Annals of Surgical Oncology

, Volume 17, Issue 2, pp 527–535 | Cite as

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

  • Mete Goerkem
  • Julia Braun
  • Sandro J. StoeckliEmail author
Head and Neck Oncology



Sentinel node biopsy (SNB) for cN0 early squamous cell carcinoma (SCC) of the oral cavity has been validated by numerous studies. Around 30% of SNB will detect occult disease. Several clinical and morphological features of the primary tumor have been claimed to be predictive for occult metastasis in elective neck dissections. The aim of this study was to assess these factors in the context of SNB.


Seventy-eight patients undergoing SNB for T1/2 oral SCC from the years 2000 to 2007 were prospectively included. Primary tumors were reviewed for the following morphological and clinical parameters: grade of differentiation, tumor depth, tumor thickness, perineural invasion, lymphatic invasion, vascular invasion, muscle invasion, lymphoplasmacytic infiltration, and mode of invasion, age, gender, primary tumor site, tumor side, and cT category.


Statistical analysis revealed significance to predict occult metastasis in the SNB for grade of differentiation (P = 0.002), lymphatic invasion (P < 0.001), and mode of invasion (P < 0.001). None of the other factors reached significance. The mean tumor depth was 6.45 mm (range 0.72–15.15 mm) and the mean tumor thickness was 7.2 mm (range 0.72–15.15 mm). None of the cutoff values reached significance for predicting occult disease.


Tumor depth and tumor thickness failed to achieve statistical significance for prediction of occult metastases in the context of SNB. Patients with cN0 early squamous cell carcinoma of the oral cavity should be offered SNB regardless of their tumor depth and thickness. Poorly differentiated carcinomas, carcinomas with lymphangiosis, and carcinomas with a dissolute mode of invasion show a high probability of positive SNB.


Sentinel Node Biopsy Negative Predictive Value Lymphatic Invasion Tumor Thickness Tumor Depth 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We are grateful to Norbert Wey for technical support and to Marianne Tinguely, MD for the review of the histological specimens.


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Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Mete Goerkem
    • 1
    • 2
  • Julia Braun
    • 3
  • Sandro J. Stoeckli
    • 2
    • 4
    Email author
  1. 1.Institute of Surgical Pathology, Department of PathologyUniversity Hospital ZurichZurichSwitzerland
  2. 2.Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital ZurichZurichSwitzerland
  3. 3.Biostatistics Unit, Institute of Social and Preventive MedicineUniversity of ZurichZurichSwitzerland
  4. 4.Department of Otorhinolaryngology, Head and Neck SurgeryKantonsspital St. GallenSt. GallenSwitzerland

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