Head and neck cancer: towards a new paradigm with sentinel node localization

Abstract

In an attempt to improve the detection of occult lymph node metastasis and avoid the morbidity, burden and costs of unnecessary elective neck dissection, sentinel node biopsy has been introduced successfully in early oral cancer: a sensitivity of 93 % and negative predictive values of 80–100 % have been reported. In comparison with elective neck dissection (in all patients), sentinel node biopsy (with neck dissection only in if sentinel node is positive) is associated with less complications, less shoulder morbidity and lower costs. In case of a positive sentinel node, neck dissections can potentially be tailored to the individual patient. Results in other non-cutaneous head and neck sites are promising, but need further research before entering routine clinical practice. New developments in tracers and instruments may increase the sensitivity of sentinel node biopsy further and facilitate harvesting of sentinel nodes.