Can Sentinel Lymph Node Biopsy Predict Various Levels of Echelon Nodes in Oral Cancers?

Abstract

Introduction The efficacy of sentinel node biopsy in early stage oral cancer is well established. Its evolving role can be reinforced by further studies. Objective Analyzing the predictability of the levels of echelon nodes for various oral cavity tumor subsites on sentinel node biopsy. Methods A prospective study of 20 patients with stage I/II oral squamous cell carcinoma who underwent sentinel node biopsy-guided neck dissection between January 2017 and 2018 at our institute. The procedure included radiotracer injection, imaging (lymphoscintigraphy, single photon emission computed tomography-computed tomography), and gamma probe application. Sentinel node detection on imaging and gamma probe were compared. Results Out of 20 patients, 13 (65%) had carcinoma of the tongue, 6 (30%) had buccal mucosa carcinoma, and 1 (5%) had retromolar trigone carcinoma. The mean age of the patients was 52.3 years. A total of 13 (65%) patients were male, and 7 (35%) were female. The sentinel node identification rates with imaging and gamma probe were of 70% and 100% respectively. In tongue and retromolar trigone primaries, the most common first-echelon nodes in both modalities were levels IIA and IB respectively. For buccal mucosa primaries, first-echelon nodes were detected only with the gamma probe, which was level IB. On imaging, second-echelon nodes were detected only for tongue primaries, and had equivalent incidence of levels II, III, and IV. On the gamma probe, level IIA, followed by III, and IV for the tongue, and level IIA were the most common second-echelon nodes for the buccal mucosa. Third-echelon nodes were detected only with the gamma probe for tongue carcinoma at level IV. Conclusion The combined use of imaging and gamma probe provides the best results, with high identification rate and predictability of echelon levels.

A Systematic Review of Oral Biopsies, Sample Types, and Detection Techniques Applied in Relation to Oral Cancer Detection

“…SLNB uses frozen section analysis with H&E during surgery to determine the presence of metastasis in cancer. The conventional method is usually paraffin blocks followed by H&E staining [ 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 ] to examine for possible metastasis and further immunohistochemical (IHC) [ 83 , 85 , 87 , 88 , 91 , 92 , 96 , 98 , 101 ] analysis for cytokeratin (AE1/AE3) [ 38 , ...…”

“…SLNB uses frozen section analysis with H&E during surgery to determine the presence of metastasis in cancer. The conventional method is usually paraffin blocks followed by H&E staining to examine for possible metastasis and further immunohistochemical (IHC) [83,85,87,88,91,92,96,98,101] analysis for cytokeratin (AE1/AE3) [38,61,63,64,69,72,74,75,77,81,86] to reveal any undetected micro-metastasis if the node was free from tumors. However, the intraoperative pathology of SLNB is only moderately sensitive, and the final pathology examination might require several days.…”

Pretreatment Blood Markers in the Prediction of Occult Neck Metastasis: A 10-Year Retrospective Study

“…Sentinel Node Biopsy has been described as an alternative to END, for identifying occult neck metastasis in patients with early-stage OSCC [ 7 , 21 , 22 ] Nevertheless, procedural success rates for sentinel node identification and the accuracy in detecting occult lymphatic metastasis depend on technical expertise and experience [ 7 ]. On the other hand, despite evidence that Sentinel Node Biopsy benefits true pN0 patients, by sparing them the potential morbidity of neck dissection, its application in pN+ patients might prove deleterious, as it is not therapeutic for this group and exposes patients to two procedures, potentially leading to a delay in delivery of adjuvant treatment [ 2 ].…”