Contemporary use of sentinel lymph node biopsy in the head and neck

Abstract

Sentinel lymph node biopsy has become a well-established and commonplace practice in many oncologic disease sites as a means to stage the regional lymphatics, avoid unnecessary surgery and decrease patient morbidity. In the head and neck, its role is well established for cutaneous melanoma with proven fidelity and survival benefit. Its role in use for other sites such as oral cavity carcinoma continues to develop with promising results from several recent trials. Although not widely adopted, the potential benefits of sentinel lymph node biopsy in the management of oral cavity carcinoma are apparent. Refinements in technology and protocols including development of novel radiopharmaceutical tracers, routine incorporation of detailed anatomic imaging, increasing surgeon experience and development of new intraoperative identification aids will likely lead to improvements in the use and accuracy of this technique.

Keywords: Head and neck cancer; Lymphoscintigraphy; Oral cavity cancer; Sentinel lymph node; Squamous cell carcinoma.

Fig. 1

2-D conventional planar lymphoscintigraphy and fused SPECT/CT in evaluation of a patient with floor-of-mouth carcinoma and the relationship of sentinel lymph node location to anatomic landmarks.