Sentinel Lymph Node Biopsy: A new approach in the management of head and neck cancers

Abstract

Cervical lymph node metastasis affects the prognosis and overall survival rate of and therapeutic planning for patients with head and neck squamous cell carcinomas (HNSCCs). However, advanced diagnostic modalities still lack accuracy in detecting occult neck metastasis. A sentinel lymph node biopsy is a minimally invasive auxiliary method for assessing the presence of occult metastatic disease in a patient with a clinically negative neck. This technique increases the specificity of neck dissection and thus reduces morbidity among oral cancer patients. The removal of sentinel nodes and dissection of the levels between the primary tumour and the sentinel node or the irradiation of target nodal basins is favoured as a selective treatment approach; this technique has the potential to become the new standard of care for patients with HNSCCs. This article presents an update on clinical applications and novel developments in this field.

Keywords: Head and Neck Cancer; Lymphoscintigraphy; Neck Dissection; Sentinel Lymph Node Biopsy; Squamous Cell Carcinomas.

Figure 1

Flowchart depicting the process of primary tumour spread to a sentinel lymph node.

Figure 2

Proposed treatment protocol for a sentinel lymph node biopsy. *A clinically negative neck indicates a primary tumour of either ≤2 cm or 2–4 cm with no regional lymph node metastasis. LSG = lymphoscintigraphy SN = sentinel node; T/t = treatment.