D. Gordon MacDonald

The accuracy of head and neck carcinoma sentinel lymph node biopsy in the clinically N0 neck.

Sentinel lymph node (SLN) biopsy originally was described as a means of identifying lymph node metastases in malignant melanoma and breast carcinoma. The use of SLN biopsy in patients with oral and oropharyngeal squamous cell carcinoma and clinically N0 necks was investigated to determine whether the pathology of the SLN reflected that of the neck.

Sentinel Node Biopsy in Head and Neck Cancer: Preliminary Results of a Multicenter Trial

Background: The aim was to determine the reliability and reproducibility of sentinel node biopsy (SNB) as a staging tool in head and neck squamous cell carcinoma (HNSCC) for T1/2 clinically N0 patients by means of a standardized technique.Methods: Between June 1998 and June 2002, 227 SNB procedures have been performed in HNSCC cases at six centers. One hundred thirty-four T1/2 tumors of the oral cavity/oropharynx in clinically N0 patients were investigated with preoperative lymphoscintigraphy (LSG), intraoperative use of blue dye/gamma probe, and pathological evaluation with step serial sectioning and immunohistochemistry, with a follow-up of at least 12 months. In 79 cases SNB alone was used to stage the neck carcinoma, and in 55 cases SNB was used in combination with an elective neck dissection (END).Results: In 125/134 cases (93%) a sentinel node was identified. Of 59 positive nodes, 57 were identified with the intraoperative gamma probe and 44 with blue dye. Upstaging of disease occurred in 42/125 cases (34%): with hematoxylin-eosin in 32/125 (26%) and with additional pathological staging in 10/93 (11%). The sensitivity of the technique with a mean follow-up of 24 months was 42/45 (93%). The identification of SNB for floor of mouth (FOM) tumors was 37/43 (86%), compared with 88/91 (97%) for other tumors. The sensitivity for FOM tumors was 12/15 (80%), compared with 30/30 (100%) for other tumor groups.Conclusion: SNB can be successfully applied to early T1/2 tumors of the oral cavity/oropharynx in a standardized fashion by centers worldwide. For the majority of these tumors the SNB technique can be used alone as a staging tool.

Oral mucosa and complete dentures

The reduction in the epithelial thickness under dentures did not reach the level of significance. The significant reduction in the epithelial morphology indicating a flatter basement membrane would suggest that the epithelium undergoes an adaptive change as a result of surface loading to produce a more uniform epithelium. The degree of keratinization was less and the stratum corneum was thinner in the epithelium under dentures. The complete dentures in these studies seemed to reduce the quantity and quality of the keratin layer. This study has shown that the presence of a denture produced a more regular epithelium with few rete ridges, and a thinner, less highly keratinized stratum corneum.

Sentinel node in head and neck cancer: use of size criterion to upstage the no neck in head and neck squamous cell carcinoma.

Anatomical imaging tools demonstrate poor sensitivity in head and neck squamous cell carcinoma (HNSCC) patients with clinically node‐negative necks (cN0). This study evaluates nodal size as a staging criterion for detection of cervical metastases, utilizing sentinel node biopsy (SNB) and additional pathology (step‐serial sectioning, SSS; and immunohistochemistry, IHC).

Sentinel lymph node biopsy in oral malignant melanoma—a possible means of investigating the clinically node-negative neck

Sentinel node biopsy has been used to determine the presence of nodal metastases in cutaneous melanoma and is being investigated as a tool in patients with oral squamous cell carcinomas. Two patients at Canniesburn Plastic Surgery Unit with oral mucosa malignant melanoma underwent sentinel node biopsy, using a combination of preoperative lymphoscintigraphy to identify lymphatic drainage, the preoperative use of blue dye injection (in one case) and localisation of radioactive nodes with a hand-held gamma probe (in both cases). The first patient presented with a well lateralised anterior tongue melanoma and was found to have “sentinel” nodes on both sides of the neck, all of which were clear of tumour; the second patient had diffuse melanosis of the palate with an invasive component on the left side and was found to have a sentinel node on the right side containing melanin. Our experience suggests that sentinel node biopsy is technically possible for oral melanoma and may be used to investigate the neck of patients with oral melanoma.