scholarly journals Elective Neck Dissection or Sentinel Lymph Node Biopsy in Early Stage Oral Cavity Cancer Patients: The Dutch Experience

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1783 ◽  
Author(s):  
Inne J. den Toom ◽  
Koos Boeve ◽  
Daphne Lobeek ◽  
Elisabeth Bloemena ◽  
Maarten L. Donswijk ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Oral Cancer ◽  
Neck Dissection ◽  
Early Stage ◽  
Lymph Node Biopsy ◽  
Elective Neck Dissection ◽  
Floor Of Mouth ◽  
Node Biopsy

Background: Sentinel lymph node biopsy (SLNB) has been introduced as a diagnostic staging modality for detection of occult metastases in patients with early stage oral cancer. Comparisons regarding accuracy to the routinely used elective neck dissection (END) are lacking in literature. Methods: A retrospective, multicenter cohort study included 390 patients staged by END and 488 by SLNB. Results: The overall sensitivity (84% vs. 81%, p = 0.612) and negative predictive value (NPV) (93%, p = 1.000) were comparable between END and SLNB patients. The END cohort contained more pT2 tumours (51%) compared to the SLNB cohort (23%) (p < 0.001). No differences were found for sensitivity and NPV between SLNB and END divided by pT stage. In floor-of-mouth (FOM) tumours, SLNB had a lower sensitivity (63% vs. 92%, p = 0.006) and NPV (90% vs. 97%, p = 0.057) compared to END. Higher disease-specific survival (DSS) rates were found for pT1 SLNB patients compared to pT1 END patients (96% vs. 90%, p = 0.048). Conclusion: In the absence of randomized clinical trials, this study provides the highest available evidence that, in oral cancer, SLNB is as accurate as END in detecting occult lymph node metastases, except for floor-of-mouth tumours.

scholarly journals Contralateral Regional Recurrence in Lateralized or Paramedian Early-Stage Oral Cancer Undergoing Sentinel Lymph Node Biopsy—Comparison to a Historic Elective Neck Dissection Cohort

2021 ◽  
Vol 11 ◽  
Author(s):  
Rutger Mahieu ◽  
Inne J. den Toom ◽  
Koos Boeve ◽  
Daphne Lobeek ◽  
Elisabeth Bloemena ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Neck Dissection ◽  
Early Stage ◽  
Lymph Node Biopsy ◽  
Elective Neck Dissection ◽  
Depth Of Invasion ◽  
Nodal Metastases ◽  
Node Biopsy

Introduction: Nowadays, two strategies are available for the management of the clinically negative neck in early-stage (cT1-2N0) oral squamous cell carcinoma (OSCC): elective neck dissection (END) and sentinel lymph node biopsy (SLNB). SLNB stages both the ipsilateral and the contralateral neck in early-stage OSCC patients, whereas the contralateral neck is generally not addressed by END in early-stage OSCC not involving the midline. This study compares both incidence and hazard of contralateral regional recurrences (CRR) in those patients who underwent END or SLNB.Materials and Methods: A retrospective multicenter cohort study, including 816 lateralized or paramedian early-stage OSCC patients, staged by either unilateral or bilateral END (n = 365) or SLNB (n = 451).Results: The overall rate of occult contralateral nodal metastasis was 3.7% (30/816); the incidence of CRR was 2.5% (20/816). Patients who underwent END developed CRR during follow-up more often than those who underwent SLNB (3.8 vs. 1.3%; p = 0.018). Moreover, END patients had a higher hazard for developing CRR than SLNB patients (HR = 2.585; p = 0.030). In addition, tumor depth of invasion was predictive for developing CRR (HR = 1.922; p = 0.009). Five-year disease-specific survival in patients with CRR was poor (42%) compared to patients in whom occult contralateral nodal metastases were detected by SLNB or bilateral END (88%), although not statistically different (p = 0.066).Conclusion: Our data suggest that SLNB allows for better control of the contralateral clinically negative neck in patients with lateralized or paramedian early-stage OSCC, compared to END as performed in a clinical setting. The prognosis of those in whom occult contralateral nodal metastases are detected at an earlier stage may be favorable compared to those who eventually develop CRR, which highlights the importance of adequate staging of the contralateral clinically negative neck.

Sentinel Lymph Node Biopsy Versus Elective Neck Dissection for Stage I to II Oral Cavity Cancer

2018 ◽  
Vol 129 (1) ◽  
pp. 162-169 ◽  
Author(s):  
John D. Cramer ◽  
Shaum Sridharan ◽  
Robert L. Ferris ◽  
Umamaheswar Duvvuri ◽  
Sandeep Samant
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Oral Cavity ◽  
Neck Dissection ◽  
Oral Cavity Cancer ◽  
Lymph Node Biopsy ◽  
Stage I ◽  
Elective Neck Dissection ◽  
Node Biopsy

scholarly journals OC-020 Sentinel lymph node biopsy for early stage oral cancer; experience of 3 Dutch Head and Neck centers

2019 ◽  
Vol 132 ◽  
pp. 12-13
Author(s):  
I. Den Toom ◽  
K. Boeve ◽  
R. Van Es ◽  
B. De Keizer ◽  
S. Van Weert ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Oral Cancer ◽  
Head And Neck ◽  
Early Stage ◽  
Lymph Node Biopsy ◽  
Node Biopsy ◽  
Cancer Experience

scholarly journals Sentinel lymph node biopsy in early oral cavity tumors: evaluation of the oncologic efficacy compared to elective neck dissection

2018 ◽  
Vol 47 (1) ◽  
Author(s):  
Marco Roberto Seferin ◽  
Fábio Roberto Pinto ◽  
Chin Shien Lin ◽  
Ana Kober Nogueira Leite ◽  
Paulo Vitor Sola Gimenes ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Oral Cavity ◽  
Neck Dissection ◽  
Lymph Node Biopsy ◽  
Elective Neck Dissection ◽  
Node Biopsy

scholarly journals What is the role of sentinel lymph node biopsy in the management of oral cancer in 2020?

2020 ◽  
Author(s):  
Remco de Bree ◽  
Bart de Keizer ◽  
Francisco J. Civantos ◽  
Robert P. Takes ◽  
Juan P. Rodrigo ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Neck Dissection ◽  
Lymph Node Biopsy ◽  
Current Evidence ◽  
Elective Neck Dissection ◽  
Selective Neck Dissection ◽  
Advantages And Disadvantages ◽  
Node Biopsy

AbstractApproximately 70–80% of patients with cT1-2N0 oral squamous cell carcinoma (OSCC) ultimately prove to have no cancer in the cervical lymphatics on final pathology after selective neck dissection. As a result, sentinel lymph node biopsy (SLNB) has been adopted during the last decade as a diagnostic staging method to intelligently identify patients who would benefit from formal selective lymphadenectomy or neck irradiation. While not yet universally accepted, SLNB is now incorporated in many national guidelines. SLNB offers a less invasive alternative to elective neck dissection (END), and has some advantages and disadvantages. SLNB can assess the individual drainage pattern and, with step serial sectioning and immunohistochemistry (IHC), can enable the accurate detection of micrometastases and isolated tumor cells (ITCs). Staging of the neck is improved relative to END with routine histopathological examination. The improvements in staging are particularly notable for the contralateral neck and the pretreated neck. However, for floor of mouth (FOM) tumors, occult metastases are frequently missed by SLNB due to the proximity of activity from the primary site to the lymphatics (the shine through phenomenon). For FOM cancers, it is advised to perform either elective neck dissection or superselective neck dissection of the preglandular triangle of level I. New tracers and techniques under development may improve the diagnostic accuracy of SLNB for early-stage OSCC, particularly for FOM tumors. Treatment of the neck (either neck dissection or radiotherapy), although limited to levels I–IV, remains mandatory for any positive category of metastasis (macrometastasis, micrometastasis, or ITCs). Recently, the updated EANM practical guidelines for SLN localization in OSCC and the surgical consensus guidelines on SLNB in patients with OSCC were published. In this review, the current evidence and results of SLNB in early OSCC are presented.

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