SENTINEL NODE LOCALIZATION FOR TUMORS OF HEAD & NECK

上呼吸道鳞状细胞癌的早期转移性疾病在检查上无临床证据的患者中是很难诊断的。事实上，相当大比例的患者都有隐匿性的颈部转移，这些转移是体检和目前的放射学技术无法发现的。本研究的目的是应用放射性核素淋巴显像和伽玛探头引导手术定位上呼吸道鳞状细胞癌患者颈部的前哨淋巴结。这项技术已成功应用于乳腺癌和黑色素瘤的特定适应症。试点数据将收集上呼吸道T1和T2鳞状细胞癌患者的数据，这些患者的肿瘤可以注射，作为他们计划治疗的一部分，将进行选择性颈清扫术。原发灶在手术前一天注入未过滤的~(99m)TcS胶体，前哨结节(S)由伽马探头定位，在肿瘤切除和颈淋巴清扫术时切除。前哨淋巴结的组织病理学(S)将与其余淋巴结的组织病理学状态相关。将评估前哨节点用于预测颈部其他节点状态的灵敏度和预测值。如果前哨淋巴结是其他颈部转移疾病的有效标志，则临床检查阴性和前哨淋巴结阴性的患者可以避免选择性颈淋巴清扫术的发生。这种方法可以显著降低治疗的发病率，同时仍可获得用于组织病理学评估和分子分析的组织。

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.