Sentinel lymph node biopsy versus elective neck dissection in squamous cell carcinoma of the oral cavity with a clinically N0 neck: Systematic review and meta‐analysis of prospective studies

Abstract

Sentinel lymph node biopsy (SLNB) is an emerging strategy for managing early‐stage oral squamous cell carcinoma (SCC) with a clinically N0 (cN0) neck. However, the role of SLNB in this scenario is debatable. Herein, relevant literature was systematically reviewed, and a meta‐analysis was performed to evaluate the potential dividends of SLNB compared to elective neck dissection (END) for these patients. The meta‐analysis, including six prospective studies, showed comparable results of the two management strategies in terms of regional recurrence (risk ratio [RR] = 0.99; 95% confidence interval [CI], 0.58–1.70), 5‐year disease‐free survival (RR = 0.99; 95% CI, 0.87–1.11), and 5‐year overall survival (RR = 1.01; 95% CI, 0.90–1.13). Fewer adverse events occurred in the SLNB arm than in the END arm (RR = 0.12; 95% CI, 0.02–0.70). Overall, SLNB results in as favorable an oncologic prognosis for patients with cN0 oral SCC as END, while significantly lessening side effects and unnecessary surgeries.

Sentinel lymph node biopsy in high‐risk cutaneous squamous cell carcinoma of the head and neck: Systematic review and meta‐analysis

“…As already stated above, several papers demonstrated the feasibility of SLNB in head and neck cutaneous melanoma and mucosal oral cavity tumors. [24][25][26][27][28] On the other hand, some aspects should be considered when dealing with a cSCCHN in terms of lymph node basins. In fact, the lymphatic network of the head and neck area is extremely complex if compared to other regions.…”

Centralised pathology service for sentinel node biopsy in oral cavity cancer: The Southeast England Consortium experience

“…Recent years have seen a growing body of evidence to indicate that SNLB, with completion neck dissection where necessary, has similar patient survival outcomes as END for the management of the N0 neck in early stage OSCC. [8][9][10][11]20 Furthermore, cost and quality of life analyses appear to favour SNLB over END in these patients. 12,21,22 Given these observations, several authorities recommend SLNB as the standard of care in cT1-2 N0 OSCC, while some professional bodies recommend that all patients with this disease should have access to the procedure.…”

“…Recent years have seen a growing body of evidence to indicate that SNLB, with completion neck dissection where necessary, has similar patient survival outcomes as END for the management of the N0 neck in early stage OSCC 8–11,20 . Furthermore, cost and quality of life analyses appear to favour SNLB over END in these patients 12,21,22 .…”

“…Recent reports indicate similar survival outcomes between SLNB and END, [8][9][10][11] while emerging evidence suggests reduced morbidity in the former. 10,12 These findings have led several authorities to recommend SLNB over END in the management of T1-2 N0 OSCC. 7,13,14 However, due to logistic challenges such as training of the multidisciplinary team and compliance to stringent regulatory protocols, SLNB is currently only limited to a few centres.…”

“…Recent reports indicate similar survival outcomes between SLNB and END, [8][9][10][11] while emerging evidence suggests reduced morbidity in the former. 10,12 These findings have led several authorities to recommend SLNB over END in the management of T1-2 N0 OSCC.…”