The Clinical Application Of Sentinel Lymph Node Biopsy For Oral Squamous Cell Cacinoma

Objective: At present, there is no clinical examination and biochemical marker available to assess the lymph node status of oral squamous cell carcinoma(OSCC) with clinically negative neck(cN0). Therefor, the treatment of the cN0 neck in oral squamous cell carcinoma is blind to some extent. Then, management of these patients remains controversial. Sentinel lymph nodes (SLN) are regional lymph nodes first involved in metastasis if lymphatic spead occurs. Preoperative lympho-scintigraphy with a kind of radilactive substance (99Tcm-DX) was used so that preoperative and intraoperative sentinel node will be got identification with the help of a gamma ray detector. Afteroperative, pathologic results of SLN and neck dissection specimen were comparision. This study assess whether lymph node status can be accurately evaluated by sentinel lymph node biopsy(SLNB) and the feasibility and accuracy of SLNB in OSCC . Then, to design if application of SLNB can bring about the individualized management of the OSCC.Material and methods:31 patients of primary OSCC and no distant metastatize spread, hospitalized in the Fourth Hospital of Hebei Privice(from Apr.2003 to Feb.2004), participated in this study. According to the standard of UICC(1987), 10 patients in stageⅠ,9 in stageⅡ,10 in stage Ⅲ,2 in stage Ⅳ.Pre-operative radiolabeled material (99Tcm_DX) were injected intracutaneously surrounding the tumor, the SLN were identified by lymphoscintigraphy and labeled on skin of body. At surgery, using the hand—held gamma probe, the SLN could be detected and SLNB were performed before the neck dissection. After surgery, all sentinel and non-sentinel lymph nodes were sent to a pathologist for histological examination and analyzed the result. The specimens were examined with hematoxylin and eosin (H and E) staining.Result :1,In 31cases studied , sentinel lymph nodes were all identified by preoperative lymphoscintigraphy, with a detection rate of 93.3% .One Oropharynx and one inferior gingival were failure .2.,In 31cases studied , sentinel lymph nodes were all identified by preoperative and intraoperative gamma probe , with a detection rate of 100% .3,Metastases were detected in neck lymph node in 13 patients by hematoxylin and eosin staining . One non-sentinel node was found with metastasis while sentinel lymph nodes were pathologically negative .4,The accuracy of the sentinel lymph node biopsy in this study was 96.8% , the sensitivity was 92.3%.Conclusions: Combination lymphoscintigraphy with gamma probe is the effective method in sentinel lymph node of oral squamous cell carcinoma detection . Sentinel lymph node biopsy is a new technology for the treatment of oral squamous cell carcinoma in clinic and has an important value . It almost has not any injury and has high accuracy and sensitivity in prediction of neck lymph nodes metastasis. But a large multi-center trial to study the clinical validity of sentinel lymph node biopsy in oral squamous cell carcinoma is underway , more experience with technique is required before SNB can be determined.