Peroperační identifikace a bioptické vyšetření sentinelové uzliny u nádorů hlavy a krku

Sentinel Node Biopsy in Head and Neck Cancer

Summary:
Approximately 30% of patients with head and neck squamous cell carcinoma have subclinical metastases in the neck. The only highly accurate means of identifying lymph node disease is to perform a staging elective lymph node dissection. The sentinel lymph node concept states that a tumour spreads via lymphatic to the first echelon lymph node encountered in the lymph node basin. If the sentinel lymph node can be identified and examined for the presence of tumour metastases, the need to perform an elective staging lymph node dissection is negated. Radiocolloid injections of the primary tumour and lymphoscintigraphy are performed on the day before surgery. Intraoperatively, the sentinel node is localised with a gamma probe and removed after primary tumour resection. Intraoperative lymphatic mapping with patent blue can facilitate sentinel lymph node identification. The rate of sentinel lymph node identification in studies with head and neck cancer varies between 90% and 100%. The sensitivity of sentinel lymph node biopsy is about 95% and specificity is up to 100% in several studies. The sentinel lymph node biopsy can find a role in the management of clinically N0 neck as a staging technique in the future.

Key words:
elective lymph node dissection, gamma probe, head and neck cancer, intraoperative lymphatic mapping, lymphoscintigraphy, sentinel lymph node.