Ultrasound guided fine needle aspiration cytology of sentinel lymph nodes in head and neck cancer patients

Background. Ultrasound guide fine needle aspiration cytology (USgFNAC) of suspicious lymph nodes in a neck without palpable metastases (NO) in patients with head and neck cancer is an accurate staging method with high sensitivity and specificity. However, this method is not able to detect all non-palpable metastases. Our aim is to investigate whether staging can be improved with the combined use of a sentinel node procedure and subsequent USgFNAC of the lymph nodes at risk to harbor metastases. Methods. Twelve patients with squamous cell carcinoma (SCC) of the oral cavity and oropharynx who underwent lymphoscintigraphy and USgFNAC of sentinel node (SN) were studied. Five patients underwent surgery with an elective neck dissction. Cytology of the aspirated SNs was correlated to the histopathological outcome for each patient. From seven patients who underwent transoral excision, cytology of the SN was correlated to the development of a metastasis during follow-up. Results. In 11 patients a SN could be detected of which in 10 patients aspiration of the SN was possible. In the patients who underwent a neck dissection the SN correctly predicted the lymph node status of the neck, whereas 1 false negative USgFNAC was observed in the patients who were managed with neck observation. Conclusions. Lymphoscintigraphic detection and USgFNAC of the SN is feasible in NO HNSCC patients. A larger series of patients has to be investigated to see whether improvement of sensitivity of USgFNAC can be achieved by selective aspiration of the SN.