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Oral Cavity Squamous Cell Carcinoma and the Clinically N0 Neck: The Past, Present, and Future of Sentinel Lymph Node Biopsy

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Abstract

Oral cavity squamous cell carcinoma (OCSCC) has a yearly incidence of 274,000 patients. Twenty percent to 30% of patients will harbor occult regional metastases, an important feature that correlates with worse outcomes. Supraomohyoid neck dissection (SND) is the gold standard treatment, but because of recent successes of sentinel lymph node (SLN) biopsy in the management of breast cancer and melanoma, many have begun evaluating its use in head and neck mucosal cancers. SLN biopsy offers patients decreased morbidity compared with SND, and has shown reproducibly low false-negative rates, high-negative predictive values, and high sensitivities. Limitations with floor-of-mouth primaries and delayed secondary SNDs have been described, but a new agent designed to address these shortcomings, Lymphoseek (Neoprobe Corp.; Dublin, OH), is currently under investigation. This article reviews the current literature on SLN biopsy and introduces a phase 3 study evaluating the efficacy of Lymphoseek in SLN biopsy of OCSCCs.

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References

Papers of particular interest, published recently have been highlighted as: • Of importance •• Of major importance

  1. Jemal A, Murray T, Ward E, et al.: Cancer statistics. CA Cancer J Clin 2005, 55:10–30.

    Article  PubMed  Google Scholar 

  2. Parkin DM, Bray F, Ferlay J, et al.: Global cancer statistics. CA Cancer J Clin 2002, 55:74–108.

    Article  Google Scholar 

  3. Shah JP: Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Am J Surg 1990, 160:405–409.

    Article  CAS  PubMed  Google Scholar 

  4. SEER Cancer Statistics Review, 1975–2005. Edited by Ries LAG, Melbert D, Krapcho M, et al. Bethesda, MD: National Cancer Institute; 2008. Available at http://seer.cancer.gov/csr/1975_2005. Accessed January 2010.

  5. Kligerman J, Lima RA, Soares JR, et al.: Supraomohyoid neck dissection in the treatment of T1/T2 squamous cell carcinoma of oral cavity. Am J Surg 1994, 168:391–392.

    Article  CAS  PubMed  Google Scholar 

  6. Morton DL, Thompson JF, Essner R, et al.: Multicenter Selective Lymphadenectomy Trial Group. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: a multicenter trial. Ann Surg 1999, 230:453–465

    Article  CAS  PubMed  Google Scholar 

  7. Giuliano AE, Kirgan DM, Guenther JM, et al.: Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 1994, 220:391–398.

    Article  CAS  PubMed  Google Scholar 

  8. Friedman M, Mafee MF, Pacella BL Jr, et al.: Rationale for elective neck dissection in 1990. Laryngoscope 1990, 100:54–59.

    CAS  PubMed  Google Scholar 

  9. Gor DM, Langer JE, Loevner LA: Imaging of the cervical lymph nodes in head and neck cancer: the basics. Radiol Clin North Am 2006, 44:101–110.

    Article  PubMed  Google Scholar 

  10. Haberal I, Celik H, Göcmen H, et al.: Which is important in the evaluation of metastatic lymph nodes in head and neck cancer: palpation, ultrasonography, or computed tomography? Otoloaryngol Head Neck Surg 2004, 130:197–201.

    Article  Google Scholar 

  11. Stern WB, Silver CE, Zeifer BA, et al.: Computed tomography of the clinically negative neck. Head Neck 1990, 12:109–113.

    Article  CAS  PubMed  Google Scholar 

  12. Righi PD, Kopecky KK, Caldemeyer KS, et al.: Comparison of ultrasound-fine needle aspiration and computed tomography in patients undergoing elective neck dissection. Head Neck 1997, 19:604–610.

    Article  CAS  PubMed  Google Scholar 

  13. Stokkel MP, ten Broek FW, Hordijk GJ, et al.: Preoperative evaluation of patients with primary head and neck cancer using dual-head ∼8fluorodeoxyglucose positron emission tomography. Ann Surg 2000, 231:229–234.

    Article  CAS  PubMed  Google Scholar 

  14. Ng SH, Yen TC, Liao CT, et al.: 18F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma: a prospective study of 124 patients with histologic correlation. Journal of Nuclear Medicine 2005, 46:1136–1143.

    PubMed  Google Scholar 

  15. Pöpperl G, Lang S, Dagdelen O, et al.: Correlation of FDG-PET and MRI/CT with histopathology in primary diagnosis, lymph node staging and diagnosis of recurrency of head and neck cancer. Rofo 2002, 174:714–720.

    PubMed  Google Scholar 

  16. Kau RJ, Alexiou C, Laubenbacher C, et al.: Lymph node detection of head and neck squamous cell carcinomas by positron emission tomography with fluorodeoxyglucose F 18 in a routine clinical setting. Arch Otolaryngol Head Neck Surg 1999, 125:1322–1328.

    CAS  PubMed  Google Scholar 

  17. • Atula T, Hunter KD, Cooper LA, et al.: Micrometastases, and isolated tumour cells in sentinel lymph nodes in oral and oropharyngeal squamous cell carcinoma. EJSO 2009, 35:532–538. This article discusses the pathologic consequences of MM and highlights the importance of serial sectioning and immunohistochemical evaluation of biopsied sentinel nodes.

    CAS  PubMed  Google Scholar 

  18. Takes RP, Knegt P, Manni JJ, et al.: Regional metastasis in head and neck squamous cell carcinoma: revised value of US with US-guided FNAB. Radiology 1996, 198:819–823.

    CAS  PubMed  Google Scholar 

  19. Ross GL, Shoaib T, Soutar DS, 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, 9:406–410.

    Article  CAS  PubMed  Google Scholar 

  20. • Schiefke F, Akdemir M, Weber A, et al.: Function, postoperative morbidity, and quality of life after cervical sentinel node biopsy and after selective neck dissection. Head Neck 2009, 31:503–512. This article assesses morbidity differences between SND and SLN biopsy, showing a lower incidence of procedure-associated dysfunction in patients treated with SLN biopsy.

    Article  PubMed  Google Scholar 

  21. Chepeha DB, Taylor RJ, Chepeha JC, et al.: Functional assessment using Constant’s Shoulder scale after modified radical and selective neck dissection. Head Neck 2002, 24:432–436.

    Article  PubMed  Google Scholar 

  22. Kuntz AL, Weymuller EA Jr: Impact of neck dissection on quality of life. Laryngoscope 1999, 109:1334–1338.

    Article  CAS  PubMed  Google Scholar 

  23. Rogers SN, Ferlito A, Pelliteri PK, et al.: Quality of life following neck dissections (review). Acta Otolaryngol 2004, 124: 231–236.

    Article  PubMed  Google Scholar 

  24. Terrell JE, Chepeha DB: Clinical predictors of quality of life in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 2004, 130:401–408.

    Article  PubMed  Google Scholar 

  25. Civantos FJ, Moffat FI, Goodwin WJ: Lymphatic mapping and sentinel lymphadenectomy for 106 head and neck lesions: contrasts between oral cavity and cutaneous malignancy. Laryngoscope 2006, 16:1–15.

    Article  Google Scholar 

  26. Byers RM, Weber RS, Andrews T, et al.: Frequency and therapeutic implications of ‘skip metastases’ in the neck from squamous cell carcinoma of the oral tongue. Head Neck 1997, 19:14–19.

    Article  CAS  PubMed  Google Scholar 

  27. •• Civantos F Jr, Zitsch R, Bared A, et al.: Sentinel node biopsy for squamous cell carcinoma of the head and neck. J Surg Oncol 2008, 97:683–690. This review article presents preliminary results of the ACOSOG Z0360 Validation Trial. This multi-institutional trial represents the strongest evidence in support of SLN biopsy in oral cavity SCC.

    Article  PubMed  Google Scholar 

  28. Woolgar JA, Rogers SN, Lowe D, et al.: Cervical lymph node metastasis in oral cancer: the importance of even microscopic extracapsular spread. Oral Oncol 2003, 39:130–137.

    Article  CAS  PubMed  Google Scholar 

  29. Stoeckli J, Pfaltz M, Steinert H, et al.: Histopathological features of occult metastasis detected by sentinel lymph node biopsy in oral and oropharyngeal squamous cell carcinoma. Laryngoscope 2002, 112:111–115.

    Article  PubMed  Google Scholar 

  30. The National Comprehensive Cancer Network: NCCN Practice Guidelines for Cancer of the Head and Neck, version 1.2000. Rockville, PA: The National Comprehensive Cancer Network, Inc.; 2000.

  31. Stoeckli SJ, Pfaltz M, Ross GL, et al.: The second international conference on sentinel node biopsy in mucosal head and neck cancer. Ann Surg Oncol 2005, 12:919–924.

    Article  PubMed  Google Scholar 

  32. Seaman WB, Powers WE: Studies on the distribution of radioactive colloidal gold in regional lymph nodes containing cancer. Cancer 1955, 8:1044–1046.

    Article  CAS  PubMed  Google Scholar 

  33. Morton DL, Wen DR, Wong JH, et al.: Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992, 127:392–399.

    CAS  PubMed  Google Scholar 

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

    CAS  Google Scholar 

  35. O’Brien CJ, Uren RF, Thompson JF, et al.: Prediction of potential metastatic sites in cutaneous head and neck melanoma using lymphoscintigraphy. Am J Surg 1995, 170:461–466.

    Article  PubMed  Google Scholar 

  36. de Wilt JH, Thompson JF, Uren RF, et al.: Correlation between preoperative lymphoscintigraphy and metastatic nodal disease sites in 362 patients with cutaneous melanomas of the head and neck. Ann Surg 2004, 239:544–552.

    Article  PubMed  Google Scholar 

  37. Chao C, Wong SL, Edwards MJ, et al.: Sentinel lymph node biopsy for head and neck melanomas. Ann Surg Oncol 2003, 10:21–26.

    Article  PubMed  Google Scholar 

  38. Morton DL, Cochran AJ, Thompson JF, et al.: Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg 2005, 242:302–311.

    PubMed  Google Scholar 

  39. Pitman KT, Johnson JT, Edington H, et al.: Lymphatic mapping with isosulfan blue dye in squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg 1998, 124:790–793.

    CAS  PubMed  Google Scholar 

  40. Shoaib T, Soutar DS, Prosser JE, et al.: A suggested method for sentinel node biopsy in squamous cell carcinoma of the head and neck. Head Neck 1999, 21:728–733.

    Article  CAS  PubMed  Google Scholar 

  41. Kuriakose MA, Trivedi MP: Sentinel node biopsy in head and neck squamous cell carcinoma. Curr Opin Otolaryngol Head Neck Surg 2009, 17:100–110.

    Article  PubMed  Google Scholar 

  42. Paleri V, Rees G, Arullendran P, et al.: Sentinel node biopsy in squamous cell cancer of the oral cavity and oral pharynx: a diagnostic meta-analysis. Head Neck 2005, 27:739–747.

    Article  PubMed  Google Scholar 

  43. Ross GL, Soutar DS, MacDonald DG, et al.: Sentinel node biopsy in head and neck cancer: preliminary results of a multicenter trial. Ann Surg Oncol 2004, 11:690–696

    Article  PubMed  Google Scholar 

  44. Alkureishi LWT, Ross GL, Shoaib T, et al.: 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, CA; July 19–23, 2008.

  45. •• Stoeckli SJ: Sentinel node biopsy for oral and oropharyngeal squamous cell carcinoma of the head and neck. Laryngoscope 2007, 117:1539–1551. This prospective study of SLN biopsy compared observation versus SND, revealing high rates of node identification, sensitivity, and negative predictive value. This study also demonstrated that SLN biopsy with observation only had similar recurrence rates to SND, thus suggesting it is an equivalent option for staging the cN0 neck.

    Article  PubMed  Google Scholar 

  46. Ambrosch P, Kron M, Pradier O, et al.: 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, 124:180–187.

    Article  CAS  PubMed  Google Scholar 

  47. Chone CT, Magalhes RS, Etchehebere E, et al.: Predictive value of sentinel node biopsy in head and neck cancer. Acta Otolaryngol 2008,128:920–924.

    Article  PubMed  Google Scholar 

  48. • Wallace AM, Hoh CK, Darrah DD, et al.: Sentinel lymph node mapping of breast cancer via intradermal administration of Lymphoseek. Nucl Med Biol 2007, 34:849–853. This phase 1 clinical trial for Lymphoseek in breast cancer demonstrated faster injection site clearance and equal SLN uptake compared with filtered [ 99 Tc] sulfur colloid, thus providing early evidence that Lymphoseek could be beneficial for SLN biopsy in cases of oral cavity SCC, specifically FOM cancers.

    Article  CAS  PubMed  Google Scholar 

  49. Wallace AM, Hoh CK, Ellner CJ, et al.: Lymphoseek: a molecular imaging agent for melanoma sentinel lymph node mapping. Ann Surg Oncol 2006, 14:913–921.

    Article  PubMed  Google Scholar 

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Correspondence to Vicente A. Resto.

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Coughlin, A., Resto, V.A. Oral Cavity Squamous Cell Carcinoma and the Clinically N0 Neck: The Past, Present, and Future of Sentinel Lymph Node Biopsy. Curr Oncol Rep 12, 129–135 (2010). https://doi.org/10.1007/s11912-010-0090-7

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