Selective neck dissection and sentinel node biopsy in head and neck squamous cell carcinomas

Area of Science:

• Oncology
• Surgical Oncology
• Head and Neck Cancer Research

Background:

• The Sentinel Node concept is established for head and neck squamous cell carcinoma (HNSCC).
• Accurate staging of the N0 neck is crucial due to the high rate of occult node metastasis in HNSCC.
• Pathologic examination of neck content is the current gold standard for N0 neck staging.

Purpose of the Study:

• To evaluate the efficacy and reliability of sentinel node dissection (SND) in staging the N0 neck for HNSCC.
• To assess the rate of skip nodal metastases following SND in a large patient cohort.

Main Methods:

• Sentinel node dissection (SND) and sentinel node biopsy (SNB) are complementary surgical procedures.
• SNB has limited use in HNSCC due to primary tumor site inaccessibility for radiotracer injection.
• SND procedures include supraomohyoid neck dissection (levels I-III) for oral cavity tumors and lateral neck dissection (levels II-IV) for other primary sites.

Main Results:

• SND is a reliable procedure for staging the N0 neck in HNSCC.
• In the authors' experience, limiting SND to levels II and III for laryngeal and oropharyngeal tumors did not increase neck failures.
• A low rate of skip nodal metastases (1.5%) was reported in 464 patients who underwent SND.

Conclusions:

• Sentinel node dissection is a dependable surgical staging procedure for HNSCC.
• SND can be effectively performed with tailored lymph node level removal based on primary tumor site.
• The low rate of skip nodal metastases supports the reliability of SND in managing the N0 neck in HNSCC.