Gamma probe-directed biopsy of the sentinel node in oral squamous cell carcinoma
Gamma probe-directed biopsy of the sentinel node in oral squamous cell carcinoma
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DOI：
10.1001/archotol.124.4.455
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发表时间：
1998-04-01
影响因子：
--
通讯作者：
Saunders, JR
中科院分区：
文献类型：
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作者：
Koch, WM;Choti, MA;Saunders, JR
目的：头颈部鳞状细胞癌N0颈的处理是头颈外科的一个重要课题。放射性核素标记胶体注射识别恶性黑色素瘤前哨淋巴结的经验表明，这种方法在识别显微镜下转移时具有很高的准确性。我们着手探讨使用手持式伽玛探头，以确定放射性标记的前哨淋巴结在口腔鳞状细胞cancer.Patient人群的可行性：5个人与N0颈部和访问口腔或口咽的主要网站从一个主要的三级referral center.Methods：放射性标记未过滤的锝Te 99米硫胶体注射在象限周围的主要网站，然后立即动态淋巴结造影。前哨淋巴结的开放活检在原发部位切除后2小时内完成。结果：2例前哨淋巴结活检准确识别出一个或多个淋巴结，其中1例包含转移癌。2例前哨淋巴结有转移，但3例前哨淋巴结未检出。结论：对N0颈部的口腔头颈部鳞癌患者，前哨淋巴结的检出和活检是可行的。这种方法可能节省时间、成本和发病率。然而，在这一有限的患者系列中，该技术遇到了一些实质性问题。在这种情况下建立淋巴结造影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，这种投资可能是不值得的。
Objective: 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.Patient Population: Five individuals with N0 necks and accessible oral or oropharyngeal primary sites from a major tertiary referral center.Methods: Radiolabel with unfiltered technetium Te 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.Results: 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.Conclusions: 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.