Sentinel Node Detection Using Rouviere's Scheme Dissection in Laryngeal Cancer. A Retrospective Analysis of 170 Cases.

Advanced head and neck squamous cell carcinoma (SCC) is a disease that metastasizes predominantly to the locoregional lymph nodes. The presence of regional metastases is crucial for staging, therapeutic decision making and prognosis. For patients with clinically negative neck nodes, there are two major management strategies: elective neck dissection or follow-up. Sentinel lymph node biopsy (SLNB) using radioisotope injection has been developed for breast cancer and cutaneous melanoma, and this method is considered the gold standard for SLNB, although in head and neck cancer, the method is not widely accepted because the radioisotope injection has to be performed under general anesthesia. This study aimed to evaluate the diagnostic reliability of sentinel lymph node biopsy in SCC of the larynx, identified using Rouvière’s scheme dissection, and that can be routinely excised without contrast-enhancement. A systematic clinical and pathological review was performed of 1500 cases of laryngectomy subjected to radical or functional neck dissection. Most patients had a tumor with negative (pN0) lymph nodes. Among 170 patients with neck metastases there were 125 cases with 1 or 2 positive nodes and 45 cases with 3 or more metastatic nodes. The most frequent loci of metastasis were the Kuttner, the omohyoid or the prelaryngeal lymph nodes; in 159 cases one or more of these were involved. In 11 cases the metastasis affected other different nodes. The possible causes of these exceptions are also investigated. In conclusion, the Kuttner, omohyoid and prelaryngeal lymph nodes are eminently suitable for use as sentinel lymph nodes.