Int J Clin Oncol. 2010 Oct;15(5):504-7. Epub 2010 Mar 16.

A false-negative sentinel lymph node in the parotid gland of a melanoma patient: a new algorithm for SLN biopsy in the parotid gland.
Hayashi T, Furukawa H, Tsutsumida A, Yoshida T.

Source
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kitaku, Sapporo, 060-8638, Japan. toshi-116@nifty.com

Abstract
The sentinel lymph node (SLN) is the first node in the lymphatic basin to be affected by metastatic tumor cells from a primary lesion. It provides a way to avoid elective neck dissection in a case in which there is no metastasis to the SLN. However, identification and excision of the SLN may be difficult due to the shine-through phenomenon, as the SLN in the parotid gland is either located close to the primary lesion or, in many cases, the lymph node of the parotid gland is small and covered by fibrous capsula. When we conducted an SLN biopsy on a 68-year-old male patient with malignant melanoma of the cheeks, the metastasis to the node of the parotid gland identified as the SLN was negative; however, 1 year later, the melanoma recurred on the lymph node of the parotid gland, or in other words, we experienced a falsenegative SLN. SLN biopsy in the parotid gland is difficult because the lymph node is small and covered by fibrous capsula. We may consider a total or partial resection of the superficial lobe of the parotid gland, particularly when identification of an SLN in the parotid gland is difficult. Therefore, we propose a new algorithm for SLN biopsy in the parotid gland.

Radiolocalization of sentinel lymph nodes in clinically N0 laryngeal and hypopharyngeal cancers.

Hu G, Zhong S, Xiao Q, Li Z, Hong S.

Source
Department of Otolaryngology, First Affiliated Hospital, Chongqing Medical University, Chongqing, China.

Abstract
OBJECTIVES:
We sought to analyze the characteristics of radioactive lymph nodes with metastatic disease and to explore methods for the localization of sentinel lymph nodes (SLNs) with radionuclide in clinically N0 laryngeal and hypopharyngeal cancer.

METHODS:
Forty-five patients with T1-T4 and clinically N0 laryngeal and hypopharyngeal cancer were recruited. For each patient, a peritumoral submucosal injection of 99mTc-labeled sulfur colloid was administered, and lymph node mapping was performed by lymphoscintigraphy 2 hours after injection. The SLNs were localized during operation by a hand-held gamma probe 10 to 12 hours after the injection, and we defined the radioactive counts from the parotideomasseteric region as background values. All lymph nodes that had accumulated radioactivity were harvested and initially termed as SLNs. Selective neck dissection was performed in all patients. The SLN specimens were sent for formal paraffinembedded sectioning, serial sectioning, and immunohistochemical assay. The results were compared to those for the remaining lymphadenectomy specimen. Resection of the primary tumor depended on its location and the T classification.

RESULTS:
Sentinel lymph nodes were identified in 41 of 45 patients (51 necks). Sentinel lymph nodes with occult metastases were found in 13 patients (15 necks). In a false-negative case, metastasis was found in a nonsentinel lymph node in 1 of the neck specimens. The SLN identification rate was 92.7%, the sensitivity was 93.7%, the false-negative rate was 6.3%, and the accuracy was 98.0%. In 11 of the 15 necks (73.3%) with pathologically positive SLNs, metastasis was found in the node with the highest radioactivity. Harvesting the first 3 nodes with the highest radioactive counts may identify patients with occult metastatic disease.

CONCLUSIONS:
Excision of the first 3 SLNs with the highest radioactive counts can be used to accurately identify the status of cervical lymph node metastases in patients with clinically N0 laryngeal or hypopharyngeal cancer

[A comparative study of sentinel lymph node detection in laryngeal and hypopharyngeal carcinoma by lymphoscintigraphy method and blue dye].
[Article in Chinese] Cheng Y, Wang BQ, Li SJ, Wen SX, Xia LJ, Li XF, Zhao DS.

Source
Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan 030001, China.

Abstract
OBJECTIVE:
To investigate the clinical value of sentinel lymph node (SLN) detection in laryngeal and hypopharyngeal carcinoma patients with clinically negative neck (cN0) by lymphoscintigraphy method and blue dye.

METHODS:
Forty patients with cN0 laryngeal neoplasms and ten patients with cN0 hypopharyngeal carcinoma scheduled for tumor resection and neck dissection, were eligible for the study. single photon emission computed tomography (SPECT)/CT lymphoscintigraphy was performed with injection of radioactivity isotope Tc(m) labeled sulfur colloid (Tc(m)-SC). Methylthioninium was injected into the same points as Tc(m)-SC during surgery, and the patients underwent lymphatic mapping with a handheld gamma-detecting probe. All removed lymph nodes were examined by routine histopathology.

RESULTS:
Thirty-five patients with laryngeal carcinoma and six patients with hypopharyngeal carcinoma detected SLN by radiolabeled tracer method, the detection rate of SLN was 82.0%. Twenty-nine patients with laryngeal carcinoma and 4 patients with hypopharyngeal carcinoma detected SLN by blue dye method, the detection rate of SLN was 66.0%. There were significant difference between two groups (chi = 2.769, P < 0.05), and the number of SLN were respectively 96 and 83 by radiolabeled tracer method and blue dye (chi = -2.098, P < 0.05), The sensitivity of SLN detection were respectively 83.3% and 66.7%. Twelve (24.0%) patients had lymph node metastasis.

CONCLUSIONS:

Either lymphoscintigraphy or blue dye mapping can be used to detect the SLN in cN0 laryngeal and hypopharyngeal carcinoma. The lymphoscintigraphy not only preoperatively can locate the accuracy of SLN detection, but also has higher detection rate and sensitivity than dye method.

Zhonghua Zhong Liu Za Zhi. 2009 Jul;31(7):532-5.

[Significance of sentinel lymph node detection for cN0 laryngeal carcinoma].

[Article in Chinese] Cheng Y, Wang BQ, Li SJ, Wen SX, Zhang CM, Zhang WC, Wu ZF, Wu LX.

Source
Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan 030001, China.

Abstract
OBJECTIVE:
The purpose of this study was to investigate the clinical value of radiolabeled tracer method, methylene blue method and combination of these two methods in detection of sentinel lymph node (SLN), and to evaluate the accuracy of SLN in predicting the cervical lymph nodes status in laryngeal carcinoma patients with clinically negative neck lymph nodes (cN0 ).

METHODS:
Forty-one patients with cN0 laryngeal neoplasms underwent SLN detection using both of radiolabeled tracer and methylene blue. SLN imaging was performed with laryngoscope-guided injection of radioactive isotope 99Tc(m)-sulfur colloid (SC) into the laryngeal carcinoma before surgery, then all these patients underwent intraoperative lymphatic mapping with a handheld gamma-detecting probe. After mapping of SLN, methylene blue was subsequently injected at the same spots around the tumor in order to identify SLN during surgery. The results of SLN detection by isotope tracer, dye and combination of both methods were compared.

RESULTS:

The SLN detection rates by radiolabeled tracer, methylene blue and combined method were 87.8%, 70.7% and 92.7%, respectively (P < 0.01). The number of detected SLN was significantly different between radiolabeled tracer method and combined method (P < 0.05), and also between blue dye method and combined method (P < 0.01). However, no statistically significant difference was found between methylene blue method and radiolabeled tracer method (P > 0.05). Nine patients were found to have lymph node metastasis by final pathological examination. The sensitivity, accuracy and negative predictive values of SLN detection by the combined method using radiolabeled tracer and methylene blue were 88.9%, 97.4% and 96.7%, respectively.

CONCLUSION:
The combined method using radiolabeled tracer and methylene blue can improve the accuracy of sentinel lymph node detection. Furthermore, sentinel lymph node detection can accurately predict the cervical lymph node status in cN0 laryngeal carcinoma