SENTINEL LYMPH NODE BIOPSY IN SQUAMOUS CELL CARCINOMA OF THE PHARYNX AND LARYNX
Autori:
Drago Prgomet, Dražen Huić, Andrea Mutvar, Zoran Rakušić, Mario Bilić, Vladimir Katić
Sažetak
Sažetak. Kod 20 bolesnika s karcinomom hipofarinksa i larinksa uspoređivani su učestalost metastaza u sentinelnim (»čuvarskim«) limfnim čvorovima s preostalim limfnim čvorovima u disektatu vrata. U studiju su uključeni bolesnici s prvim primarnim tumorom, koji je patohistološki preoperativno verificiran kao planocelularni karcinom uz klinički negativan vrat (cN0). Sentinelni limfni čvorovi prikazani su s pomoću humanoga serumskog albumina u obliku koloida, obilježenog radioaktivnim tehnecijem-99m (Tc-99m) aktivnosti 0,5 mCi (18 MBq). Ukupno su prikazana 32 sentinelna limfna čvora. Svi su nađeni u regijama II do IV, a najveći broj u regiji II. Kod tri bolesnika sentinelni limfni čvorovi su identificirani na obje strane vrata. Kod dva bolesnika (tumor hipofarinksa i glotisa) nisu se preoperativno prikazali scintigrafijski limfni čvorovi. Učinjeno je dvadeset i šest selektivnih disekcija vrata (u šest bolesnika disekcija je bila obostrana). Ukupno je u disektatima bilo izolirano 319 limfnih čvorova. Kod pet bolesnika, u sedam limfnih čvorova, nađene su metastaze. Kod tri bolesnika metastaze su u sentinelnome limfnom čvoru. Kod jednog pacijenta smo uz pozitivan patohistološki nalaz u sentinelnom limfnom čvoru našli metastaze i u drugim čvorovima (pN2b). Kod jednog bolesnika smo imali lažno negativni nalaz. Naime sentinelni limfni čvor bio je i na intraoperativnoj i definitivnoj patohistološkoj obradi bez metastaza, dok je u drugom čvoru u istom disektatu definitivni patohistološki nalaz bio pozitivan. Oba čvora bila su u regiji III. Ovo istraživanje je potvrdilo da su limfna drenaža gornjeg aerodigestivnog trakta, kao i regije metastaziranja kod planocelularnog karcinoma te lokalizacije konstantne i predvidljive.
Summary
Summary. The study included 20 patients with carcinoma of the pharynx and larynx. The incidence of metastases was compared between sentinel lymph nodes and the rest of lymph nodes in resected material. Patient inclusion criteria were primary tumor verified as squamous cell carcinoma by preoperative histopathology and negative clinical neck finding (cN0). Human serum albumin radiocolloid labeled with radioactive technetium-99m 0.5 mCi (18 MBq) was used. In two patients (with tumors of the hypopharynx and glottis), lymph nodes were not preoperatively visualized by scintigraphy. A total of 32 lymph nodes (range 0–4), were visualized. All nodes were found in regions II-IV, mostly in region II. In three patients, sentinel lymph nodes were detected bilaterally. Twenty six selective neck resections were performed (bilateral in six patients). A total of 319 (mean 12) lymph nodes were isolated in resected material, 7 of them were positive, all ipsilateral. A positive definitive histopathology finding was recorded in five patients. Three patients had one positive lymph node each (pN1), all sentinel lymph nodes. In one patient, positive sentinel lymph node histopathology was associated with tumor lesions detected in other lymph nodes (pN2b). One patient had false negative result. Study results confirmed the lymphatic drainage of the upper aerodigestive tract and metastasizing area from tumors of this localization are constant and predictable.
