Sentinel Lymph Node Biopsy using blue dye technique in Carcinoma of the Buccal Mucosa
Seema Singh, Umakant Gaud, Amit ND Dwivedi, Ram C Shukla, Mridula Shukla, Mohan Kumar and Manoj Pandey
World Journal of Surgical Medical and Radiation Oncology 2011, 1:1
Aim: This study was carried out to evaluate the feasibility and role of sentinel lymph node biopsy by using blue dye in identifying occult metastasis in neck in N0 neck patients with carcinoma buccal mucosa.
Material and Methods: A prospective study was carried out between 2006 to 2008, a total of 28 patients of carcinoma buccal mucosa with clinically negative neck were recruited. Sentinel lymph node biopsy was carried out by peritumoral injection of 1-2 ml of 2.5% isosulphan blue dye. Any blue lymph node visualized during neck dissection was dissected out and sent for histological examination and immunohistochemistry for cytokeratin was performed using PAP peroxidase and anti-peroxidase method.
Results: Sentinel nodes were identified In 27 patients. A total of 37 sentinel nodes were harvested with average of 1.3 lymph nodes per neck, the harvest in our cases was lower than that reported in literature. Of the 37 harvested nodes, 14 were positive and 23 were negative for metastases. One of the 14 positive sentinel nodes (3.7%) patient showed micro metastases that were identified by cytokeratin immunostaining though this node was negative on histology. Out of 14 positive necks level Ib was positive in 6, Level IIa in 6 and Level Ia in 2 cases. Six patients had only sentinel nodes positive for metastases while others also had other positive nodes beside sentinel.
Conclusion: Results of the present study show that sentinel node biopsy using the blue dye alone is feasible, it further demonstrates an orderly spread in cancers of the buccal mucosa, none of the patients with negative sentinel nodes had node positivity in other nodes, suggesting a definite role of sentinel node biopsy in N0 cancers of the buccal mucosa.
World J Surg Med Radiat Oncol 2012; 1:1-8