Clinical examination alone is not sufficient to precisely evaluate lymph node involvement in head and neck cancer. The results of computed tomography of the neck and lymphoscintigraphy were evaluated in 21 patients with carcinoma of the mouth and oropharynx staged N0. Nine patients were treated by homolateral and 12 by bilateral neck dissection. Sensitivity and specificity of computed tomography were 16% and 73% for homolateral side and 0% and 90% for contralateral side, respectively. Lymphatic drainage was observed in 76.2% of the cases. No-migration was associated with cases involving the retromolar region and tonsillar fossa, where injection of the 99mTc-Dextran 500 is more difficult. Bilateral migration occurred only in carcinomas of the floor of the mouth, with involvement of the midline. From these results it was concluded that computed tomography was less efficient than clinical examination. Nevertheless, it must be considered that conventional computed tomography was used. We are currently undertaking similar studies with helical computed tomography. Lymphoscintigraphy showed promising results, and the same method to evaluate sentinel lymph nodes in patients with carcinoma of the mouth is being used.
Scintigraphy; Nuclear medicine; Computed tomography
