Skip to main content

Advertisement

SpringerLink
Log in

Radioguided sentinel node biopsy to avoid unnecessary neck dissection in T1–T2N0 oral cavity squamous cell carcinoma: personal experience with same day protocol

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

Abstract

Purpose

Data from literature show a mean incidence of occult metastases of 33% in early OCSCC. The gold standard for most authors is a selective neck dissection and a routine pathological examination. 60–70% of unnecessary neck dissections with associated morbidity, can be avoided by using SNB. The aim of this study is to present the results of one of the major Italian centres for the SNB procedure, reserving neck dissection only for proven positive lymphatic metastases.

Methods

From July 2004 to March 2015, 48 patients with transorally resectable cT1–T2N0 oral SCC were submitted to a lymphoscintigraphic examination one-three hours before surgery and a radio-guided SNB (same day protocol). Patients with a negative SNB were checked every 3 months by ultrasound examination. The minimum follow-up was 5 years.

Results

Sentinel nodes were found in all cases, with 71% localized in the ipsilateral neck only in levels I–II. Metastases were found in 15 out of 48 cases (31.2%), on levels I, II and III. Further metastatic nodes were found in 6 cases in the neck dissection specimen. In the cohort of 33 patients with SNB negative at 5 years, no-one had a recurrence on the ipsilateral neck.

Conclusion

This study confirms the accuracy of SNB in predicting the presence of occult metastases, sparing the need for unnecessary neck dissection in 70% of cases. The same day protocol is designed to detect sentinel nodes, which are almost always on neck level I–II, thereby limiting the number of nodes examined and the extension of the surgical approach.

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
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Layland MK, Session DG, Lenox J (2005) The influence of node metastases in the treatment of squamous cell carcinoma of the oral cavity, oropharynx, larynx and hypopharynx: NO versus N+. Laryngoscope 115(4):629–639. https://doi.org/10.1097/01.mlg.0000161338.54515.b1

    Article  PubMed  Google Scholar 

  2. Leemans CR, Tiwari R, Van der Wall I, Karim ABMF, Nauta JP, Snow GB (1990) The efficacy of comprehensive neck dissection with or without postoperative radiotherapy in nodal metastases of squamous cell carcinoma of the upper respiratory and digestive tracts. Laryngoscope 100(11):1194–1198. https://doi.org/10.1288/00005537-199011000-00012

    Article  CAS  PubMed  Google Scholar 

  3. Coughlin A, Resto VA et al (2010) Oral cavity squamous cell carcinoma and the clinically N0 neck: the past, present, and future of sentinel node biopsy. Curr Oncol Rep 12(2):129–135. https://doi.org/10.1007/s11912-010-0090-7

    Article  PubMed  PubMed Central  Google Scholar 

  4. Van der Breckel MW, Van der Wall I et al (1996) The incidence of micrometastases in neck dissection specimens obtained from elective neck dissection. Laryngoscope 106:987–991. https://doi.org/10.1097/00005537-199608000-00014

    Article  Google Scholar 

  5. Li-Jen L, Wu Chia L, Wan Lun H et al (2012) Detection of cervical lymph node metastases in head and neck cancer patients with clinically N0 neck—a metanalysis comparing different imaging modalities. BMC Cancer 12:236–242. https://doi.org/10.1186/1471-2407-12-236

    Article  Google Scholar 

  6. Kligerman J, Lima RA et al (1994) Supraomohyoid neck dissection in the treatment of T1/T2 SCC of the oral cavity. Am J Surg 168:39–41. https://doi.org/10.1016/s0002-9610(05)80082-0

    Article  Google Scholar 

  7. Clayman GL, Frank DK et al (1988) Selective neck dissection of anatomically appropriate levels is as efficacious as modified radical neck dissection for elective treatment of the clinically neck in patients with squamous cell carcinoma of the upper respiratory and digestive tracts. Arch Otolaryngol Head Neck Surg 124:348–352. https://doi.org/10.1001/archotol.124.3.348

    Article  Google Scholar 

  8. Yuen APW, Wei WI, Wong YM, Tang KC (1997) Elective neck dissection versus observation in the treatment of early oral tongue carcinoma. Head Neck 19:583–588. https://doi.org/10.1002/(sici)1097-0347(199710)19:7%3c583:aid-hed4%3e3.0.co;2-3

    Article  CAS  PubMed  Google Scholar 

  9. Hosal AS, Carrau RL, Johnoson JT, Myers EN (2000) Selective neck dissection in the management of clinically node negative neck. Laryngoscope 110:2037–2040. https://doi.org/10.1097/00005537-200012000-00011

    Article  CAS  PubMed  Google Scholar 

  10. Nieuwenhuis EJ, Castelijns AJ, Pijpers R, van den Brekel MW et al (2002) Wait and see policy for 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):282–289. https://doi.org/10.1002/hed.10018

    Article  PubMed  Google Scholar 

  11. Stoeckli SJ, Alkureishi LWT, Ross GL et al (2009) Sentinel node biopsy for early oral and oropharyngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 266:787–793. https://doi.org/10.1007/s00405-009-0955-2

    Article  PubMed  Google Scholar 

  12. Erman AB, Collar RM, Griffith KA, Lowe L, Sabel MS, Bichakjian CK, Wong SL, McLean SA, Rees RS, Johnson TM, Bradford CR (2012) Sentinel lymph node biopsy is accurate and prognostic in head and neck melanoma. Cancer 118:1040–1047. https://doi.org/10.1002/cncr.26288

    Article  PubMed  Google Scholar 

  13. Alex JC, Sasaki CT et al (2000) Sentinel lymph node radiolocalisation in head and neck squamous cell carcinoma. Laryngoscope 110:198–203. https://doi.org/10.1097/00005537-200002010-00003

    Article  CAS  PubMed  Google Scholar 

  14. Dunne AA, Kulkens C et al (2001) Value of sentinel lymphonodectomy in patients with squamous cell carcinoma of the head and neck. Auris Nasus Larynx 28:339–344. https://doi.org/10.1016/s0385-8146(01)00107-9

    Article  CAS  PubMed  Google Scholar 

  15. Mozzillo N, Chiesa F, Botti G et al (2001) Sentinel node biopsy in head and neck cancer. Ann Surg Oncol 8(9):103S–105S

    CAS  PubMed  Google Scholar 

  16. Shoaib T, Soutar DS et al (2001) The accuracy of head and neck carcinoma sentinel lymph node biopsy in clinical NO neck. Cancer 91(11):2077–2083. https://doi.org/10.1002/1097-0142(20010601)91:11%3c2077:aid-cncr1235%3e3.0.co;2-e

    Article  CAS  PubMed  Google Scholar 

  17. Stoeckli SJ, Steinert H et al (2001) Sentinel lymph node evaluation in squamous cell carcinoma of the head and neck. Otolaryngol Head Neck Surg 125:221–226. https://doi.org/10.1067/mhn.2001.118074

    Article  CAS  PubMed  Google Scholar 

  18. Ross GL, Shoaib T, Sutar D, Camilleri D et al (2002) The use of sentinel node biopsy to upstage the clinical N0 neck in head and neck cancer. Arch Otolaryngol Head Neck Surg 128:1287–1291. https://doi.org/10.1001/archotol.128.11.1287

    Article  PubMed  Google Scholar 

  19. Ross GL, Soutar DS et al (2004) Improved staging of cervical metastases in clinically node-negative patients with head and neck squamous cell carcinoma. Ann Surg Oncol 11(2):213–218. https://doi.org/10.1001/archotol.128.11.1287

    Article  CAS  PubMed  Google Scholar 

  20. Kovacs AF, Landes CA et al (2005) Sentinel node biopsy as staging tool in a multimodality treatment approach to cancer of the oral cavity and the oropharynx. Otolaryngol Head Neck Surg 132(4):1–10. https://doi.org/10.1016/j.otohns.2004.09.051

    Article  Google Scholar 

  21. Werner JA, Dunne AA et al (2004) The sentinel node concept in Head and Neck Cancer: solution for the controversies in the N0 neck? Head Neck 26:603–611. https://doi.org/10.1002/hed.2006

    Article  PubMed  Google Scholar 

  22. Vigili MG, Tartaglione G, Rahimi S, Mafera B, Pagan M (2007) Lymphoscintigraphy and radioguided sentinel node biopsy in oral cavity squamous cell carcinoma: same day protocol. Eur Arch Otorhinolaringol 264:163–167. https://doi.org/10.1007/s00405-006-0150-7

    Article  Google Scholar 

  23. Alkureischi LWT, Ross GL, Shoaib T, Soutar DS, Robertson AG, Thompson R, Hunter KD, Sorensen JA, Thomsen J, Krogdahal A, Alvarez J, Barbier L, Santamaria J, Poli T, Sesenna E, Kovacs AJ, Grunawald F, Barzan L, Sulfaro S, Alberti F (2010) Sentinel node biopsy in head and neck squamous cell cancer: 5-year follow up of a European multicenter trial. Ann Surg Oncol 17:2459–2464. https://doi.org/10.1245/s10434-010-1111-3

    Article  Google Scholar 

  24. Civantos FJ, Zitsch RP, Shuller DE et al (2010) 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 28:1395–1400. https://doi.org/10.1200/jco.2008.20.8777

    Article  PubMed  PubMed Central  Google Scholar 

  25. Schilling C, Stoeckli SJ, Haerle SK, Broglie MA, Huber GF, Sorensen JA, Bakholdt V, Krogdahl A, von Buchwald C, Bilde A, Sebbesen LR, Odell E, Gurney B, O’Doherty M, de Bree R, Bloemena E, Flach GB, Villarreal PM, Florentino M, Forcelledo F, Junquera Gutierrez LM, Amezaga JA, Barbier L, Santamarıa Zuazua J, Moreira A, Jacome M, Vigili MG, Rahimi S, Tartaglione G, Lawson G, Nollevaux MC, Grandi C, Donner D, Bragantini E, Dequanter D, Lothaire P, Poli T, Silini EM, Sesenna E, Dolivet G, Mastronicola R, Leroux A, Sassoon I, Sloan P, McGurk M (2015) Sentinel European Node Trial (SENT): 3-year results of sentinel node biopsy in oral cancer. Eur J Cancer 51:277–284. https://doi.org/10.1016/j.ejca.2015.08.023

    Article  Google Scholar 

  26. Thompson CF, St John MA, Lawson G, Grogan T, Elashoff D, Memdelshon AH (2013) Diagnostic value of sentinel lymph node biopsy in head and neck cancer: a meta analysis. Eur Arch Otolaryngol 270:2115–2122. https://doi.org/10.1007/s00405-012-2320-0

    Article  CAS  Google Scholar 

  27. Tartaglione G, Stoeckli SJ, deBree R, Schilling C, Flach GB, Bakholdt V, Sorensen JA, Bilde A, von Buchwald C, Lawson G, Dequanter D, Villarreal PM, Forcelledo MF, Amezaga JA, Moreira A, Poli T, Grandi C, Vigili MG, O’Doherty M, Donner D, Bloemena E, Rahimi S, Gurney B, Haerle SK, Broglie MA, Huber GF, Krogdah AL, Sebbesen LR, Odell E, Junquera Gutierrez LM, BarbieSantamaria-Zuazua J, Jacome M, Nollevaux MC, Bragantini E, Lothaire P, Silini EML, Sesenna E, Dolivet G, Mastronicola R, Leroux A, Sassoon I, Sloan P, Colletti PM, Rubello D, McGurk M (2016) Sentinel node in oral cancer: the nuclear medicine aspect. A survey from the Sentinel European Node Trial. Clin Nucl Med 41(7):534–542. https://doi.org/10.1097/rlu.000000000000124

    Article  PubMed  Google Scholar 

  28. Giammarile F, Schilling C, Gnanasegaran G, Bal C, Oyen WJG, Rubello D, Schwarz T, Tartaglione G, Miller RN, Paez D, van Leeuwen FWB, Valdés Olmos RA, McGurk M, Delgado Bolton RC (2019) The EANM practical guidelines for sentinel lymph node localisation in oral cavity squamous cell carcinoma. Eur J Nucl Med Mol Imaging 46(3):623–637. https://doi.org/10.1007/s00259-018-4235-5

    Article  PubMed  Google Scholar 

  29. Heuveling DA, Flach GB, van Schie A, van Weert S, Karagozoglu KH, Bloemena E, Leemans CR, de Bree R (2012) Visualization of the sentinel node in early-stage oral cancer: limited value of late static lymphoscintigraphy. Nucl Med Commun 33(10):1065–1069. https://doi.org/10.1097/MNM.0b013e3283571089

    Article  PubMed  Google Scholar 

  30. Stoeckli SJ, Huebner T, Huber GF, Broglie MA (2016) Technique for reliable sentinel node biopsy in squamous cell carcinomas of the floor of mouth. Head Neck 38(9):1367–1372. https://doi.org/10.1002/hed.24440

    Article  PubMed  Google Scholar 

  31. Schilling C, Stoeckli SJ, Vigili MG, deBree R, Lai SY, Alvarez J, Christensen A, Cognetti DM, D’Cruz AK, Frerich B, Garrel R, Kohno N, Klop M, Kerawala C, Lawson G, McMahon J, Sasson I, Shaw RJ, Tvedskov JF, von Buchwald C, McGurk M (2019) Surgical consensus guidelines on sentinel node biopsy (SNB) in patients with oral cancer. Head Neck 41(12):4236–4242. https://doi.org/10.1002/hed.25739

    Article  Google Scholar 

  32. Kosuda S, Kusano S, Kohno N, Ohno Y et al (2003) Feasibility and cost effectiveness of sentinel lymph node radiolocalisation in stage NO head and neck cancer. Arch Otolaryngol Head Neck Surg 129(10):1105–1109. https://doi.org/10.1001/archotol.129.10.1105

    Article  PubMed  Google Scholar 

  33. O’Connor R, Pezier T, Schilling C, Mc Gurk M (2013) The relative cost of sentinel lymph node biopsy in early oral cancer. J Cranio Maxillo Fac Surg 41:721–727. https://doi.org/10.1016/j.jcms.2013.01.012

    Article  Google Scholar 

  34. D’Agnese GP, Percoco G, Vigili MG (2016) Sentinel node biopsy in oral cavity squamous cell carcinoma: analysis of cost effectiveness using BEHC. In: Vigili MG (ed) Sentinel lymph node biopsy in head and neck cancer. Quaderni monografici di Aggiornamento AOOI Torgraf Ed, pp 215–228. www.aooi.it

  35. Brown JS, Shaw RJ, Bekiroglu F, Rogers SN (2012) Systematic review of the current evidence in the use of postoperative radiotherapy for oral squamous cell carcinoma. Br J Oral Maxillofac Surg 50(6):481–489. https://doi.org/10.1016/j.bjoms.2011.08.014

    Article  CAS  PubMed  Google Scholar 

  36. Ganly I, Goldstein D, Carlson DL, Patel SG et al (2013) Long term regional control and survival in patients with low risk, early stage oral tongue cancer managed by partial glossectomy and neck dissection without postoperative radiotherapy: the importance of tumor thickness. Cancer 119(6):1168–1176. https://doi.org/10.1002/cncr.27872

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery - Head and Neck consultant, Istituto Dermopatico Dell’Immacolata IDI-IRCCS, Rome, Italy

    Maurizio Giovanni Vigili

  2. Frontier Pathology-Histopathology, Brighton and Sussex University Hospital NHS Trust, Brighton, UK

    Siavash Rahimi

  3. School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK

    Siavash Rahimi

  4. Department of Histopathology, San Carlo Hospital GVM Care and Research, Rome, Italy

    Carla Marani & Maria Emanuela Natale

  5. Department of Nuclear Medicine, Cristo Re Hospital, Rome, Italy

    Girolamo Tartaglione

Authors
  1. Maurizio Giovanni Vigili
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Siavash Rahimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carla Marani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maria Emanuela Natale
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Girolamo Tartaglione
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maurizio Giovanni Vigili.

Ethics declarations

Conflicts of interest

Maurizio Giovanni Vigili declare no disclosure of potential conflicts of interest.

Ethical approval

The study was approved by ethical committee.

Informed consent

All patients were submitted to informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vigili, M.G., Rahimi, S., Marani, C. et al. Radioguided sentinel node biopsy to avoid unnecessary neck dissection in T1–T2N0 oral cavity squamous cell carcinoma: personal experience with same day protocol. Eur Arch Otorhinolaryngol 277, 3479–3487 (2020). https://doi.org/10.1007/s00405-020-06107-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-020-06107-3

Keywords

Search

Navigation