Lymphatic Mapping With Isosulfan Blue Dye in Squamous Cell Carcinoma of the Head and Neck

Pitman, Karen T.; Johnson, Jonas T.; Edington, Howard; Barnes, Eleanor; Day, Roger; Wagner, Robin L.; Myers, Eugene N.

doi:10.1001/archotol.124.7.790

Cited by 101 publications

(54 citation statements)

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“…The aim of reducing a potential excess of surgical therapy for the patient is currently achieved quite successfully in other tumour entities by applying the so-called sentinel node (SN) concept (Lingam et al, 1997;De Cicco et al, 2000;Lantzsch et al, 2001). The extensive investigations on large patient cohorts in breast cancer and malignant melanoma are opposed by a comparative paucity of experience with the SN concept for SCC of the upper aerodigestive tract (Pitman et al, 1998;Shoaib et al, 1999Shoaib et al, , 2001Alex et al, 2000;Chiesa et al, 2000;Colnot et al, 2001;Stoeckli et al, 2001). Most of these articles predominantely deal with oral cancer.…”

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Sentinel node detection in N0 cancer of the pharynx and larynx

et al. 2002

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Neck lymph node status is the most important factor for prognosis in head and neck squamous cell carcinoma. Sentinel node detection reliably predicts the lymph node status in melanoma and breast cancer patients. This study evaluates the predictive value of sentinel node detection in 50 patients suffering from pharyngeal and laryngeal carcinomas with a N0 neck as assessed by ultrasound imaging. Following 99m-Technetium nanocolloid injection in the perimeter of the tumour intraoperative sentinel node detection was performed during lymph node dissection. Postoperatively the histological results of the sentinel nodes were compared with the excised neck dissection specimen. Identification of sentinel nodes was successful in all 50 patients with a sensitivity of 89%. In eight cases the sentinel node showed nodal disease (pN1). In 41 patients the sentinel node was tumour negative reflecting the correct neck lymph node status (pN0). We observed one false-negative result. In this case the sentinel node was free of tumour, whereas a neighbouring lymph node contained a lymph node metastasis (pN1). Although we have shown, that skipping of nodal basins can occur, this technique still reliably identifies the sentinel nodes of patients with squamous cell carcinoma of the pharynx and larynx. Future studies must show, if sentinel node detection is suitable to limit the extent of lymph node dissection in clinically N0 necks of patients suffering from pharyngeal and laryngeal squamous cell carcinoma. British Journal of Cancer (2002) Paralell to other tumour entities there were intensified efforts within the last two decades, which are still discussed controversially, to limit the extent of lymph node dissection in the clinically staged N0 situations also for head and neck cancer patients. The aim of reducing a potential excess of surgical therapy for the patient is currently achieved quite successfully in other tumour entities by applying the so-called sentinel node (SN) concept (Lingam et al, 1997;De Cicco et al, 2000;Lantzsch et al, 2001). The extensive investigations on large patient cohorts in breast cancer and malignant melanoma are opposed by a comparative paucity of experience with the SN concept for SCC of the upper aerodigestive tract (Pitman et al, 1998;Shoaib et al, 1999Shoaib et al, , 2001Alex et al, 2000;Chiesa et al, 2000;Colnot et al, 2001;Stoeckli et al, 2001). Most of these articles predominantely deal with oral cancer. Contrary to this, it was the aim of the present study to analyse the role of the SN procedure in patients with pharyngeal and laryngeal carcinoma, which are the most frequent cancers of the upper aerodigestive tract. Primary criterion for inclusion was the N0 neck as staged by ultrasound scanning. Further inclusion criterion was the feasibility of a transoral exposure of the tumour. Adequate injection of the tracer substance especially in the caudal margin of the tumour. Due to inadequate exposure of the tumour three patients (2x larynx, 1x hypopharynx) had to be excluded from the study. PATIENTS ...

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Sentinel node detection in N0 cancer of the pharynx and larynx

et al. 2002

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“…The time course for transit from the injection site to the sentinel node is estimated to be 5-15 min for cutaneous melanomas, with lymph node losing their blue color after approximately 20 min due to systemic absorption [14,15]. Skin flaps elevation for neck dissection takes approximately 5-15 min, thus obviating the window of opportunity to visualize lymphatic channels and thereby lymph node identification.…”

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confidence: 99%

Sentinel Lymph Node Localization Using 1 % Isosulfan Blue Dye in Cases of Early Oral Cavity and Oropharyngeal Squamous Cell Carcinoma

Sangwan¹,

Nilakantan

Patnaik³

et al. 2014

Indian J Otolaryngol Head Neck Surg

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To study the use of 1 % isosulfan blue dye in identifying sentinel node, sensitivity and specificity of frozen section and predictive value of sentinel node in predicting other nodal status in the cases of oral cavity and oropharyngeal squamous cell carcinoma. 15 patients of oral cavity and oropharyngeal SCC with clinically N0 neck, who required WLE of the primary lesion as well as neck dissection as per recommended treatment protocol, were selected from OPD. 1 % Isosulfan dye was injected peritumorally intraoperatively after the induction of general anaesthesia. Neck dissection was performed and first node taking up the blue dye was identified, dissected, removed and was sent for frozen section. In two of the 15 cases a sentinel node was identified (sensitivity of the technique-13 %). Both the sentinel nodes were positive for presence of metastasis on final histopathology (specificity-100 %). However, five cases had nodal metastasis on final histopathological examination of the neck dissection specimen (sensitivity of sentinel lymph node biopsy-40 %). Frozen section examination had a sensitivity and specificity of 100 %. All data was analyzed using SPSS 16 software. Use of 1 % Isosulfan Dye for identification of sentinel node is a simple and cheap technique, however, it has low sensitivity as compared to the use of triple diagnostic procedure consisting of lymphoscintigraphy, per op gamma probe localization and using isosulfan dye for sentinel node identification. Sentinel lymph node is representative of nodal status and correlates well with the final histopathological examination of the dissected neck nodes.Keywords Sentinel node Á N0 neck Á Isosulfan blue dye Á Frozen section Á SLNB (sentinel lymph node biopsy)

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“…The first biopsy of a radiolabelled sentinel lymph node in head and neck cancer was performed by Alex and Krag (1996). Initial investigations of the sentinel lymph-node concept in head and neck cancer were disappointing using blue dye only (Alex and Krag, 1996;Pitman et al, 1998;Shoaib et al, 1999). Studies applying a radiolabelled tracer with or without additional blue dye, however, were promising.…”

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confidence: 99%

Sentinel lymph-node biopsy in head and neck cancer

et al. 2004

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The aim of the study was to assess the diagnostic value of the sentinel node method in patients suffering from squamous cell carcinoma of the upper aerodigestive tract. In 50 patients with oral, pharyngeal or laryngeal carcinomas staged N0 up to 50 MBq technetium-99m colloid were injected peritumorally. Sentinel nodes were localised using a g-probe in the setting of an elective neck dissection. Pathological findings of sentinel nodes and corresponding neck specimens were compared. In 46 patients sentinel nodes were detected. Of these 34 patients were free of metastatic disease in the sentinel nodes and in the neck specimens. In 12 patients clinically occult metastases were found in the sentinel nodes. Three metastases were detected only after additional sectioning of the sentinel nodes. In four patients, a sentinel lymph node could not be localised. Our results support the sentinel node concept in head and neck cancer and a definition of the sentinel nodes as the three nodes with the highest activity. Careful clinical staging of the neck and thorough pathological evaluation of the sentinel nodes are necessary to avoid false-negative results.

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Lymphatic Mapping With Isosulfan Blue Dye in Squamous Cell Carcinoma of the Head and Neck

Abstract: The technique of intraoperative lymphatic mapping with isosulfan blue dye requires further study before it can be used for the detection of occult cervical metastases in squamous cell carcinoma of the head and neck.

Cited by 101 publications

References 10 publications

Sentinel node detection in N0 cancer of the pharynx and larynx

Sentinel node detection in N0 cancer of the pharynx and larynx

Sentinel Lymph Node Localization Using 1 % Isosulfan Blue Dye in Cases of Early Oral Cavity and Oropharyngeal Squamous Cell Carcinoma

Sentinel lymph-node biopsy in head and neck cancer

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