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

Abstract

Objective We assessed the diagnostic accuracy of sentinel lymph node biopsy (SLNB) for detecting neck nodal metastasis in early oral squamous cell carcinoma (OSCC) as an alternative to elective neck dissection. Study Design A systematic search for relevant literature was conducted in the PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases. Methods Two reviewers individually searched the five databases up to November 2019. For studies that met inclusion criteria, data on patient diagnoses were pooled, including true positives, true negatives, false positives, and false negatives. Methodological quality was checked with the Quality Assessment of Diagnostic Accuracy Studies (version 2) tool. Results In total, 98 observational or retrospective studies were included. The diagnostic odds ratio of SLNB was 326.165 (95% confidence interval [CI]: 231.477–459.587; I2 = 0%). The area under the summary receiver operating characteristic curve was 0.982. Sensitivity was 0.827 (95% CI: 0.804–0.848), and specificity was 0.981 (95% CI: 0.975–0.986). The correlation between sensitivity and the false positive rate was −0.076, which indicates that heterogeneity did not exist. Subgroup analyses were performed with the subgroups reference test type, publication year, and study type. No significant difference was found within the reference test type subgroup. However, differences within the publication year and study type subgroups were significant, where the retrospective study subgroup was significantly more sensitive and specific than the prospective study subgroup. Conclusion Results of this meta‐analysis imply that the high specificity of SLNB supports its role as a diagnostic tool for patients with clinical tumor stage (CT)1‐2 clinically negative (N0) OSCC. More studies should be done to further verify the results of this study. Level of Evidence 2a Laryngoscope, 131:E459–E465, 2021

Elective node dissection versus observation for management of patients with early‐stage cT1/T2N0 tongue carcinoma: A systematic review and meta‐analysis of prospective studies

“…38 Recent high-quality meta-analysis endorsed the diagnostic accuracy (in terms of sensitivity and specificity) of SLNB in detecting occult cervical metastasis in patients with cN0 oral cavity cancers. 39 This conclusion was also reinforced in another meta-analysis in patients with only cN0 tongue carcinoma. 38 Additionally, it should be noted that the NCCN guidelines for head and neck cancers highlight SLNB as one of the valuable tools in predicting cervical metastatic disease and subsequently informing the decision of undertaking END in patients with early-stage cT1/T2N0 oral cavity cancers.…”

“…Indeed, SLNB can favourably improve cosmetic outcomes, reduce unnecessary surgery‐associated morbidities and circumvent needless invasive neck dissections 38 . Recent high‐quality meta‐analysis endorsed the diagnostic accuracy (in terms of sensitivity and specificity) of SLNB in detecting occult cervical metastasis in patients with cN0 oral cavity cancers 39 . This conclusion was also reinforced in another meta‐analysis in patients with only cN0 tongue carcinoma 38 .…”

Predictive value of ipsilateral central lymph node metastasis for contralateral central lymph node metastasis in patients with thyroid cancer: Systematic review and meta‐analysis

“…The area under the SROC curve was 0.851, suggesting acceptable diagnostic accuracy (Figure 2). 22 The correlation between sensitivity and the false‐positive rate was 0.197, indicating the absence of heterogeneity. The sensitivity, specificity, and negative predictive value were 0.8925 ([0.8232–0.9368], I 2 = 55.4%), 0.6884 ([0.6311–0.7404], I 2 = 87.4%), and 0.9802 ([0.9631–0.9894], I 2 = 68.2%), respectively.…”

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

“…Considerable validation studies have demonstrated high intraoperative detection rates (more than 98%) of the sentinel node in oral cancer 13–15 . Moreover, SLNB has exhibited powerful sensitivities ranging from 71.4% to 95% and excellent specificity according to the two latest prospective trials and several diagnostic meta‐analyses 14–18 . In this context, SLNB has been incorporated into the National Comprehensive Cancer Network (NCCN) guidelines for stage I to II SCC of the oral cavity 19 .…”