Sentinel node biopsy for early oral and oropharyngeal squamous cell carcinoma
- 496 Downloads
The appearance of lymph node metastases represents the most important adverse prognostic factor in head and neck squamous cell carcinoma. Therefore, accurate staging of the cervical nodes is crucial in these patients. The management of the clinically and radiologically negative neck in patients with early oral and oropharyngeal squamous cell carcinoma is still controversial, though most centers favor elective neck dissection for staging of the neck and removal of occult disease. As only approximately 30% of patients harbor occult disease in the neck, most of the patients have to undergo elective neck dissection with no benefit. The sentinel node biopsy concept has been adopted from the treatment of melanoma and breast cancer to early oral and oropharyngeal squamous cell carcinoma during the last decade with great success. Multiple validation studies in the context of elective neck dissections revealed sentinel node detection rates above 95% and negative predictive values for negative sentinel nodes of 95%. Sentinel node biopsy has proven its ability to select patients with occult lymphatic disease for elective neck dissection, and to spare the costs and morbidity to patients with negative necks. Many centers meanwhile have abandoned routine elective neck dissection and entered in observational trials. These trials so far were able to confirm the high accuracy of the validation trials with less than 5% of the patients with negative sentinel nodes developing lymph node metastases during observation. In conclusion, sentinel node biopsy for early oral and oropharyngeal squamous cell carcinoma can be considered as safe and accurate, with success rates in controlling the neck comparable to elective neck dissection. This concept has the potential to become the new standard of care in the near future.
KeywordsHead and neck Metastasis Sentinel node biopsy Neck dissection Lymphscintigraphy Imaging
Conflict of interest statement
The authors declare that they have no conflict of interest.
- 6.Ries LAG, Melbert D, Krapcho M, Stinchcomb DG, Howlader N, Horner MJ, Mariotto A, Miller BA, Feuer EJ, Altekruse SF, Lewis DR, Clegg L, Eisner MP, Reichman M, Edwards BK (eds) (1975–2005) SEER Cancer Statistics Review. National Cancer Institute. Bethesda, MDGoogle Scholar
- 11.Stoeckli SJ, Schuknecht B, Strobel K (2009) Initial staging of the neck in HNSCC: is PET/CT the best? Head Neck (in press)Google Scholar
- 12.Nieuwenhuis EJ, Castelijns JA, Pijpers R, van den Brekel MW, Brakenhoff RH, van der Waal I, Snow GB, Leemans CR (2002) Wait-and-see policy for the N0 neck in early-stage oral and oropharyngeal squamous cell carcinoma using ultrasonography-guided cytology: is there a role for identification of the sentinel node? Head Neck 24(3):282–289PubMedCrossRefGoogle Scholar
- 29.Haerle SK, Hany TF, Strobel K, Sidler D, Stoeckli SJ (2009) Is there an additional value of SPECT/CT over lymphoscintigraphy for sentinel node mapping in oral/oropharyngeal squamous cell carcinoma? Ann Surg Oncol (in press)Google Scholar
- 35.Sobin LH, Wittekind C (eds) (2002) TNM classification of malignant tumours, 6th edn. Wiley, New YorkGoogle Scholar
- 37.Atula T, Hunter KD, Cooper LA, Shoaib T, Ross GL, Soutar DS (2009) Micrometastases and isolated tumour cells in sentinel lymph nodes in oral and oropharyngeal squamous cell carcinoma. Eur J Surg Oncol (in press)Google Scholar
- 41.Alkureishi LWT, Ross GL, Shoaib T, Sorensen J, Alvarez J, Poli T, Kovacs A, Alberti F, Soutar DS (2008) Sentinel node biopsy in oral/oropharyngeal squamous cell cancer: five year follow-up. Presented at the annual meeting of the American Head and Neck Society (AHNS), San Francisco, July 2008Google Scholar