Lymphatic Mapping With Isosulfan Blue Dye in Squamous Cell Carcinoma of the Head and Neck

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Abstract
ONE OF THE goals of head and neck surgeons treating squamous cell carcinoma of the head and neck (SCCHN) is the accurate identification of patients with clinically negative (N0) necks who harbor microscopic cervical metastases. Radiographic staging of the cervical lymphatics is imperfect because lymph nodes smaller than 1.0 cm are not considered suspicious by radiographic criteria yet may harbor metastatic disease.1 The most accurate method currently available for staging the N0 neck is pathologic examination of the neck contents after elective neck dissection. The identification of occult cervical metastases before neck dissection would represent an important advance in the treatment of patients with SCCHN. Since 60% to 70% of patients with N0 necks do not harbor occult regional metastases, preoperative diagnosis of microscopic metastases would identify the 30% to 40% of patients with N0 necks who would derive therapeutic benefit from neck dissection. Therefore, if there were a method to accurately identify occult metastases preoperatively, management of the N0 neck would be more selective and would reduce the overall morbidity and cost of treatment in cases that are now managed with the policy of elective neck dissection.