O.484 Fine needle aspiration cytology: the role of washings

Oral Presentations cell carcinoma with CT proven N0 necks. Patients with identifiable Sentinel Nodes on lymphoscintigraphy were entered in the study and nodes retrieved intraoperatively by hand held gamma probe and blue dye. A positive SN led to neck dissection within 3 weeks of biopsy. Results: In the period 2006−7 176 cases were recruited, (62% M, 38% F, 64% T1, 31% T2, 5% T3). Positive SNB occurred in 38 patients (22%), 9 of which had further positive nodes on neck dissection. False negative occurred in 7 cases, subsequently treated with neck dissection and adjuvant RT (2 with concomitant chemotherapy). Tumour recurrence after positive SNB and neck dissection occurred in 3 patients and a further 3 cases (all negative SNB) had a new primary. Complications were low (<5%). 5 patients excluded from the trial due to disease elsewhere or death from other causes. Conclusions: As a result of SNB 138 patients (78%) avoided neck dissection. All patients are disease free at mean of one year follow up. SNB has a sensitivity of 84% and a negative predictive value of 95%. O.482 European Sentinel Node Trial – positive node study B. Gurney, C. Schilling, L. Cascarini. Guy’s Hospital, London, UK Objectives: Sentinel node biopsy (SNB) is an established technique and its role is being explored in head and neck surgery. Preliminary data suggest that a positive sentinel node frequently exists in isolation and that if additional positive nodes are present, they lie anatomically close in the neck. If proven, it may allow a more conservative surgical approach to these patients. Methods: A European multi-centre retrospective study of patients with positive SNB was performed. Neck dissection pathology records were reviewed and the following retrieved: primary tumour histology, sentinel node pathology, number of positive nodes, treatment received, anatomical relationship of positive neck nodes to the positive sentinel node, nodal tumour content and presence of extra-capsular spread. The variables were correlated to patient outcome. Results: N = 34 patients had positive SNB (October 2005 to present) across 22 European Centres. 33% had positive neck disease upon subsequent neck dissection. Of these, 83% had neck disease in the same or adjacent anatomical neck basin to that of the positive sentinel node. In 17%, neck disease was found in a non-adjacent basin. Conclusions: The data suggest that if an oral cancer patient has a positive SNB, then in 2/3 of cases this will be the only cervical node with metastasis. If additional positive nodes are present, then the majority (83%) lie close to the positive sentinel node. Further work is needed to examine the reliability of this observation to establish whether with early occult disease, a standard neck dissection might be replaced by a more conservative procedure. O.483 Facial oncology surgery limits between sense and sensitivity E. Urtila1 , Z. Crainiceanu2 , E. Paraschivescu3 , F. Urtila3 . 1 UMF Victor Babes Timisoara, Timisoara, Romania; 2 Plastic Surgery Department, District Hospital Timisoara, Romania; 3 C.M.F. Surgery Department, Municipal Hospital Timisoara, Romania Oncological phatology of oral and maxilo-facial region is common, and evolutive stages of presentation in our clinic are different. In our study we will discuss about the situation of the patients who are in advanced stages of the disease. In those cases are several problems to take in discussion: – Local and general condition of the patient allows the surgical intervention with minimal risk;

Pathology and surgery of the maxillo-facial malignancies II

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– Immediate post operator consequences, linked to anatomic and functional conecerns; – Patinent benefit regarding the evolutin after the surgery; – How and with what results the anatomic and functional sequels after the intervention may be ameliorated; – Life impact of these patiens in society and family; – What is the social and psychical impact, for the pacient and the family, after extensive surgery with large post operator aesthetic sequels. These are some of the problems that we want to discuss, trying to find opinions of specialists regarding these cases. What we could observe is that pacients with a lower educational background accept better postoperative situation, and some of them actually try to find preoccupations corresponding to their condition. O.484 Fine needle aspiration cytology: the role of washings T. Daniel, T. Pepper, R. Anand, S. D’Sa, M. Al-Gholmy, P.A. Brennan. Queen Alexandra Hospital, Portsmouth, UK Introduction:Fine needle aspiration cytology (FNAC) was first described in 1930 and its use in diagnosis of head and neck lumps is well documented [1,2]. The sensitivity of this technique is reliant on an adequate technique and good cytologist. We have recently shown in a separate study that sensitivity is not compromised with the use of a 23gauge needle but patient comfort is significantly increased. In order to increase sensitivity it has been shown that needle washings can be used and one study has done this utilising a 21 gauge (green) needle [3]. We therefore wanted to determine whether washings from an FNAC undertaken with a 23 gauge needle and fixing them was a clinically useful additional procedure when performing fine needle aspiration cytology. Methods: This was a prospective study of fifty consecutive patients on whom FNAC was performed by a single operator. After FNAC biopsy using a standard technique, 1 ml of fixative was drawn into the syringe, agitated, and evacuated on to a slide for cytology. Results: Of 50 cases, six FNA biopsies (12%) were inadequate, 38 (76%) were diagnostic, and in six (12%) the standard FNA biopsy was inadequate but the washing provided the diagnosis. Conclusions: The results confirm that washing of the syringe and needle is a worthwhile additional procedure to undertake when performing FNA cytology. Washings enhance the diagnostic ability of the FNA technique. References [1] Martin, H. E. and Ellis, E. B. (1930) Biopsy by needle puncture and aspiration. Annals of Surgery, 92: 169–181. [2] Shah KA. How I do it: Fineneedle aspiration. The Journal of Laryngology & Otology June 2003, Vol. 117, pp. 493–495. [3] N. Patel, J. Gill, A. Al-Shammari, H. M. B. Khalil and C. R. Chowdhury. Fine needle aspiration cytology – are we getting it right? Department of Otolaryngology, Harold Wood Hospital, Essex, England, UK International Congress Series Volume 1240, October 2003, Pages 1399–1402. O.485 Identification of SN using CT lymphograpy in oral cancer Y. Ueyama, K. Uchida, K. Harada, M. Mihara, Ta. Mano. Dept. of Oral & Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan Objectives: Sentinel node (SN) assessment for patients with oral cancer has usually used lymphoscintigraphy with radiolabeled colloids, interstitial administration of vital blue dye, or both. However, there is the possibility that distal lymph nodes will be identified as SNs by these methods. Then we use computed