Applicability of lymphoscintigraphy with sentinel node biopsy to eccrine carcinoma of the head and neck.
Overview
abstract
BACKGROUND: Eccrine carcinoma of the head and neck has the propensity to metastasize both to regional and distant sites. When associated with nodal metastasis, there is a high incidence of distant spread of disease, ultimately being associated with the death of the patient. Management of the patient with clinically negative nodes remains controversial. Although elective nodal dissection has been performed, the impact of this intervention remains indeterminate. This case series serves as a feasibility study for use of the technique of lymphoscintigraphy with sentinel node biopsy for eccrine carcinoma arising in the head and neck. METHODS: Two patients with eccrine carcinoma underwent sentinel node biopsy by way of the standard, three-part technique using lymphoscintigraphy, 1% isosulfan blue dye, and intraoperative use of the gamma probe. RESULTS: In each of these cases, the lymphoscintigram successfully identified sentinel lymph nodes. Intraoperative findings were significant for confirmation of sentinel nodes with the presence of blue dye in the lymph node. In one case, frozen section identified a positive sentinel lymph node, and the patient underwent definitive nodal dissection and postoperative radiotherapy. In the second case, immunohistochemistry as part of final pathology identified a single microscopic foci of metastatic eccrine carcinoma, for which the patient elected to receive definitive radiation therapy. CONCLUSIONS: This report documents the efficacy of lymphoscintigraphy with sentinel lymph node biopsy in identifying microscopic metastasis eccrine carcinoma in primary lesions arising in the head and neck.
