| Part I : Study of sentinel node biopsy in clinical lymph node negative oralsquamous cell carcinomaObjective: The aim of this study was to evaluate the feasibility and accuracy of sentinel lymph node biopsy (SLNB) in cNO oral squamous cell carcinoma (OSCC) and to determine the predictive value of the SLN for occult metastasis of the neck in cNO OSCC. Methods: 30 patients with cNO oral squamous cell carcinoma (OSCC) were detected by means of the lymphoscintigraphic technique and intraoperative detection through blue-dye combined with gamma-ray probe to facilitate identification of the SN. SN biopsy and complete neck dissections were performed for all CNO patients and then the histological evaluation compared. Results: Lymphoscintigraphy and blue-dye combined with gamma-ray probe could accurately identify 1 or more SLNs in all 30 patients. In 7(20%) of the 30 patients, the SLN correctly identified the metastatic disease. In no instance, the SLN was negative while the lymphadenectomy specimen was positive. Micrometastases were found in 8 out of the 52 SLNs, upstaging 7 out of 30 patients (23%) from cNO to pN+ Purthermore, a total of 1290 lymph nodes from the neck dissection specimens were analyzed, confirming no one metastatic disease. Conclusions: Sentinel lymph node biopsy is feasible and appears to accurately predict the presence of occult metastatic disease. Although further study is warranted, SLN biopsy could potentially guide head and neck oncologists to the patient with cNO disease, which would prevent the morbidity of unnecessary neck dissection. An elective neck dissection may become unnecessary if the SLN shows no nodal metastases in patients with cNO oral cavity carcinoma.Part II: IHC analysis and serial sectioning of SLN in cNO oralsquamous cell carcinoma.Objective: The aim of the study was to improve the accuracy of occult metastases in sentinel lymph nodes of patients with cNO oral squamous cell carcinoma and evaluate the histopathological features of occult metastasis detected by sentinel lymph node in oral squamous cell carcinoma. Methods: Original specemens were re-examined from 30 patients on a research from 30 SLN negative patients. Both serial sectioning of SLN (HE) and cytokeratin immunohistochemical staining were employed for the presence of micrometastasis. Results: In 30 patients with CNO OSCC who had SLNs, 52 SLNS and 1290 NSLNs were examined by multiple section and IHC, 2 additional SLNs were indentified for tumor-positive. Multiple section and IHC stains on SLNs could reduce the false-negative rate of SLN. 9 patients showed micrometastasis with a mean size of 1.6 mm (range, 0.1-2.7 mm), separate micrometastases and additional cluster of isolated tumor cells, micrometastasis and macrometastasis (2.4 and 2.7mm). Conclusions: IHC analysis and serial sectioning of SLN can improve the sensitivity this staging technique. Occult metastasis can be subdivided histopathologically in isolated tumor cells, micrometastasis and macrometastasis. We described a variety of these subtypes in sentinel lymph nodes from oral squamous cell carcinoma. Because the independent prognostic factor and clinical relevance of these subtypes is still unclear, we think the results of these finding induce future studies.Part III: Cyclin Dl expression and amplification in predicting the risk ofmicrometastasis in cNO OSCC by HSH and IHCObjective: The aim of this study was to investigate the value of cyclin Dl gene expression and amplification in predicting the risk of occult lymph node metastases in patients with cNO oral squamous cell carcinoma (OSCC). Methods: 30 OSCC patients specimens with clinically and radiologically negative lymph...
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