SENTINEL NODE LOCALIZATION FOR TUMORS OF HEAD & NECK

在没有区域性疾病临床证据的患者中，很难诊断上消化道鳞状细胞癌的早期转移性疾病。事实上，有相当比例的患者存在隐匿性宫颈转移，这些转移无法通过体格检查和当前的放射技术检测到。本研究的目的是利用淋巴显像和伽玛探针引导手术定位上消化道鳞状细胞癌患者颈部前哨淋巴结。该技术已成功用于乳腺癌和黑色素瘤的特定适应症。试点数据将收集T1和T2上气消化道鳞状细胞癌患者，这些患者的肿瘤容易感染，并将选择性颈部清扫作为其计划治疗的一部分。在手术前一天，将原发肿瘤部位注射Technetium Tc 99m硫胶体，通过伽玛探头定位前哨淋巴结，随后在肿瘤切除和颈部清扫时切除。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。前哨淋巴结的敏感性和预测价值是其他宫颈转移性疾病的有效标志，临床检查阴性且前哨淋巴结阴性的住院患者可避免一次颈部清扫的发病。这种方法可以显著降低治疗的发病率，同时仍可获得组织病理评估和分子分析。

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 indications 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 infection and are to have a selective neck dissection as part of their planned treatment. The primary tumor site will be injected with 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 is an effective marker for the presence of other cervical metastatic disease, the morbidity of a neck dissections could be avoided inpatients 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.