Characteristics of Patients with Upstaging by Sentinel Lymph Node Biopsy of the N0 Neck in Head and Neck Cancer

Introduction: To investigate the possible role of sentinel lymph node biopsy (SLNB) to upstage the N0 neck in patients with oral and oropharyngeal squamous cell carcinoma. Methods: Patients with T1-T2 oral and oropharyngeal squamous cell carcinoma accessible to injection and staged N0 into the neck by palaption and CTscan were enrolled in the study. All patients underwent regular follow-up to identify possible recurrence. Results: A sentine lymph node biopsy was performed by 21 consecutive patients. 4 of the 21 patients were upstaged by SNLB. There was a mean follow-up of 31 months. Two patients developed subsequent disease after having been staging by SLNB, respectively negative in one case and positive in the other case. Tumor site, the staging of the primary tumor, presence of ulceration, tumor thickness were the same in the upstaged initially N0 patients. Conclusions: Sentinel lymph node biopsy can be used to upstage the N0 neck patients in perhaps well defined patients.

Is Routine Bilateral Neck Dissection Absolutely Necessary in the Management of N0 CT Negative Neck in Patients with T4 Laryngeal Head and Neck Carcinoma?

Objectives: Elective neck treatment of clinically N0 patients in patients with head and neck carcinomas is widely accepted as a standard approach. However, the issue whether elective neck treatment should routinely be directed on both sides of the neck is still controversial. The present study is aimed at determining whether T4 staged head and neck carcinomas required bilateral neck dissection in the management clinically No necks especially CT negative cervical nodes. Methods: We performed a retrospective analysis of patients with advanced head and neck disease who received bilateral neck dissection. All the patients had curative surgery as their initial treatment for the primary tumor and the neck. Results: All the 28 consecutive patients had T4 staged primary laryngeal cancer. Patients with clinically and radiologically N+ disease had invaded lymph node metastases in all cases. Patients staged clinically and radiologically N0 had no invaded cervical lymph nodes found by pathologic examination. Patients staged clinically N0 and radiologically N+ had invaded cervical lymph nodes in 8/12 cases and in 50% (4/8) of the cases bilaterally. Conclusion: This study showed the importance on adequate clinical and radiological staging. By patients with advanced disease clinically and radiologically N0, bilateral neck dissection should not be necessary. But in patients radiologically N+, routine bilateral neck dissection is beneficial.