Sentinel lymph node biopsy in squamous cell carcinoma of the head and neck: where we stand now, and where we are going.

Background and objectives: This review was performed to evaluate the existing literature on sentinel lymph node biopsy (SLNB) for early-stage oral and oropharyngeal head and neck squamous cell carcinoma (HNSCC) in clinically negative (N0) necks.

Methods: A Medline search identified 43 pertinent published trials and reviews in the English-language literature from 1990 to 2005.

Results: Recent studies consistently show high sensitivities > 93% for T1 and T2 HNSCC. SLNB has the potential to replace neck dissection in those patients. Data on T3 and T4 tumours are not as promising, although research is currently under way to determine the true metastasis detection rate. Appropriate technique is crucial for the complete detection of the sentinel nodes. For HNSCC sentinel lymphadenectomy, many studies have advocated the use of a colloid tracer and gamma probe detector, as well as the harvesting of a total of three nodes as a good standard technique.

Conclusions: American multicentre trials are currently under way gathering crucial data on this technique. It is very likely that SLNB will become indicated for T1 and T2 oral cavity squamous cell carcinoma with N0 necks, and it is possible that the indication will extend to all early-stage HNSCCs. However, more research will be necessary for advanced head and neck cancers.