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Sentinel lymph node biopsy or elective neck dissection for patients with oral squamous cell carcinoma?

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Sentinel lymph node biopsy (SNB) seems to be a promising method for staging clinically N0 neck in patients with oral squamous cell carcinoma (OSCC). In the present study, SNB was performed on 46 patients having elective neck dissection (END; six bilateral dissections) for T1–T3N0 OSCC. Sentinel lymph nodes (SLN) were first examined according to only slightly modified standard histopathologic protocol including sections at 1–2 mm intervals and H&E staining. SLN that appeared false negative (i.e. metastatic non-SLN without metastasis in a SLN) after the initial histopathologic examination were further assessed by step sectioning at 150 μm intervals and immunohistochemistry. Of the 47 neck sides with at least one SLN identified, nine contained metastasis in nine patients. After the initial histopathologic examination, SLNs were negative for malignant cells in four out of the nine metastatic neck sides. In one neck side, two metastatic SLNs were detected after the additional meticulous histopathologic work-up of the initially false negative SLNs. Therefore, in three neck sides the SLN did not contain metastasis although there was a metastasis in a non-SLN. In all these three cases with a false negative SLN, only one SLN had been identified. The sensitivity of the method (employing extensive histopathologic work-up) for detection of occult cervical metastasis was 67% (6/9 neck sides). The sensitivity of SNB for detection of occult metastasis seems to be poor in cases where only one SLN can be identified. The results of this study do not entitle us to entirely replace END by SNB in patients with OSCC.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Central Hospital, P. O. Box 220, 00029 HUCH, Helsinki, Finland

    Harri Keski-Säntti & Timo Atula

  2. Department of Maxillofacial Surgery, Helsinki University Central Hospital, Helsinki, Finland

    Risto Kontio & Jyrki Törnwall

  3. Haartman Institute, University of Helsinki and HUSLAB, Helsinki, Finland

    Ilmo Leivo

  4. Department of Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital, Helsinki, Finland

    Sorjo Mätzke

  5. Department of Plastic Surgery, Helsinki University Central Hospital, Helsinki, Finland

    Sinikka Suominen

  6. Clinical laboratory, Central Finland Health Care District, Jyväskylä, Finland

    Esa Leppänen

Authors
  1. Harri Keski-Säntti
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  2. Risto Kontio
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  3. Jyrki Törnwall
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  4. Ilmo Leivo
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  5. Sorjo Mätzke
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  6. Sinikka Suominen
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  7. Esa Leppänen
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  8. Timo Atula
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Correspondence to Harri Keski-Säntti.

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Keski-Säntti, H., Kontio, R., Törnwall, J. et al. Sentinel lymph node biopsy or elective neck dissection for patients with oral squamous cell carcinoma?. Eur Arch Otorhinolaryngol 265 (Suppl 1), 13–17 (2008). https://doi.org/10.1007/s00405-007-0465-z

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  • DOI: https://doi.org/10.1007/s00405-007-0465-z

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