Sentinel lymph node biopsy or elective neck dissection for patients with oral squamous cell carcinoma?
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.
KeywordsOral Oropharyngeal Oral cavity Cancer Metastasis Treatment Diagnosis
Conflict of interest statement
The authors declare that they have no conflict of interest.
- 1.Po Wing Yuen A, Lam KY, Lam LK, Ho CM, Wong A, Chow TL, Yuen WF, Wei WI (2002) Prognostic factors of clinically stage I and II oral tongue carcinoma-A comparative study of stage, thickness, shape, growth pattern, invasive front malignancy grading, martinez-gimeno score, and pathologic features. Head Neck 24:513–520PubMedCrossRefGoogle Scholar
- 7.Morton DL, Thompson JF, Essner R, Elashoff R, Stern SL, Nieweg OE, Roses DF, Karakousis CP, Mozzillo N, Reintgen D, Wang HJ, Glass EC, Cochran AJ (1999) Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: a multicenter trial. Multicenter selective lymphadenectomy trial group. Ann Surg 230:453–463, (Discussion 463–5)PubMedCrossRefGoogle Scholar
- 15.Ross GL, Soutar DS, Gordon MacDonald D, Shoaib T, Camilleri I, Robertson AG, Sorensen JA, Thomsen J, Grupe P, Alvarez J, Barbier L, Santamaria J, Poli T, Massarelli O, Sesenna E, Kovacs AF, Grunwald F, Barzan L, Sulfaro S, Alberti F (2004) Sentinel node biopsy in head and neck cancer: preliminary results of a multicenter trial. Ann Surg Oncol 11:690–696PubMedCrossRefGoogle Scholar