SENTINEL LYMPH NODE BIOPSY IN ORAL CAVITY SQUAMOUS CELL CARCINOMA WITHOUT CLINICALLY EVIDENT METASTASIS Risto Kontio, MD, 1 I. Leivo, MD, PhD, 2 E. Leppa ¨nen, MD, 3 T. Atula, MD, PhD 4 1 Department of Maxillofacial Surgery, Helsinki University Central Hospital, Kasarmikatu 11 – 13, 00130 Helsinki, Finland. E-mail: risto.kontio@hus.fi 2 Department of Pathology, Helsinki University Central Hospital, Helsinki, Finland 3 Department of Laboratory Diagnostics and Nuclear Medicine, Helsinki University Central Hospital, Helsinki, Finland 4 Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Central Hospital, Helsinki, Finland Accepted 5 May 2003 Published online 2 December 2003 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/hed.10355 Abstract: Background. The clinically N0 neck in patients with oral SCC is commonly treated by neck dissection because the existence of metastases cannot be excluded. To determine whether unnecessary treatment could be avoided, we evaluated the feasibility of sentinel lymph node (SLN) biopsy. Methods. Fifteen previously untreated patients with T1 or T2 oral SCC without clinically or radiologically detectable meta- stasis were included. A blue dye and gamma probe were used to identify SLNs. SLNs were stained with cytokeratins. All nodes in neck dissection specimens were stained using H & E. Results. SLNs were identified in 14 patients by lympho- scintigraphy and in all patients when probe and dye were combined. Four neck dissection specimens contained four metastatic lymph nodes. Three of the four lymph nodes were SLN. One SLN was found to be metastatic after immunostaining. However, although there was one blue sentinel node in one neck, a metastatic non-SLN was present. Conclusions. Our results show that SLN biopsy is a promising tool for use in patients with oral SCC. However, further studies are necessary. A 2004 Wiley Periodicals, Inc. Head Neck 26: 16 – 21, 2004 Keywords: metastasis; neck dissection; oral cancer; sentinel lymph node Despite the quality of current imaging methods, the risk of occult metastasis in necks categorized as N0 in patients with squamous cell carcinoma (SCC) of the head and neck region is still between 20% and 30%. 1 In addition to being related to tumor site and size, the risk is related to depth of infiltration. 2 Treatment of the N0 neck is con- troversial. The main options are neck dissection, radiotherapy, a combination of the two, or simply a wait and see policy. 3 In many institutions, the neck is treated when risk of occult metastasis exceeds 20%. Most patients concerned are there- fore over treated. Sentinel lymph node (SLN) biopsy has recently been used in connection with the treatment of oral and oropharyngeal SCC. If successful, SLN biopsy could allow neck dissection to be avoided in patients with no lymph node metastasis in the Correspondence to: R. Kontio B 2004 Wiley Periodicals, Inc. HEAD & NECK January 2004 16 Sentinel Lymph Node in Head and Neck Cancer