A Study to Detect Sentinel Lymph Node by Methylene Blue Dye and Histopathological Confirmation of Metastasis in Oral Squamous Cell Carcinoma Patient
Background: Oral Squamous Cell Carcinoma (OSCC) first metastasizes via lymphatic route and the first draining lymph node is Sentinel Lymph Node (SLN). SLN is identified by combine use of nuclear imaging and dye method, as nuclear imaging facility is expensive, not easily available and radioactive materials have more potential complications so dye alone can be an alternative.
Aims: To assess the feasibility of using methylene blue dye (MBD) for detection of SLN in OSCC patient and using frozen section analysis to analyze metastatic status of SLN.
Method: 20 patients with the histopathological diagnosis of OSCC, irrespective of stage underwent SLN identification by using a peritumoral injection of MBD. Surgery of neck was done first with reflection of subplatysmal flap to identify blue-stained node as SLN in the neck region and sent for frozen section analysis. Surgery was completed with primary resection and neck dissection. Histopathological analysis of SLN was done later.
Results: SLN was identified in level Ib and II in 18 cases (identification rate=90%). The accuracy, sensitivity, specificity, PPV and NPV of SLN biopsy with frozen section analysis were 94%, 92.3%, 100%, 100%, 83.3% respectively.
Conclusion: Methylene blue dye alone can be successfully used to detect sentinel lymph node in OSCC patient. SLN biopsy with frozen section analysis is sensitive enough to detect the metastatic status of regional lymph node.
Capote A, Escorial V, Muñoz-Guerra M, Rodríguez-Campo F, Gamallo C, Naval L. Elective neck dissection in early-stage oral squamous cell carcinoma—does it influence recurrence and survival? Head & Neck. 2006, 29(1):3-11
Noguti J, Moura CFG de, Jesus GPP de, Silva VHP da, Hossaka TA, Oshima CTF, et al. Metastasis from Oral Cancer: An Overview. Cancer Genomics Proteomics [Internet]. 2012, 9(5):329-35
Hornstra M, Alkureishi L, Ross G, Shoaib T, Soutar D. Predictive factors for failure to identify sentinel nodes in head and neck squamous cell carcinoma. Head & Neck. 2008, 30(7):858-862
Don DM, Anzai Y, Lufkin RB, Fu Y-S, Calcaterra TC. Evaluation of cervical lymph node metastases in squamous cell carcinoma of the head and neck. Laryngoscope. 1995, 105:669-674
Choi SH, Barsky SH, Chang HR. Clinicopathologic analysis of sentinel lymph node mapping in early breast cancer. Breast J [Internet]. 2003, 9(3):153-162
Kowalski LP, Sanabria A. Elective neck dissection in oral carcinoma: a critical review of the evidence. Acta Otorhinolaryngol Ital organo Uff della Soc Ital di Otorinolaringol e Chir Cerv-facc [Internet]. 2007, 27(3):113-117
Blessing WD, Stolier AJ, Teng SC, Bolton JS, Fuhrman GM. A comparison of methylene blue and lymphazurin in breast cancer sentinel node mapping. Am J Surg. 2002, 184(4):341-345
Nour A. Efficacy of Methylene Blue Dye in Localization of Sentinel. Breast J. 2004, 10(5):388-391 2014, 10(2):88-91.
Thevarajah S, Huston TL, Simmons RM. A comparison of the adverse reactions associated with isosulfan blue versus methylene blue dye in sentinel lymph node biopsy for breast cancer. Am J Surg. 2005, 189(2):236-239
Waal I Van Der, Freeman JL, Snow GB. The Incidence of Micrometastases in. 1996, (August):987-991Waal, I. Van Der, Freeman, J. L., Snow, G.
Habib MA, Rahman QB, Hossain S, Imon AA, Kundu GC. Effectiveness of preoperative lymphoscintigraphy for the detection of cervical lymph node metastasis in patients with oral squamous cell carcinoma. Ann Maxillofac Surg. 2017, 7:30-36
Byakodi R, Byakodi S, Hiremath S, Byakodi J, Adaki S, Marathe K, et al. Oral cancer in India: An epidemiologic and clinical review. J Community Health. 2012, 37(2)
Calabrese L, Bruschini R, Ansarin M, Giugliano G, De Cicco C, Ionna F, et al. Role of sentinel lymph node biopsy in oral cancer. Acta Otorhinolaryngol Ital organo Uff della Soc Ital di Otorinolaringol e Chir Cerv-facc. 2006, 26(6):345-349
Peng H, Wang SJ, Niu X, Yang X, Chi C, Zhang G. Sentinel node biopsy using indocyanine green in oral/oropharyngeal cancer. World J Surg Oncol [Internet]. 2015, 13:278
Ozdemir A, Mayir B, Demirbakan K, Oygur N. Efficacy of Methylene Blue in Sentinel Lymph Node Biopsy for Early Breast Cancer. The Journal of Breast Health. 2014, 10(2):88-91
Ramamurthy R, Kottayasamy Seenivasagam R, Shanmugam S, Palanivelu K. A Prospective Study on Sentinel Lymph Node Biopsy in Early Oral Cancers Using Methylene Blue Dye Alone. Indian J Surg Oncol. 2014, 5(3):178-183
Wu H, Ying H, Xi X, Shen N, Shu Y, Hoffman MR, et al. Localization of the sentinel lymph node in tongue VX2 carcinoma via indirect CT lymphography combined with methylene blue dye injection. Acta Otolaryngol [Internet]. 2010, 130(4):503-510
Shah JP. Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Am J Surg. 1990, 160(4):405-409
Ross G, Shoaib T, Soutar DS, et al. The use of sentinel node biopsy to upstage the clinically n0 neck in head and neck cancer. Arch Otolaryngol Neck Surg [Internet]. 2002, 128(11):1287-1291
Sangwan P, Nilakantan A, Patnaik U, Mishra A, Sethi A. Sentinel Lymph Node Localization Using 1 % Isosulfan Blue Dye in Cases of Early Oral Cavity and Oropharyngeal Squamous Cell Carcinoma. Indian J Otolaryngol Head Neck Surg [Internet]. 2015, 67(S1):56-61
Payoux P, Dekeister C, Lopez R, Lauwers F, Esquerré JP, Paoli JR. Effectiveness of lymphoscintigraphic sentinel node detection for cervical staging of patients with squamous cell carcinoma of the head and neck. J Oral Maxillofac Surg [Internet]. 2005, 63(8):1091-1095
- There are currently no refbacks.