4. Preoperative identification of the sentinel lymph node

Preoperatively we determined the neck status of all the patients with the ultrasound. The study included the patients with T1 and T2 cancers of the oral cavity and oropharynx in whom no suspicious lymph nodes were found by ultrasound.

identified the sentinel lymph node as the one which colored blue. With the use of gamma-ray

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If the accumulation was 3-times larger than that of its surroundings, we considered it as a warm node, and therefore as our sentinel lymph node. Most of the sentinel lymph nodes turned blue and accumulated the radioisotope. However, there were some lymph nodes which only turned blue or only accumulated the radiocolloid, but not both. We treated these as the sentinel ones as well. We removed all the nodes that were assumed as the sentinel ones from the dissected material and sent them separately to a histopathological examination with the serial slicing. The

detector, we confirmed the accumulation of the radioisotope in the lymph node.

rest of the lymph nodes were examined with the classic histopathological methods.

immunocytochemical staining with cytokeratin were used.

classification changed from N0 to N2b in 4 of 7 patients.

clonal mouse anti-human cytokeratin clone AE 1/AE 3) was used.

neck

lymph node.

8. Results

9. Discussion

7. Examination of the sentinel lymph node and dissected material of the

The sentinel lymph node was prepared by the pathologist in paraffin blocks with serial cuts at 100–150 microns. With serial cuts, the alternating staining with hematoxylin and eosin and

As a reagent for immunohistochemical staining, a reagent produced by Dako-Glostrup (mono-

All the remaining removed lymph nodes were examined with the classical methods of staining with hematoxylin and eosin in paraffin blocks with 1–3 slices along the longitudinal axis of the

Forty patients were treated with this method. In 18 out of 40 patients, we found metastases. In 10 of these 18 patients, the metastases were already discovered with the classical method (i.e., first cut of the sentinel lymph node). In 8 of the 18 patients with metastases, the metastases were only discovered after the serial slicing and immunocytochemical staining. In 3 of 10 patients in whom the metastases were already found with the classical method, the metastases were also found in the other lymph nodes, which meant that the N classification in these three patients changed from N0 to N2b. With the use of serial cuts of all sentinel lymph nodes, the

A final and accurate status of the neck provides us with a very good evaluation of the actual state of the neck and the need for eventual inclusion of the additional adjuvant radiotherapy. With the use of classical histopathological examination of removed lymph nodes after elective

Approximately, an hour before the surgical procedure, a lymphoscintigraphy of the tumor region was performed. The static and dynamic scintigraphy allowed for the localization of the sentinel lymph node, which was marked on the skin.
