Another controversy surrounding elective neck dissection concerns the value of sentinel node biopsy. Considering the experience with this technique in patients with melanoma and breast cancer, it is anticipated that gamma probe-directed biopsy of the sentinel node may be useful in the management of the NO neck in patients with squamous cell carcinoma of the head and neck. To that end, a recent study of 5 patients conducted by Koch et al.12 showed that identification and biopsy of the sentinel node are feasible in these patients. However, a number of substantial problems were identified: (1) the proximity of the primary tumor obscures the lymphoscintigram, particularly when the tumor is located in the oral cavity; (2) intramucosal injection of the radiolabeled material is more difficult than intradermal injections and the isotope often extrudes into the saliva; and (3) some sites in the head and neck are inaccessible, and the technique is limited in patients who have been previously irradiated. According to these investigators, their observations "cast doubt on the general applicability and utility of the technique" for squamous cell carcinoma of the head and neck.12
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