Sentinel Node Biopsy for Head and Neck Cancer

摘要: The presence of cervical lymph node metastases remains one the most important prognostic factors for various solid tumors head and neck, including melanoma, squamous cell carcinoma (SCC), Merkel (MCC). In patients with clinically evident neck involvement, regional lymphatics clearly require directed treatment, this may involve therapeutic dissection or radiotherapy. However, decision whether not to electively treat uninvolved is usually less clear-cut. On hand, elective simultaneously allows accurate pathological staging definitive surgical management found harbor occult metastatic disease. other majority negative (cN0) necks do disease would therefore be overtreated by an dissection. significant morbidity associated means that a real concern, efforts minimize extent intervention while maintaining oncologic safety are ongoing. radical en bloc dissections introduced at start twentieth century have largely been surpassed more focused procedures, modified (MRND) recently, selective (SND). operative MRND SND procedures compares favorably extensive dissections, though it significant. Sentinel biopsy (SLNB) represents extension principle; super-selecting small subset nodes likely disease, can further minimized without adversely affecting diagnostic accuracy. sentinel concept states tumor spread occurs in stepwise progression from primary first-echelon nodes, before remainder lymphatic basin. These known as harvested, examined tumor, used predict status entire region, considerable variability exists patterns drainage each site, exact location varies between patients. order accurately locate SLNs, number techniques employed. Preoperatively, radio-labeled tracer injected peritumoral fashion, traveling via where detected gamma camera during lymphoscintigraphy (LSG). A handheld probe utilized intraoperatively afford precise radiolocalization, some surgeons choose also inject blue dye, easing visual identification lymphatics. comprise technique, which has applied variety tumors, breast cancer, malignant melanoma (MM), penile cancer. This chapter describes SLNB relates particularly SCC, MCC. brief history development technique its reported accuracy presented, advantages disadvantages relatively new application discussed. Finally, explores possible roles play future