Sentinel lymph node biopsy reduces the incidence of secondary neck metastasis in patients with oral squamous cell carcinoma

Abstract

Abstract. It has recently been established that sentinel node biopsy (SNB) is an applicable and feasible procedure for the prediction of neck lymph node status in patients with early oral squamous cell carcinoma (OSCC) who are clinically negative for neck metastasis (cN0). The aim of this study was to retrospectively compare excision followed by watchful waiting with excision and SNB, in order to determine the effectiveness of SNB. A total of 125 patients with cN0 early OSCC were divided into two groups, namely the excision alone (n=78) and excision with SNB (n=47) groups. The clinical data of these two groups between 2006 and 2013 were analyzed. In the excision with SNB group, the negative predictive value and false-negative rate of SNB were 94% (30̸32) and 18% (2̸11), respectively. Secondary neck metastasis, also known as delayed neck metastasis, occurred in 24.2% of the patients in the excision alone group and 4.9% of the patients in the excision with SNB group. The 5-year overall survival (OS) rates were 84.0 and 97.5% in the excision alone and excision with SNB groups, respectively. Significant differences were found in the rate of secondary neck metastasis and OS between the two groups. SNB may be effective in the detection of occult neck lymph node metastasis, with a reduction in the incidence of secondary neck metastasis and improvements in the 5-year OS in patients with early-stage (stage I̸II) oral cancer. IntroductionThe status of lymph nodes in the neck is the most important prognostic factor for oral squamous cell carcinoma (OSCC). The rate of secondary neck metastases of OSSC is ~20-30% (1-6). Even with advanced modern imaging techniques, including computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US) and fluorodeoxyglucose positron emission tomography (FDG-PET), the accuracy of current diagnostic imaging does not exceed 80% (2).The treatment strategies for early-stage oral cancer clinically negative for neck metastasis (cN0) include performing elective neck dissection (END) or opting for the watchful waiting approach. END is currently the standard treatment for patients in the absence of positive lymph nodes on imaging tests. Some reports recommend END, as it reduces the risk of uncontrolled disease (2,3). Furthermore, a recent meta-analysis of randomized controlled trials suggested a survival advantage with END (7). However, ≤70% of patients undergo unnecessary neck dissection, resulting in decreased quality of life (8,9).Therefore, accurate detection of occult metastases is crucial, as it allows for appropriate treatment planning.With respect to sentinel node biopsy (SNB) in oral cancer, large multi-institutional clinical trials have been conducted (10,11) and numerous studies have demonstrated that SNB is associated with predictably high accuracy in identifying occult metastasis (10,12).The objective of this study was to determine the benefits of SNB for cN0 disease. We retrospectively compared long-term survival following excision alone or excision and SNB in patients wit...

Usefulness of Sentinel Lymph Node Biopsy for Oral Cancer: A Systematic Review and Meta‐Analysis

“…Two authors individually collected data from included articles in forms commensurate with each other. Diagnostic accuracy, represented by DOR, summary receiver operating characteristic (SROC) curve, and area under the curve (AUC), was calculated 1,5,11–102 . DOR was calculated as (true positive [TP]/false positive [FP])/(false negative [FN]/true negative [TN]) to assess diagnostic accuracy with 95% confidence intervals (CIs).…”

Sentinel Lymph Node Biopsy Versus Elective Node Dissection in Stage cT1‐2N0 Oral Cavity Cancer

“…We used Meta-Essentials to test publication bias (Erasmus Research Institute, Rotterdam, the Netherlands). 35 There were five retrospective studies included in the analysis, [14][15][16]20,22 which all have an inherent risk of bias in selection of participants based on methods for exclusion of patients.…”

“…There were 10 studies included in our analysis, published between 2014 and 2021, with sample sizes ranging from 70 to 8328 patients diagnosed with cT1-T2N0 OCSCC. [14][15][16][17][18][19][20][21][22][23] The total cohort contained 10,498 patients with 1,396 in the SNB group and 9,102 in the END group. Study characteristics are summarized in Table II.…”

Efficacy of different sentinel lymph node biopsy protocols in oral squamous cell carcinoma: Systematic review and meta‐analysis

“…Out of the 23 1,17–38 articles, 15 were prospective 1,18,19,21,24–28,30–32,34,37,38 and eight were retrospective 18,20,22,23,29,33,35,36 . All of the articles considered tumors on the tongue, as well as other locations in the oral cavity.…”