Archives of Otol

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American Head & Neck Society
July 21-25, 2012
Metro Toronto Convention Centre
Toronto, ON, Canada

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Presentation: P101
Topic: Management of the Neck
Type: Poster
Date: Sunday - Tuesday, July 22 - 24, 2012
Session: Designated Poster viewing times
Authors: Nirav P Trivedi, MS MCH, Vikram Kekatpure, Moni Kuriakose, Subramania Iyer, krishnakumar Thankappan
Institution(s): Mazumdar-Shaw Cancer Center & Narayana Hrudayalaya, Bangalore, India.


Sentinel node biopsy (SNB) has been proposed as method to identify occult metastasis in head and neck cancer. Various methods of pathological evaluation have enabled us to identify smaller pathological and subpathological occult metastasis. It is important to demonstrate clinical significance of smaller metastasis in order to implement these findings in clinical practice.

Methods and Materials:

As a part of ongoing trial, total 80 patients were randomized in two arms (42 in Arm I and 38 in Arm II). All patients underwent SNB upfront and nodes were evaluated by standard pathological examination and serial step sectioning technique. Occult metastasis were subclassified as macrometastasis, micrometastasis and isolated tumor cells (ITC). All patients in Arm I underwent neck dissection while only those patients with macrometastasis in Arm II underwent neck dissection. Patients were followed up for two years for loco-regional recurrence.


Total 20 patients had occult metastasis (10 in each arm). Macrometastasis was identified in 5 cases in Arm I and 3 cases in Arm II while micrometastasis in 5 cases in Arm I and 2 cases in Arm II. ITC were identified in 5 cases in Arm II (cluster of cells-3, single cells-2). Seven patients with micrometastasis and ITC in Arm II were observed and 3 of them developed neck failure. Two of them had ITC (cluster of cells) and one had micrometastasis.


Smaller occult metastasis like micrometastasis and ITC can cause clinically significant disease and elective neck treatment may be performed for them.

Key words: Sentinel lymph node, lymphoscintigraphy, occult metastasis, micrometastasis, isolated tumor cells, lymph node metastasis, clinical significance.



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