Abstract
Conclusions: Because computed tomography (CT) lymphography provides preoperative images of anatomic relationships between a tumor, its associated lymph vessels, and the sentinel lymph node (SLN), it may aid in directing the SLN biopsy for management of early tongue cancer. Objectives: SLN biopsy using a radioisotope (RI) generally has been performed in head and neck cancer. However, this method can be performed only at institutions that are licenced for its use. In this study, we evaluated the utility of performing SLN biopsy in patients with early tongue cancer using the newly developed technique of CT lymphography. Methods: Enrolled in this study were 31 patients with T1N0 or T2N0 tongue cancer. CT images were obtained before and after injection of iopamidol into the peritumoral region and the SLN was identified as the first enhanced lymph node. SLN biopsy was performed using CT lymphographic guidance combined with blue dye injection. Results: The SLN was detected by CT lymphography in 28 cases (90.3%). By intraoperative frozen section examination, metastases to SLNs were found in 4 (14.3%) (T1N0, 1 patient; T2N0, 3 patients) of the 28 patients. Of these four, SLN micrometastases were found in one patient.
Highlights
Metastasis to the cervical lymph nodes represents the single most important prognostic indicator in head and neck squamous cell carcinoma (HNSCC), and management of the cervical lymph node is one of the most important factors in the control of HNSCC [1]
computed tomography (CT) lymphography images of both enhanced lymph vessels draining the tumor injection site and sentinel lymph node (SLN) were obtained in 28 patients (90.3%); lymph vessels only were detected in 1 patient (3.2%); and neither lymph vessels nor an SLN were detected in 2 patients (6.5%)
The day after the CT lymphography, SLN biopsy using CT lymphographic guidance combined with the blue dye method and glossectomy were performed in the 28 patients having identified SLNs with CT lymphography
Summary
Metastasis to the cervical lymph nodes represents the single most important prognostic indicator in head and neck squamous cell carcinoma (HNSCC), and management of the cervical lymph node is one of the most important factors in the control of HNSCC [1]. 25–40% of patients diagnosed with T1N0 or T2N0 tongue cancer have occult metastases in the neck [2,3,4]. If a ‘watchful waiting’ policy is chosen for T1/T2N0 tongue cancer, careful and frequent follow-up will be needed, which in turn causes both surgeons and patients to have much mental stress about neck recurrence after glossectomy. When neck recurrence is diagnosed, sometimes salvage neck dissection will be difficult because the tumor grows rapidly and results in late-stage regional failure. On the basis of the high incidence of neck recurrence, elective neck dissection has predominated until recently [5,6]. The policy of elective neck dissection exposes at least 60% of patients with T1/T2N0 tongue cancer to an unnecessary procedure.
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