the nodes at final pathologic study in 2.
Detection and biopsy of the sentinel node are feasible for selected patients with oral head and neck squamous cell carcinoma with N0 necks. There is a potential savings of time, cost, and morbidity with this approach. However, several substantial problems were encountered with the technique in this limited series of patients. Establishing the reliability of lymphoscintigraphy in this setting would require testing in a much larger patient cohort. Our experience suggests that such an investment may not be warranted.
对头颈外科医生而言，头颈部鳞状细胞癌N0颈部的处理是一个重要问题。放射性核素标记胶体注射用于识别恶性黑色素瘤前哨淋巴结的经验表明，该方法在识别存在的微小转移方面具有较高的准确性。我们着手探讨使用手持式γ探测器识别口腔鳞状细胞癌中放射性标记前哨淋巴结的可行性。
来自一家大型三级转诊中心的5例N0颈部且口腔或口咽原发部位易于触及的患者。
在原发部位周围的象限注射未过滤的锝Tc 99m硫胶体进行放射性标记，随后立即进行动态淋巴闪烁显像。在切除原发部位后2小时内完成前哨淋巴结的开放活检。在前哨淋巴结活检后进行区域或全颈清扫。
前哨淋巴结活检在2例中准确识别出一个或多个淋巴结，其中1例包括含有转移性癌的淋巴结。在另外3例中，尽管最终病理研究显示2例患者的淋巴结存在转移性疾病，但放射性标记未能识别出前哨淋巴结。
对于选定的N0颈部口腔头颈部鳞状细胞癌患者，前哨淋巴结的检测和活检是可行的。这种方法有可能节省时间、成本和降低发病率。然而，在这一有限系列的患者中，该技术遇到了几个重大问题。在这种情况下确定淋巴闪烁显像的可靠性需要在更大的患者队列中进行测试。我们的经验表明，这样的投入可能并不值得。
