Evaluation of Sentinel Lymph Node Assisted Neck Dissection Using Methylene Blue Dye in Oral Cavity Cancers

Kathirvel Kumaran, P (2013) Evaluation of Sentinel Lymph Node Assisted Neck Dissection Using Methylene Blue Dye in Oral Cavity Cancers. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION : Carcinoma of the oral cavity is the second most common cancer in India and fourth most common in Madras Metropolitan Tumor Registry. Cervical nodes form the first echelon of metastases in cancers of the oral cavity. The frequency of cervical nodal metastases varies depending on the subsite, tumour size, depth of invasion, tumour grade, etc. The treatment of cervical nodal metastases from oral cancers depends on the number, size, and level of nodal spread; it can be surgery, radiation, chemotherapy or their combinations. Clinically node negative (N0) patients form a specific subset among oral cancers for whom the treatment of neck is not well standardised. Treatment options include observation, elective neck dissection or elective neck irradiation and depends on various factors like risk category, patient preference, treatment availability, treatment for the primary, physician preference etc. The chance of occult metastases in clinically N0 disease can be up to 30 percent. Elective treatment of neck is recommended in high risk groups defined as those patients with risk of lymph node metastasis risk more than 20 percent (3). If the neck is not addressed while adequately treating the primary, there is a high chance of nodal recurrence in those patients who harbor metastases. AIM : Primary Aim : The primary aim of this study is to evaluate the feasibility and efficacy of sentinel lymph node using methylene blue dye in clinically node negative early stage oral cavity cancers in avoiding morbidity of neck dissection. Secondary Aims: (1) To identify most common site of sentinel lymph node for oral cancers. (2) Usefulness of USG imaging in assessing neck metastasis not apparent clinically. (3) Correlation of sentinel node with non-sentinel node metastases (4) Assessing possibility of level IIB, IV and V sparing neck dissections in oral cancers N0 neck MATERIAL AND METHODS : This prospective pilot study was carried out in Department of Surgical oncology with collaboration of Department of pathology and Radiology, Government Royepettah Hospital, Chennai. Patients of oral cancer with clinically negative neck are included in the study, after obtaining informed consent. Thirty two patients with oral cancers with stages T1-T3, N0 were included in the study. Sentinel Lymph Node Biopsy in Oral Cancers CONCLUSION : Sentinel Lymphnode Biopsy (SLNB) addresses some of the complex issues of the management of clinically neck node negative oral cavity cancers. SLNB is still in early stages of development for head and neck cancers. This pilot study has shown that using blue dye alone to identify SLNB, does not meet recommended standard due to the lower sentinel lymphnode identification rate and mean node harvest. This study has also shown other important results: 1. The sensitivity, specificity and negative predictive value of sentinel node biopsy improved when enhanced pathological review or IHC incorporated in the protocol. Hence two staged sentinel procedure including both may be considered for further studies. 2. Level IIA, IB is the most common site of sentinel nodes from oral cancers. 3. USG imaging is not useful in assessment of occult neck metastases as it is observer dependent. 4. SLNB using methylene blue alone has high Negative Predictive Value. 5. Absence of sentinel node metastasis has good correlation with negative nonsentinel nodes. 6. No incidence of nodal metastases in Level IIB, IV and V in clinically N0 oral cancers. Routine dissections of these levels may be reconsidered among N0 patients to reduce morbidity. We anticipate a broader role for SLNB in future for staging and management of clinically node negative head and neck cancers. Radiocolloid localisation, IHC, Intraoperative RT-PCR and other molecular techniques may improve accurate identification of SLNB and detection of micro metastases.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Sentinel Lymph Node ; Neck Dissection ; Methylene Blue Dye ; Oral Cavity Cancers.
Subjects: MEDICAL > Surgical Oncology
Depositing User: Kambaraman B
Date Deposited: 26 Jul 2017 03:15
Last Modified: 14 May 2018 16:56
URI: http://repository-tnmgrmu.ac.in/id/eprint/2175

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