SENTINEL NODE LOCALIZATION FOR TUMORS OF HEAD & NECK

上呼吸消化道鳞状细胞癌的早期转移性疾病，在临床检查中没有局部病变的证据时，很难诊断。 事实上，很大一部分患者隐匿性颈淋巴结转移是体检和目前的放射学技术无法发现的。 本研究的目的是使用淋巴结造影和伽玛探针引导手术定位前哨淋巴结在患者的颈部鳞状细胞癌的上呼吸消化道。 该技术已成功应用于乳腺癌和黑色素瘤的特定适应症。 将收集上呼吸消化道T1和T2鳞状细胞癌患者的初步数据，这些患者的肿瘤可进行注射，并将进行选择性颈清扫术作为其计划治疗的一部分。 在手术前一天，将在原发肿瘤部位注射未过滤的锝99 m硫胶体，并通过伽马探针定位前哨淋巴结，随后在肿瘤切除和颈淋巴结清扫术时将其切除。前哨淋巴结的组织病理学将与其余淋巴结的组织病理学状态相关。 将评估前哨淋巴结预测颈部其他淋巴结状态的敏感性和预测价值。 如果前哨淋巴结是其他颈部转移性疾病的有效标志物，则临床检查阴性和前哨淋巴结阴性的患者可以避免择期颈清扫术的发病率。 这种方法可以显著降低治疗的发病率，同时仍然获得组织用于组织病理学评价和分子分析。

It is difficult to diagnose early metastatic disease from squamous cell carcinoma of the upper aerodigestive tract in patients who have no clinical evidence of regional disease on examination. In fact, a significant proportion of patients harbor occult cervical metastases that are undetected by physical exam and current radiographic techniques. The objective of this study is to use lymphoscintigraphy and gamma-probe guided surgery to localize the sentinel node in the neck of patients with squamous cell carcinoma of the upper aerodigestive tract. This technique has been successfully implemented for specific indication in breast cancer and melanoma. Pilot data will be gathered on patients with T1 and T2 squamous cell carcinomas of the upper aerodigestive tract whose tumors are accessible for injection and are to have a selective neck dissection as part of their planned treatment. The primary tumor site will be injected with unfiltered Technetium Tc 99m Sulfur Colloid on the day prior to surgery and the sentinel node(s) will be located by the gamma probe and removed subsequently at the time of tumor resection and neck dissection. The histopathology of the sentinel node(s) will be correlated with the histopathological status of the remainder of the lymph nodes. The sensitivity and predictive value of the sentinel node for predicting the status of other nodes in the neck will be evaluated. If sentinel node is an effective marker for the presence of other cervical metastatic disease, the morbidity of an elective neck dissection could be avoided in patients with clinically negative exam and negative sentinel lymph node. This approach could significantly reduce the morbidity of treatment while still obtaining tissue for histopathological evaluation and molecular analysis.