Visiting professor discusses lymph node testing for oral cancers

David Kutler, MD, chief of the Division of Head and Neck Surgery of the Department of Otolaryngology – Head and Neck Surgery at Weill Cornell Medicine, recently was the visiting professor at Houston Methodist where he conducted Grand Rounds on “Novel uses and techniques for sentinel lymphoscintigraphy in oral cavity cancer.” Sentinel lymphoscintigraphy is a nuclear test he commonly uses to treat oral cavity cancers. Dr. Kutler said he chose the topic because he wanted to speak on a subject that was not commonly conducted at Houston Methodist, and it would be “a true learning experience” for those in attendance.

David Kutler, MD

“My hope was by teaching a procedure they don’t use as much, they would be interested, do more of it and maybe start their own program,” Dr. Kutler said. At Weill Cornell, he said, he sees a lot of oral cavity cancer and uses sentinel lymph node dissection to treat oral cavity cancers instead of elective neck dissection and, thus, the procedure is far less invasive.

“We are comparing sentinel node for oral cavity results to what we do now – neck dissection – to see if we get the same results,” he said, pointing out that nearby MD Anderson Cancer Center currently is conducting a large-scale comparison of the two procedures.

In lymphoscintigraphy, a nuclear tracer is injected around the tumor. The tracer gets taken up by the lymphatic pathways in the neck; the first lymph node to take up the tracer is the “sentinel node.” These sentinel lymph nodes are then removed and can determine if the oral cavity cancer has spread to the lymph nodes in the neck. Dr. Kutler said that the incidence of oral cavity cancer has decreased in modern times with less smoking and better health knowledge. “We now see younger non-smoking patients more often and with earlier stage tumors. We can make a diagnosis sooner for better outcomes.”

I was amazingly impressed with Houston Methodist. They have a lot of funds and capacity, a great amount of equipment and ability to teach various procedures. It’s an impressive setup.

David Kutler, MD

Chief of the Division of Head and Neck Surgery of the Department of Otolaryngology – Head and Neck Surgery at Weill Cornell Medicine

When he was in Houston, Dr. Kutler also met with residents from different hospital systems as well as Houston Methodist’s residents, spoke to the Houston Society of Otolaryngology – Head and Neck Surgery (ENT Society) and sampled a traditional Texas steak from one of Houston’s famous restaurants. “The City of Houston and Houston Methodist simply have a lot of space that, let’s face it, New York will never have,” said Dr. Kutler. He was likewise impressed with the Houston Methodist Institute for Technology, Innovation & Education (MITIE). MITIE’s high-tech simulation spaces, access to a world-class imaging center and integrated audiovisual and virtual reality capabilities encompass a comprehensive unique training system. A center of innovation, MITIE offers a wide spectrum of training, clinical research and industry development resources. Of even greater value is MITIE’s access to the combined expertise of professionals from across Houston Methodist. “I was amazingly impressed with Houston Methodist. They have a lot of funds and capacity, a great amount of equipment and ability to teach various procedures. It’s an impressive setup.”