Sentinel-Lymphknoten bei oralen und oropharyngealen epithelialen Tumoren

Abstract

Carcinomatous metastases in regional lymph nodes worsen substantially the prognosis of patients with oral cavity and oropharyngeal cancer. Due to the high probability of occult metastasis (about 30%), during surgical resection of the primary tumor usually also elective dissection of lymph nodes is performed. Opinions on the extent of the elective neck dissection still differ, whereas selective dissection increasingly gains in importance. The aim of selective dissections, based on the predictability of formation of metastases, is the identification and exstirpation of the sentinel lymph node. In this prospective study the applicability of the concept of the sentinel lymph node in patients with oral cavity and oropharyngeal cancer was analysed. 12 patients with oral cavity and orophangeal cancer, staging T1-T3, all N0 (examined by palpation and sonography) were included. The localization of the sentinel(s) was determined preoperatively by radioisotope (Tc Nanocolloid). Sentinel(s) were identified first with a gamma probe (Neoprobe 2000); we then injected methylene blue into the peritumoral area for easier detection of the sentinel(s). The sentinels were removed and sent for frozen section examination. Regardless of the findings of the frozen section examination modified dissection was carried out. Later we compared frozen sections with paraffin microtome sections of sentinel(s) and of other exstirpated neck lymph nodes. We could identify the sentinel lymph node in all patients, in 6/12 patients we found several sentinels. If sentinels were not affected by tumor cells, there were no metastases in the downstream neck lymph nodes either. If in the sentinel lymph nodes no metastases can be determined, eliminating the environment alone could be sufficient. However, this assumption requires verification in a larger patient group.

The role of preoperative lymphoscintigraphy in surgery planning for sentinel lymph node biopsy in malignant melanoma

“…Overall regional nodal and systemic recurrence of 5.0% in our study group during the 46 months follow-up period is quite similar to other recent published data (22,(24)(25)(26)(27)(28)(29). The false negative rate of 1.3% is less than 5% that is generally considered acceptable (28).…”

Diagnostic test accuracy of sentinel lymph node biopsy in squamous cell carcinoma of the oropharynx, larynx, and hypopharynx: A systematic review and meta‐analysis

“…For 8 of 120 remaining records, full‐text could not be retrieved, leaving 112 records for assessment of eligibility. All inclusion criteria were met in 19 articles and these were included in the analysis 30–48 . Reasons for exclusion and the flow of information through the review process are shown in Figure 1.…”

“…All inclusion criteria were met in 19 articles and these were included in the analysis. 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 Reasons for exclusion and the flow of information through the review process are shown in Figure 1 . The included studies reported the results of SLNB in a total of 377 patients with oropharyngeal ( n = 162), laryngeal ( n = 181), or hypopharyngeal ( n = 34) SCC.…”

Vergleich von klinischem und histopathologischem Staging bei Patienten mit Oropharynxkarzinom

“…Für das Oropharynxkarzinom werden in der Literatur Raten zwischen 20-38 % angegeben [19,22,[30][31][32][33][34]. Wird durch das klinische Staging eine cN0-Situation festgestellt, so kann in 11-30 % der Fälle dennoch ein histopathologischer Lymphknotenbefall nachgewiesen werden [18,35,36]. Die Ergebnisse unserer Studie mit einer hohen Rate an klinischen Unterschätzungen, Überschätzungen und einer hohen Rate an okkulten Metastasen, die durch die Literatur bestätigt werden, unterstreichen den Stellenwert der elektiven ND (chirurgisches Staging) als diagnostisches Verfahren.…”

“…Die Ergebnisse unserer Studie mit einer hohen Rate an klinischen Unterschätzungen, Überschätzungen und einer hohen Rate an okkulten Metastasen, die durch die Literatur bestätigt werden, unterstreichen den Stellenwert der elektiven ND (chirurgisches Staging) als diagnostisches Verfahren. Patienten, die erst nach dem Auftreten klinischer Metastasen operiert werden, weisen eine geringere Überlebensrate auf als Patienten, die mit einer elektiven ND therapiert wurden [36,37]. Die Notwendigkeit einer elektiven Behandlung bei einer cN0-Situation ergibt sich auch aus der Tatsache, dass kein bildgebendes Verfahren befähigt ist, okkulte Metastasen und den N-Status zuverlässig zu bestimmen [22].…”