Skip to main content
SpringerLink
Log in

Sentinel Lymph Node Biopsy for T1/T2 Oral Cavity Squamous Cell Carcinoma—A Prospective Case Series

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Sentinel lymph node biopsy (SLNB) is an established technique in breast and melanoma surgery and is gaining acceptance in the management of oral cavity squamous cell carcinoma. We report a single institution’s experience of SLNB between 2006 and 2010.

Methods

Prospective consecutive cohort study of 59 patients recruited between 2006 and 2010. All patients underwent SLNB with preoperative lymphoscintigraphy, intraoperative blue dye, and handheld gamma probe. Sentinel nodes were evaluated with step-serial sectioning and immunohistochemistry. Endpoints included: overall survival (OS), disease-specific survival (DSS), local recurrence-free survival (LRFS), and regional recurrence-free survival (RRFS).

Results

A total of 59 patients (36 male and 23 female) were operated on. Of these, 42 patients (71%) were pT1 and 17 patients (29%) were pT2. In two patients the sentinel node was not identified and proceeded to elective neck dissection. A total of 150 nodes were harvested from the remaining 57 patients of which 21 nodes were positive in 17 patients; three patients had positive contralateral nodes. The 2-year OS, DSS, LRFS, and RRFS for the SLNB negative patients were 97.5, 100, 95.8, and 95.8% and for the SLNB positive patients 68.2, 81.8, 83.9, and 100% respectively. Only OS and DSS approached statistical significance with P values of 0.07 and 0.06.

Conclusions

SLNB is a safe and accurate diagnostic technique for staging the neck with a negative predictive value in our series of 97.5%. Furthermore, in our series three patients (5%) had positive contralateral neck drainage that would have been missed by conventional ipsilateral neck dissection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Tankere F, Camproux A, Barry B, Guedon C, Depondt J, Gehanno P. Prognostic value of lymph node involvement in oral cancers: a study of 137 cases. Laryngoscope. 2000;110:2061–5.

    Article  PubMed  CAS  Google Scholar 

  2. van den Brekel MW, van der Waal I, Meijer CJ, Freeman JL, Castelijns JA, Snow GB. The incidence of micrometastases in neck dissection specimens obtained from elective neck dissections. Laryngoscope. 1996;106:987–91.

    Article  PubMed  Google Scholar 

  3. Alex JC, Krag DN. The gamma-probe-guided resection of radiolabeled primary lymph nodes. Surg Oncol Clin N Am. 1996;5:33–41.

    PubMed  CAS  Google Scholar 

  4. Pitman KT, Johnson JT, Myers EN. Effectiveness of selective neck dissection for management of the clinically negative neck. Arch Otolaryngol Head Neck Surg. 1997;123:917–22.

    Article  PubMed  CAS  Google Scholar 

  5. Shah JP. Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Am J Surg. 1990;160:405–9.

    Article  PubMed  CAS  Google Scholar 

  6. Byers RM, Wolf PF, Ballantyne AJ. Rationale for elective modified neck dissection. Head Neck Surg. 1988;10:160–7.

    Article  PubMed  CAS  Google Scholar 

  7. Yuen AP, Wei WI, Wong YM, Tang KC. Elective neck dissection versus observation in the treatment of early oral tongue carcinoma. Head Neck. 1997;19:583–8.

    Article  PubMed  CAS  Google Scholar 

  8. Yuen AP, Ho CM, Chow TL, Tang LC, Cheung WY, Ng RW, et al. Prospective randomized study of selective neck dissection versus observation for N0 neck of early tongue carcinoma. Head Neck. 2009;31:765–72.

    Article  PubMed  Google Scholar 

  9. Sobol S, Jensen C, Sawyer W, 2nd, Costiloe P, Thong N. Objective comparison of physical dysfunction after neck dissection. Am J Surg. 1985;150:503–9.

    Article  PubMed  CAS  Google Scholar 

  10. Schiefke F, Akdemir M, Weber A, Akdemir D, Singer S, Frerich B. Function, postoperative morbidity, and quality of life after cervical sentinel node biopsy and after selective neck dissection. Head Neck. 2009;31:503–12.

    Article  PubMed  Google Scholar 

  11. Murer K, Huber GF, Haile SR, Stoeckli SJ. Comparison of morbidity between sentinel node biopsy and elective neck dissection for treatment of the n0 neck in patients with oral squamous cell carcinoma. Head Neck. 2011;33:1260–4.

    Article  PubMed  Google Scholar 

  12. Civantos FJ, Stoeckli SJ, Takes RP, Woolgar JA, de Bree R, Paleri V, et al. What is the role of sentinel lymph node biopsy in the management of oral cancer in 2010? Eur Arch Otorhinolaryngol. 2010;267:839–44.

    Article  PubMed  Google Scholar 

  13. Civantos FJ, Zitsch RP, Schuller DE, Agrawal A, Smith RB, Nason R, et al. Sentinel lymph node biopsy accurately stages the regional lymph nodes for T1-T2 oral squamous cell carcinomas: results of a prospective multi-institutional trial. J Clin Oncol. 2010;28:1395–400.

    Article  PubMed  Google Scholar 

  14. Alkureishi LW, Ross GL, Shoaib T, Soutar DS, Robertson AG, Thompson R, et al. Sentinel node biopsy in head and neck squamous cell cancer: 5-year follow-up of a European multicenter trial. Ann Surg Oncol. 2010;17:2459–64.

    Article  PubMed  Google Scholar 

  15. Wittekind C, Compton CC, Greene FL, Sobin LH. TNM residual tumor classification revisited. Cancer. 2002;94:2511–6.

    Article  PubMed  Google Scholar 

  16. Byers RM, Weber RS, Andrews T, McGill D, Kare R, Wolf P. Frequency and therapeutic implications of “skip metastases” in the neck from squamous carcinoma of the oral tongue. Head Neck. 1997;19:14–9.

    Article  PubMed  CAS  Google Scholar 

  17. van den Brekel MW, Stel HV, Castelijns JA, Nauta JJ, van der Waal I, Valk J, et al. Cervical lymph node metastasis: assessment of radiologic criteria. Radiology. 1990;177:379–84.

    PubMed  Google Scholar 

  18. Goerkem M, Braun J, Stoeckli SJ. Evaluation of clinical and histomorphological parameters as potential predictors of occult metastases in sentinel lymph nodes of early squamous cell carcinoma of the oral cavity. Ann Surg Oncol. 2010;17:527–35.

    Article  PubMed  Google Scholar 

  19. Civantos F, Jr., Zitsch R, Bared A, Amin A. Sentinel node biopsy for squamous cell carcinoma of the head and neck. J Surg Oncol. 2008;97:683–90.

    Article  PubMed  Google Scholar 

  20. Stoeckli SJ. Sentinel node biopsy for oral and oropharyngeal squamous cell carcinoma of the head and neck. Laryngoscope. 2007;117:1539–51.

    Article  PubMed  Google Scholar 

  21. Ambrosch P, Kron M, Pradier O, Steiner W. Efficacy of selective neck dissection: a review of 503 cases of elective and therapeutic treatment of the neck in squamous cell carcinoma of the upper aerodigestive tract. Otolaryngol Head Neck Surg. 2001;124:180–7.

    Article  PubMed  CAS  Google Scholar 

  22. Kligerman J, Lima RA, Soares JR, Prado L, Dias FL, Freitas EQ, et al. Supraomohyoid neck dissection in the treatment of T1/T2 squamous cell carcinoma of oral cavity. Am J Surg. 1994;168:391–4.

    Article  PubMed  CAS  Google Scholar 

  23. Liu TR, Yang AK, Chen FJ, Zeng ZY, Li OL, Wei MW, et al. [Value of elective neck dissection in patients with clinically stage I squamous cell carcinoma of the tongue]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2006;41:38–42.

    PubMed  Google Scholar 

  24. Koch WM, Bhatti N, Williams MF, Eisele DW. Oncologic rationale for bilateral tonsillectomy in head and neck squamous cell carcinoma of unknown primary source. Otolaryngol Head Neck Surg. 2001;124:331–3.

    Article  PubMed  CAS  Google Scholar 

  25. Shim SJ, Cha J, Koom WS, Kim GE, Lee CG, Choi EC, et al. Clinical outcomes for T1-2N0-1 oral tongue cancer patients underwent surgery with and without postoperative radiotherapy. Radiat Oncol. 2010;5:43.

    Article  PubMed  Google Scholar 

  26. Ross GL, Shoaib T, Soutar DS, MacDonald DG, Camilleri IG, Bessent RG, et al. The First International Conference on Sentinel Node Biopsy in Mucosal Head and Neck Cancer and adoption of a multicenter trial protocol. Ann Surg Oncol. 2002;9:406–10.

    Article  PubMed  CAS  Google Scholar 

  27. Rogers SN, Panasar J, Pritchard K, Lowe D, Howell R, Cawood JI. Survey of oral rehabilitation in a consecutive series of 130 patients treated by primary resection for oral and oropharyngeal squamous cell carcinoma. Br J Oral Maxillofac Surg. 2005;43:23–30.

    Article  PubMed  CAS  Google Scholar 

  28. Lawson G, Matar N, Nollevaux MC, Jamart J, Krug B, Delos M, et al. Reliability of sentinel node technique in the treatment of N0 supraglottic laryngeal cancer. Laryngoscope. 2010;120:2213–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Head & Neck Surgery, Guy’s & St. Thomas’s Hospital NHS Trust, London, UK

    Thomas Pezier MRCS, Iain J. Nixon FRCS ORL-HNS, Ben Gurney MRCS, Clare Schilling MRCS, Karim Hussain FRCS, Andrew J. Lyons FRCS OMFS, Richard Oakley FRCS ORL-HNS, Ricard Simo FRCS ORL-HNS, Jean-Pierre Jeannon FRCS ORL-HNS & Mark McGurk FRCS OMFS

Authors
  1. Thomas Pezier MRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Iain J. Nixon FRCS ORL-HNS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ben Gurney MRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Clare Schilling MRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karim Hussain FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrew J. Lyons FRCS OMFS
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Richard Oakley FRCS ORL-HNS
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ricard Simo FRCS ORL-HNS
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jean-Pierre Jeannon FRCS ORL-HNS
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mark McGurk FRCS OMFS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark McGurk FRCS OMFS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pezier, T., Nixon, I.J., Gurney, B. et al. Sentinel Lymph Node Biopsy for T1/T2 Oral Cavity Squamous Cell Carcinoma—A Prospective Case Series. Ann Surg Oncol 19, 3528–3533 (2012). https://doi.org/10.1245/s10434-011-2207-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-011-2207-0

Keywords

Search

Navigation