Intraparotid sentinel lymph node biopsy for head and neck melanoma

OBJECTIVE: The objective of this retrospective clinical review was to assess the safety and accuracy of intraparotid sentinel node biopsy in patients with melanoma. SETTING: This study was conducted at a tertiary referral center. PATIENTS: Twenty-eight patients with cutaneous melanoma of the head and neck undergoing sentinel lymph node (SLN) biopsy in which the radionuclide localized to the parotid gland on preoperative lymphoscintigraphy were studied. METHODS: All patients underwent wide local excision of the tumor and intraparotid sentinel node biopsy using intraoperative gamma probe localization. RESULTS: There were 25 men and 3 women ranging in age from 34 to 81 years. The primary site was on the auricle in 14 patients: temple, 4; forehead, 5; cheek, 3; and on the neck in 2 patients, respectively. The mean Breslow thickness was 2.3 mm (range, 0.9-7.0 mm). In 27 of 28 patients, an intraparotid SLN was identified. In one patient, final pathology did not reveal lymphoid tissue despite a high count in the parotid tissue excised. Median number of SLN per patient was two. Six patients had microscopic metastases in the SLN. In two of these patients, additional microscopic lymph node metastases were found in the neck after subsequent formal lymphadenectomy. The pathologic staging for the group (n = 14) was: stage 1B, 4; 2A, 4; stage 2B, 3; and stage 3B, 3 patients, respectively. All patients are alive and without evidence of disease (mean follow up, 31 months). There were no surgical complications, specifically no patient experienced temporary or permanent facial paralysis. CONCLUSION: Intraparotid SLN biopsy for staging cutaneous head and neck melanoma is a reliable, accurate, and safe procedure.     

Role of the head and neck surgeon in sentinel lymph node biopsy for cutaneous head and neck melanoma

OBJECTIVE: To determine the reliability of sentinel lymph node biopsy (SLNB) in head and neck cutaneous melanomas to accurately stage nodal basins, describe techniques for safe SLNB in the neck and parotid regions, and discuss treatments. STUDY DESIGN: Retrospective chart review with follow-up mean of 11 months. METHODS: The charts of 80 patients treated for head and neck cutaneous malignancies from January 2001 through June 2003 were reviewed for presentation, treatment, and outcome. RESULTS: All patients received lymphoscintigraphy and SLNB for melanoma with Breslow thickness greater than 1 mm. Accurate preoperative lymphoscintigraphy and blue dye injection along with facial nerve monitoring when indicated correlated with safe SLNB. Eleven (14%) patients required completion surgery after positive SLNB and underwent evaluation for adjuvant therapies. There were three cases with complications: two postoperative hematomas and one seroma. CONCLUSIONS: Safe and reliable SLNB depends on the knowledge of the anatomy in the head and neck region, reliability of preoperative lymph node mapping with lymphoscintigraphy, and possible additions of blue dye injection and facial nerve monitoring. Complete surgical treatment of positive SLNB cases along with adjuvant therapies potentially improves control of these cutaneous malignancies with manageable morbidity.     

Sentinel lymph node biopsy staging for cutaneous malignant melanoma of the head and neck

Conclusion Sentinel lymph node biopsies (SLNBs) can be performed safely and with reasonable accuracy in HNM patients. The outcome provides important prognostic information concerning DFS and further treatment. However, one must recognize that SLNB is a multidisciplinary procedure with a learning curve for all. Objectives To evaluate efficacy of performing SLNBs in a series of consecutive patients with cutaneous head and neck melanoma (HNM)?≥?T1b from introduction of the procedure and 10 years onward. Method End-points comprised of SLNB outcome, disease-free survival (DFS), and overall survival (OS). Results SNs were harvested in 128 of 160 patients (median Breslow?=?2.0?mm, 29% ulcerated); success rate?=?80.0%, or 92.1% if excluding patients where SLNBs were omitted due to non-localization on pre-operative imaging or because of SN-location in the parotid basin. Ten patients (7.8%) had positive SLNBs and were offered early completion neck dissections. Of the 146 patients available for follow-up (median?=?27 months), 15.8% had recurrent disease. The risk of a regional nodal recurrence after a negative SLNB was 7.5%. SN-negative patients had improved DFS c.f. SN-positive patients (p?p?相似文献   

Sentinel lymph node biopsy in head and neck squamous cell carcinoma

OBJECTIVES/HYPOTHESIS: Sentinel lymph node biopsy is a minimally invasive method to stage the regional lymphatics that has revolutionized the management of patients with intermediate-thickness cutaneous melanoma. Head and neck surgeons have been encouraged by the accuracy of sentinel lymph node biopsy in cutaneous melanoma and have applied the technique to patients with head and neck squamous cell carcinoma (HNSCC). The objectives of the study were 1) to study the feasibility and accuracy of sentinel lymph node biopsy as a method to stage the regional lymphatics in HNSCC and 2) to determine whether there are qualitative differences between the cutaneous and mucosal lymphatics that would affect the technique used in HNSCC. STUDY DESIGN: Two methods of investigation were employed: a prospective laboratory study using a feline model for sentinel lymph node biopsy and a retrospective review of patients who received lymphoscintigraphy before neck dissection and intraoperative identification of the sentinel lymph node. METHODS: Lymphoscintigraphy and a gamma probe were used in four felines to study the kinetics of technetium-labeled sulfa colloid (Tc-SC) in the mucosal lymphatics. In the second part of the feline study, eight subjects were studied intraoperatively. Tc-SC and isosulfan blue dye were used to study the injection technique for the mucosal lymphatics and to determine the time course of the dye and Tc-SC to the sentinel lymph node. In Part II of the present study, a retrospective review of 33 patients with HNSCC was conducted. Twenty patients (stage N0) whose treatment included elective neck dissection were studied with preoperative lymphoscintigraphy and underwent intraoperative identification of the sentinel lymph node to determine the accuracy and feasibility of sentinel lymph node biopsy. Eight patients with palpable neck disease and five patients with recurrent or second primary disease whose previous treatment included neck dissection were also studied with lymphoscintigraphy before neck dissection. RESULTS: In the feline study, both Tc-SC and isosulfan blue dye traversed the lymphatics rapidly, appearing in the sentinel lymph node in less than 5 minutes. Modification of the injection technique used for cutaneous melanoma was required to depict the sentinel lymph node of the base of tongue. In the human study, the sentinel lymph node was accurately identified in 19 of 20 (95%) N0 patients. On average, 2.9 sentinel lymph nodes (range, 1-5) were identified in 2.2 (range, 1-4) levels of the neck. Sentinel lymph nodes were bilateral in 4 of 19 patients. When the sentinel lymph node was identified, it accurately predicted the pathological nodal status of the regional lymphatics. Three of 20 patients had cervical metastases, and the sentinel lymph node was identified in 2 of 3 patients with pathologic nodes (pN+). Focal areas of radiotracer uptake were identified in seven of eight patients with palpable disease. These areas corresponded to the level with palpable disease in four patients. The lymphatics delineated by lymphoscintigraphy in the five patients with previous neck dissection were outside the levels that had been dissected. Lymphoscintigraphy depicted collateral patterns of lymphatic drainage. CONCLUSIONS: Sentinel lymph node biopsy is technically feasible and is a promising, minimally invasive method for staging the regional lymphatics in patients with stage N0 HNSCC. Lymphoscintigraphy alone may determine the levels that require treatment in patients with disrupted or previously operated cervical lymphatics.     

Endoscopic sentinel lymph node biopsy in a porcine model

OBJECTIVE: The objective of this study was to investigate the feasibility of endoscopic sentinel lymph node biopsy in a porcine model. METHODS: One hundred microcuries of technetium-labeled sulfa colloid (Tc-SC) was injected into the right and left ventrolateral surfaces of the oral tongue of six adult Yorkshire pigs. A handheld gamma probe was used to locate the region of focal radioactivity on the neck that corresponded to the sentinel lymph node (SLN). Next, 0.25 mL of isosulfan blue dye was injected into the Tc-SC injection sites on the tongue. Endoscopic SLN dissection was then performed using a combination of balloon dissection and CO2 insufflation. The operative time, blood loss, and radioactivity of the SLN were measured for each animal. RESULTS: The SLN was detected transcutaneously with the gamma probe, and endoscopic SLN excision was successful. Endoscopic visualization and an endoscopic gamma probe confirmed the presence of both isosulfan blue dye and radiopositivity in the SLN in each pig. The procedure lasted 22 to 61 minutes (median duration, 35 minutes). There was no measurable blood loss in any of the animals. Mean radioactivity measured 14,466 counts/second per lymph node. CONCLUSIONS: Endoscopic SLN biopsy for oral tongue lesions is feasible and warrants further study.     

Predictive value of sentinel node biopsy in head and neck cancer

Conclusions. The negative predictive value (NPV) of sentinel lymph node biopsy (SNB) in this study was 95%. The accuracy of SNB compared to histopathologic evaluation of surgical specimen of subsequent neck dissection (ND) was 96%. Objective. To evaluate NPV of SNB in head and neck cancer. Patients and methods. This was a prospective clinical study comprising 35 patients (50 necks) with squamous cell carcinoma (SCC) of head and neck with clinically (cN0) and radiologically negative necks, without previous treatment, who underwent SNB with gamma probe and subsequent ND. The NPV, accuracy, sensitivity, and specificity of SNB were compared to histopathologic assessment of surgical specimens from NDs. Negative sentinel lymph nodes (SLNs) on histopathology were evaluated with step serial section (SSS) and immunohistochemistry (IHC). When a neck had a positive SLN, all lymph nodes of subsequent NDs were studied with SSS and IHC. Results. There were primaries of the oral cavity (n=24), lip (n=3), oropharynx (n=3), and larynx (n=5). All patients had detected SLNs. In all, 41 necks were SLN-negative on histopathologic evaluation but 2 (5%) had metastases in non-SLNs after ND. Of these 41 necks, SLNs were level Ib (26%), IIa (45%), III (21%), and IV (8%). Nine necks presented positive SLN on histopathologic evaluation, level Ib (n=3), IIa (n=5), and III (n=2), and subsequent NDs were negative on conventional histopathologic analysis, but after SSS and IHC, two presented micrometastases.     

Patients with cutaneous head and neck melanoma,particularly elderly with more advanced primary tumors,seem to benefit from initial CT staging before considering a sentinel lymph node biopsy

Abstract

Background: The role of CT scanning at the time of diagnosis for patients with primary cutaneous head and neck melanoma (cHNM) clinically asymptomatic for metastatic disease remains unclear.

Aim: To determine the positive yield of initial CT scanning before considering sentinel lymph node biopsy (SLNB) staging.

Materials and methods: A retrospective review was performed on 170 consecutive patients with cHNM referred to a tertiary head and neck academic center for SLNBs from 2014 through 2018.

Results: Initial CTs identified occult melanoma metastases in 7.1% and other advanced malignancies in 4.7%. The overall CT yield for patients >65 years (n?=?115) was 13.9%, and 5.5% for patients <65 (only occult melanoma metastases). The SLNB yield did not differ between older (11.5%) and younger patients (10.2%). Patients with more advanced primary tumors were upstaged more often by both staging procedures. Multivariate analysis indicated a true-positive CT finding as the strongest prognostic factor for OS (p<.001).

Conclusions and significance: The CT yield was >11% and higher for older than for younger patients. The findings suggest that CT imaging may be considered before SLNB staging, potentially identifying metastatic melanoma disease as well as other occult malignancies, enabling especially older patients to bypass the SLNB procedure.     

Sentinel lymph node biopsy in cutaneous melanoma of the head and neck using the indocyanine green SPY Elite system

Purpose

Lymph node status is the single most important prognostic factor for patients with early-stage cutaneous melanoma. Sentinel lymph node biopsy (SLNB) has become the standard of care for intermediate depth melanomas. Modern SLNB implementation includes technetium-99 lymphoscintigraphy combined with local administration of a vital blue dye. However, sentinel lymph nodes may fail to localize in some cases and false-negative rates range from 0 to 34%. Here we demonstrate the feasibility of a new sentinel lymph node biopsy technique using indocyanine green (ICG) and the SPY Elite near-infrared imaging system.

Need for intensive histopathologic analysis to determine lymph node metastases when using sentinel node biopsy in oral cancer

OBJECTIVE: To determine the predictive value of sentinel node biopsy (SNB)-assisted neck dissection in patients with oral squamous cell carcinoma (SCC) stage T1 to 2N0M0 and to determine the incidence of subclinical metastases. STUDY DESIGN: Prospective cohort study. METHODS: Fifty-one patients with clinically N0 neck underwent SNB-assisted neck dissection. The localization of the sentinel node (SN) was determined using dynamic and planar lymphoscintigraphy and single photon emission computed tomography-computed tomography. Histopathologic examination of the harvested SN was performed using step-serial sectioning with hematoxylin-eosin (H&E) and immunohistochemistry on formalin-fixed, paraffin-embedded tissue. RESULTS: A total of 181 SNs were excised with a median of 3 (range 1-7) SNs per patient. Four percent (2 of 51) of patients with subclinical (occult) lymph node metastasis would have been identified using routine H&E staining, whereas the 18% (9 of 49) were upstaged as a result of additional histopathology when the H&E evaluation was negative. Overall, the incidence of subclinical metastases was 22% (11 of 51). CONCLUSION: In this study, SNB-assisted neck dissection proved to be technically feasible in identifying subclinical metastasis, thus accurately staging the neck with a high degree of sensitivity in patients with oral SCC T1 to 2N0M0 when additional histopathology was performed. The vast majority of patients in this study would have been spared selective neck dissection had reliance on SNB been used and selective neck dissection performed only in the case of a positive SN. Future studies should focus on determining whether SNB alone reduces patient morbidity and whether this is as equally effective in the treatment of cervical nodal metastases as compared with selective neck dissection in patients with oral SCC.     

Sentinel node biopsy for oral and oropharyngeal squamous cell carcinoma of the head and neck

OBJECTIVES: The aims were to assess the technical feasibility of sentinel node biopsy (SNB), to validate SNB against elective neck dissection, and to report the results of the clinical application of the SNB concept for early oral and oropharyngeal squamous cell carcinoma. STUDY DESIGN: Prospective consecutive cohort analysis. METHODS: Between 2000 and 2006, a total of 79 patients were included. Lymphatic mapping consisted of preoperative lymphoscintigraphy and intraoperative use of a hand-held gammaprobe. Twenty-eight patients were assessed for feasibility and validation; the SNB was done in context with an elective neck dissection. Fifty-one patients were evaluated in an observational trial; elective neck dissection was performed only in case of positive SNB. RESULTS: Validation revealed a sentinel node detection rate by lymphoscintigraphy of 93%, with the gammaprobe of 100%. The negative predictive value of a negative SNB was 100%. During the observational trial 40% of the patients were upstaged as a result of a positive SNB. Intraoperative frozen section analysis showed a negative predictive value of 83%. Two patients (6%) with negative SNB experienced a neck recurrence, the negative predictive value of SNB was therefore 94%. Patients with positive SNB were treated successfully with elective neck dissection. CONCLUSIONS: SNB is technically feasible and reproducible with a high sentinel node detection rate. Validation against elective neck dissection revealed a negative predictive value of 100%. Application of the SNB concept in clinical practice was very successful. The recurrence rate within the neck was very low and the morbidity and cost of an elective neck dissection could be spared to 60% of the patients.     

前哨淋巴结检测在头颈部鳞状细胞癌中的应用

目的　评价前哨淋巴结 (sentinellymphnode ,SLN)检测在N0头颈鳞状细胞癌 (简称鳞癌 )中的可行性以及SLN对微小转移灶的诊断价值。方法　分析研究中国医学科学院肿瘤医院头颈外科 2 0 0 1年 8月～ 2 0 0 2年 2月收治的 10例头颈鳞癌患者 ,为未经治疗临床诊断为N0的患者。所有患者术前均在肿瘤周围的黏膜下注射锝标记的右旋糖酐胶体 (technetium 99m preparedwithdextrancolloid ,99mTc DX) ,约 30min后行单光子发射计算机断层显像术扫描 ,在相应的颈部皮肤上标记显像“热点” ;术中翻开皮瓣后用手提探测仪探测术野 ,以高于背景计数 4倍以上确定为SLN。将确定的SLN送病理学检查 ,并借助淋巴结连续切片和免疫组化法检测微小转移灶。结果　术前淋巴结显像及术中探测仪探测所识别的SLN行病理学检查 ,10例N0患者有 3例发现隐性转移 ,其隐性转移率为 30 % (3/ 10 ) ,SLN的阳性率为 2 2 .7% (5 / 2 2 ) ,非SLN的阳性率为 0 .4 % (1/ 2 4 7)。经病理证实为SLN阴性的患者的非SLN无阳性发现。结论　头颈鳞癌颈部N0的SLN检测对发现临床隐性转移灶是可行的。SLN检测技术可缩小手术范围 ,减少手术的创伤及并发症 ,该技术的进一步推广还需更多的研究。     

Use of low-dose technetium Tc 99m sulfur colloid to locate sentinel lymph nodes in melanoma of the head and neck: preliminary study

OBJECTIVES/HYPOTHESIS: Because sentinel lymph nodes are the first lymph nodes that drain a primary cancer site, results of sentinel lymph node (SLN) biopsy indicate status of the regional lymph nodes. Preoperative lymphoscintigraphy and intraoperative combined application of the handheld gamma probe and blue-dye technique (i.e., the "combined technique") was used previously to accurately identify the SLN, mostly in melanoma of the extremities and trunk and, sometimes, in melanoma of the head or neck, which is anatomically complex. Because of this complexity, melanoma in the head or neck is inherently problematic to treat: Localization of the SLN can be difficult or impossible because the primary cancer site can be near or overlapping the nodal basin. The objective of the present study was to determine the technical modifications and other considerations that can make SLN localization feasible in cases of melanoma occurring near or overlapping the nodal basin in the head or neck. STUDY DESIGN/METHODS: In a retrospective study of clinical records containing our database of melanoma diagnoses made between January 1996 and December 1999, we identified 27 patients diagnosed with stage I or II primary melanoma of the head or neck with clinically negative neck nodes who also had had preoperative lymphoscintigraphy. Of the 27 patients (17 male and 10 female patients; mean age, 54 y), 24 had SLN biopsy by intraoperative localization using both the handheld gamma probe and the blue-dye technique. RESULTS: Among the 27 patients who had SLN mapping, a median Breslow thickness of 1.8 mm was noted. Sentinel lymph node was noted at preoperative lymphoscintigraphy in 26 (96%) of the 27 patients. Activity of technetium Tc 99m (Tc-99m) sulfur colloid injected ranged from 10 to 1000 microCi (0.37 to 37 megabecquerel [MBq]). Intraoperative use of the combined technique for sentinel lymphadenectomy was successful in 92% of patients. Sentinel lymph nodes were identified in all 14 patients who received Tc-99m sulfur colloid at an activity level less than 60 microCi (2.2 MBq); mean activity level of injected TC-99m sulfur colloid was 28 microCi (1.04 MBq). Sentinel lymph nodes were identified in 8 (80%) of 10 patients who received Tc-99m sulfur colloid at an activity level greater than 100 microCi (3.7 MBq); mean activity of injected Tc-99m sulfur colloid in these patients was 482 microCi (17.8 MBq). A mean number of 1.4 sentinel lymph nodes per patient was identified at preoperative lymphoscintigraphy, and a mean number of 3 sentinel lymph nodes per patient was identified intraoperatively using the combined technique. Tumor recurrence was seen in 2 (10%) of the 19 patients who had cancer-free SLN at mean follow-up of 18 months (range, 1 to 47 mo). Sentinel lymphadenectomy of the parotid region did not injure the facial nerve in any patients. CONCLUSIONS: For patients with primary melanoma that is near or overlaps the nodal basin in the head or neck, SLN biopsy can be accurately performed using Tc-99m sulfur colloid at low activity levels (10 microCi to 60 microCi [0.37 to 2.2 MBq]. However, background radiation from the primary injection site can incorporate the SLN, making localization at preoperative lymphoscintigraphy difficult if not impossible; therefore, the high doses commonly used for melanoma of the extremities and trunk (500 to 2000 microCi [18.5 to 74 MBq]) should not be used for melanoma of the head or neck if the primary site is near or overlaps the nodal basin. In addition, absorption of Tc-99m sulfur colloid by salivary glands increases background radiation in the nodal basin; therefore, use of the handheld gamma probe for intraoperative localization of SLN can be problematic in regions where lymph nodes are adjacent to or within the substance of the salivary gland (i.e., the submandibular and parotid glands).     

Lymph node metastases in the neck and parotid gland from an unknown primary melanoma

A lymph node metastasis in the neck or parotid region from an unknown primary melanoma is an uncommon occurrence. Out of a total of 300 patients with head and neck melanoma treated at the Netherlands Cancer Institute between 1976 and 1992, 17 (5.7%) presented in this way. The most common site for metastatic lymph nodes (18 nodes in 17 patients) was level V (n= 7), followed by the parotid region (n= 4), level II (n= 4), level III (n= 2), and level IV (n= 7). Two patients had local excision of the neck node metastasis only, while the remaining 15 patients underwent more extensive surgical treatment. The 5-year disease-specific survival rate in this group was 48%, with a median survival of 36 months, which is more or less similar to the prognosis of stage II melanoma of the head and neck with a known, surgically treated primary tumour. No relation was found between disease-free interval and sex, the number of positive lymph nodes or the duration of symptoms.     

Pediatric melanoma of the head and neck: a single institutions experience

OBJECTIVES: The objectives of this study were to review our experience with pediatric melanoma of the head and neck and discuss proper diagnostic protocols and suggest a possible treatment algorithm. STUDY DESIGN: The authors conducted a retrospective chart review of patients under the age of 18 who underwent treatment for melanoma of the head and neck at a tertiary care university hospital. RESULTS: Six patients were identified in the last 25 years at our institution. Four patients had melanomas in the auricle, one in the cheek, and one in the forehead. All occurrences identified presented in the past 7 years. All were treated with wide local excision. Three patients received sentinel lymph node biopsy, one received a neck dissection after identification of positive sentinel nodes, and two patients received postoperative interferon therapy. No surgical complications were reported. At the time of this submission, no patients were found to have recurrence of the disease. CONCLUSIONS: Pediatric melanoma of the head and neck may be managed effectively using current techniques used in treating adult patients. The use of sentinel lymph node biopsy is recommended when the depth of invasion cannot be determined from original biopsy, the original pathologic diagnosis is ambiguous, or depth of invasion from biopsy is sufficient to warrant its use. In addition, the use of adjuvant interferon alpha-2b is recommended in patients at high risk for recurrence.     

Elective, therapeutic, and delayed lymph node dissection for malignant melanoma of the head and neck: analysis of 1444 patients from 1970 to 1998

OBJECTIVE: The purpose of this article is to evaluate the effects on survival, disease-free interval, and recurrence patterns for patients undergoing elective, therapeutic, and delayed lymph node dissection for malignant melanoma of the head and neck. STUDY DESIGN AND METHODS: A retrospective computer-aided analysis was performed comparing 1444 patients treated from 1970 to 1998 at Duke University Medical Center. A total of 446 of the 1444 (32%) of patients with head and neck melanoma underwent some form of lymph node dissection. Survival, disease-free interval, and recurrence rates for patients having 1) no initial lymph node dissection (no LND), 2) elective lymph node dissection (ELND) within 2 months of date of diagnosis, 3) therapeutic lymph node dissection (TLND) for metastatic regional disease at diagnosis, or 4) delayed lymph node dissection (DLND) for patients developing regional lymph node metastasis later than 3 months from the date of diagnosis were compared. RESULTS: A total of 246 patients undergoing ELND demonstrated 11% with occult disease. DLND for regional lymph node recurrence was reported at a median time interval of 1.2 years from diagnosis. Multivariate analysis indicated a significant improvement in survival for DLND when compared with patients undergoing ELND plus sign in circle or TLND (P =.01). Distant metastasis was the site of first recurrence in 12% of patients undergoing no initial LND. Five-year survival after DLND and TLND was 56% and 36%, respectively. CONCLUSION: Patients undergoing DLND had an overall better survival than patients undergoing TLND or ELND with positive nodes. The progression of metastatic disease following regional node disease occurred in 35% to 45% of cases, underscoring the need for effective adjunctive therapy.     

High sensitivity and negative predictive value of sentinel lymph node biopsy in a retrospective early stage oral cavity cancer cohort in the Northern Netherlands

Objectives

In cT1‐2N0, oral squamous cell carcinoma (OSCC) occult metastases are detected in 23%‐37% of cases. Sentinel lymph node biopsy (SLNB) was introduced in head and neck cancer as a minimally invasive alternative for an elective neck dissection in neck staging. Meta‐analyses of SLNB accuracy show heterogeneity in the existing studies for reference standards, imaging techniques and pathological examination. The aim of this study was to assess the sensitivity and negative predictive value (NPV) of the SLNB in detecting occult metastases in cT1‐2N0 OSCC in a well‐defined cohort.

Design

Retrospective study. The SLNB procedure consisted of lymphoscintigraphy, SPECT/CT‐scanning and gamma probe detection. Routine follow‐up was the reference standard for the SLNB negative neck. Histopathological examination of sentinel lymph nodes (SLN) consisted of step serial sectioning, haematoxylin‐eosin and cytokeratin AE1/3 staining.

Setting

Two comprehensive oncology centres.

Participants

A total of 91 consecutive patients with primary cT1‐2N0 OSCC treated by primary resection and neck staging by SLNB procedure between 2008 and 2016.

Main outcome measures

Sensitivity and negative predictive value.

Results

In all cases, SLNs were harvested. A total of 25 (27%) patients had tumour‐positive SLNs. The median follow‐up was 32 months (range 2‐104). Four patients were diagnosed with an isolated regional recurrence in the SLNB negative neck side resulting in an 85% sensitivity and a 94% NPV.

Conclusion

In our cohort, the SLNB detected occult metastases in early OSCC with 85% sensitivity and 94% NPV. This supports that SLNB is a reliable procedure for surgical staging of the neck in case of oral cT1‐2N0 SCC.