High rate of unexpected lymphatic drainage patterns and a high accuracy of the sentinel lymph node biopsy in oral cancer after previous neck treatment

Toom, Inne J den; Boeve, Koos; Weert, Stijn van; Bloemena, Elisabeth; Brouwers, Adrienne H.; Hoekstra, Otto S.; Keizer, Bart de; Vegt, Bert van der; Willems, Stefan M.; Leemans, C. René; Witjes, Max J. H.; Bree, Remco de

doi:10.1016/j.oraloncology.2019.05.007

Cited by 24 publications

(18 citation statements)

References 23 publications

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“…Furthermore, SLNB allows assessment of individual lymphatic drainage patterns and is able to detect aberrant drainage patterns (14,15). This feature is of particular benefit in OSCC, since even lateralized OSCC occasionally metastasizes to contralateral cervical lymph nodes [2.7% (95% CI 1.2-4.2%)] (8,9,14,(16)(17)(18)(19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“… 6 , 7 A meta‐analysis reported a high pooled sensitivity (87%) and negative predictive value (94%) for detecting occult metastasis using the SLNB procedure. 8 Advantages of the SLNB are individual drainage pattern assessment 9 and more comprehensive histological assessment of the lymph node allowing the detection of micrometastasis (0.2–2 mm) and isolated tumor cells (ITCs, metastasis size <0.2 mm). 7 Despite these advantages, the SLNB is still an invasive staging procedure.…”

Section: Introductionmentioning

confidence: 99%

Cortactin expression assessment improves patient selection for a watchful waiting strategy in pT1cN0‐staged oral squamous cell carcinomas with a tumor infiltration depth below 4 mm

et al. 2021

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Background In this feasibility study we aimed to evaluate the value of previously reported molecular tumor biomarkers associated with lymph node metastasis in oral squamous cell carcinoma (OSCC) to optimize neck strategy selection criteria. Methods The association between expression of cortactin, cyclin D1, FADD, RAB25, and S100A9 and sentinel lymph node status was evaluated in a series of 87 (cT1‐2N0) patients with OSCC treated with primary resection and SLNB procedure. Results Tumor infiltration depth and tumor pattern of invasion were independent prognostic markers for SLN status, while none of the tumor makers showed a better prognostic value to replace SLNB as neck staging technique in the total cohort. However, in the subgroup of patients with pT1N0 OSCC, cortactin expression (OR 16.0, 95%CI 2.0–127.9) was associated with SLN classification. Conclusions Expression of cortactin is a promising immunohistochemical tumor marker to identify patients at low risk that may not benefit from SLNB or END.

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“…A recent study by den Toom et al of patients who developed recurrent oral cavity SCC found that sentinel lymph node biopsy (SLNB) had a sensitivity of 75% for detecting occult lymph node metastasis, with a negative predictive value of 98%. 31 They also identified unexpected drainage patterns in 30% of patients, suggesting significant alterations in lymphatic channels by prior radiation or surgery. Robbins et al reported using super selective neck dissection (SSND) confined to one or two neck levels after radiation to the neck and found no regional recurrences after SSND among 30 patients.…”

Section: Discussionmentioning

confidence: 98%

Meta‐analysis of risk of occult lymph node metastasis in the irradiated, clinically N0 neck

et al. 2020

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Background Recurrent head and neck squamous cell carcinoma (HNSCC) after radiation is associated with poor survival, and management of the clinically negative (N0) neck during salvage surgery is controversial. Methods Studies were selected according to preferred reporting items for systematic reviews and meta‐analyses guidelines. Inclusion criteria were patients with HNSCC, prior radiation to the lateral neck nodal basin, undergoing salvage surgery for local recurrence, persistence or second primary, and N0 at time of salvage. Eleven studies with a total of 382 patients met inclusion criteria. Results The rate of occult metastasis was 15.4%. The pooled rate of occult nodal metastasis was 16.2% for oral cavity, 12.9% for oropharynx, 23.7% for hypopharynx, and 27.3% for supraglottic or transglottic tumors. There was a significantly higher relative risk of occult metastasis for locally advanced tumors. Conclusion Elective neck dissection at time of salvage surgery should be considered based on subsite, T classification, and prior history of nodal metastasis.

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High rate of unexpected lymphatic drainage patterns and a high accuracy of the sentinel lymph node biopsy in oral cancer after previous neck treatment

Cited by 24 publications

References 23 publications

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

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

Cortactin expression assessment improves patient selection for a watchful waiting strategy in pT1cN0‐staged oral squamous cell carcinomas with a tumor infiltration depth below 4 mm

Meta‐analysis of risk of occult lymph node metastasis in the irradiated, clinically N0 neck

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