Sentinel Node Biopsy in Head and Neck Cancer: Preliminary Results of a Multicenter Trial (original) (raw)
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European Archives of Oto-Rhino-Laryngology, 2006
The routine use of a sentinel node biopsy (SNB) protocol in oral cavity squamous cell carcinomas (SCC) has been challenged on the basis of the elevated number of sentinel nodes (SNs) detected (>2.5) and on the multiply neck level involvement reported in several studies. These data limit the practical application of the protocol, because in such cases, it seems easier and safer to perform a selective neck dissection. The aim of our study is to perform radioguided surgery 1-3 h after lymphoscintigraphy (same day protocol) to detect the lymph nodes closest to the tumour site. In our study, 12 patients aVected by cT1-2 N0 SCC of the oral cavity were submitted to a same day protocol of a lymphoscintigraphic examination (1-3 h before surgery) and a radioguided SNB. We used a hand-held gamma probe and performed an elective neck dissection on all patients. The SNs were found in all cases with 83% localised in the ipsilateral neck in only levels I-II. The mean number of SN detected was 2.1, with a mean pathological size of 13.8 mm measured on pathological specimen. Metastases were found in 5/12 cases (41.6%), on levels I, II and III and all were identiWed by step serial sectioning and routine H&E staining. This study conWrms the accuracy of SNB in predicting the presence of occult metastases. This protocol is designed to detect SNs, which are almost always on neck level I and II, thereby limiting the number of nodes examined and the extension of the surgical approach.
European Archives of Oto-Rhino-Laryngology, 2020
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.
Sentinel Node Biopsy in Squamous Cell Carcinoma of the Oral Cavity
2007
Head and Neck Squamous Cell Carcinoma (SCC) spreads via lymphatics to the regional draining lymph nodes in the neck. Since the presence of lymph node metastases is the most important prognostic factor in Head and Neck (H&N) cancer, decreasing survival by 50%, reliable staging of the neck in this disease is imperative to determine further management. [14] Data from Literature show an incidence of occult metastases in oral cavity tumours ranging from 12% to 50% (mean 33%). Traditional imaging techniques (UlS, CT, MRI) are not able to obtain a detailed staging of N0 neck, having a specificity of 75% to 92% [14]. So, for most Authors [7, 23] the gold standard in these cases is to treat the patients with elective neck dissection and routinelly pathological examination of the surgical specimen. This policy means that up to 60-70 % of patients with N0 neck have unnecessary operations, with
The Value of Sentinel Lymph Node Biopsy in Oral Cavity Cancers
Turk Otolarengoloji Arsivi/Turkish Archives of Otolaryngology, 2015
The aim of this study was to establish the effectiveness of sentinel lymph node biopsy in the detection of metastasis in N0 necks of T1-T2 early-stage oral cavity cancers. Materials and Methods: Twenty neck dissections were performed in 18 patients diagnosed with T1 and T2 oral cavity cancer, with an indication for elective neck dissection between November 2007 and January 2011. The male to female ratio was 12:8, with a mean age of 54.5 years (range 28-76). Eight of the dissections were performed for lower lip cancer, 7 for tongue cancer, and 5 for floor of the mouth cancer. Sentinel lymph node biopsy was used to detect metastatic lymph nodes. Tc99m radionuclide injection was administered to the periphery of the tumor 24 h before the operation, and a lymphoscintigraphy image was obtained 30 min after the injection. Sentinel lymph nodes were localized and excised on the day of surgery using static lymphoscintig-raphy images and a gamma probe. Sentinel lymph nodes were sent for a frozen section examination, and either a selective or a comprehensive neck dissection was performed for each neck according to the results. Results: After the final histopathological examination of the specimens, the negative predictive value, the positive predictive value, the accuracy of the sentinel lymph node biopsy, and frozen section accuracy were found to be 100%. Conclusion: Sentinel lymph node biopsy was found to be an efficient method in the pathological staging and management of the N0 neck in early T-stage oral cavity cancers.
Journal of Cancer Metastasis and Treatment, 2023
Sentinel node biopsy (SNB) is considered the standard surgical procedure for detecting occult neck node metastasis in oral squamous cell carcinoma (OSCC) in many centers around the world. Due to the fact that this method removes and evaluates the first lymph node(s) reached by the lymphatic flow from the tumor area, this has raised the question of whether SNB could also be considered a therapeutic procedure by targeted lymphadenectomy instead of elective neck dissection (END). Compared to END, its safety and low morbidity have been established. However, the surgical management of the clinical node-negative (cN0) neck in T1/T2 oral carcinoma has been under ongoing debate due to the lack of randomized studies comparing SNB to END in terms of overall survival (OS), disease-free survival (DFS) and neck recurrence rates (NRRs). In the last years, two prospective randomized studies have proven with high-level evidence the noninferiority of SNB compared to END in terms of oncologic outcome while reducing costs and morbidity. In our opinion, SNB should be offered as the new standard therapeutic procedure in early OSCC.
Head & Neck, 2014
Background This study aimed to compare sentinel node biopsy (SNB) and Ultrasonography(US) guided fine needle aspiration cytology (USgFNAC) for preoperative evaluation of the N0 neck in T1-T2 oral cavity squamous cell carcinoma (OCSCC). Methodology Consecutive 51 patients with T1-T2 N0 OCSCC were included. Pre-operative US was performed in all patients. USgFNAC was performed in patients where US was reported as indeterminate or positive. SNB was done in all patients followed by elective neck dissection (END). Histopathology of END was considered as gold standard for all statistical analysis. Results The incidence of occult metastasis was 26.4%. The sensitivity , specificity, positive predictive value (PPV) and negative predictive value (NPV) were 71.4%, 100%, 100% and 90.2% for SNB and 14.3%, 100%, 100% and 76.5% for USgFNAC. Conclusion USgFNAC lacked sufficient accuracy to detect occult metastases. SNB is a reliable method to detect occult metastasis which has potential to replace END.
Clinical Nuclear Medicine, 2016
PURPOSE: Nuclear imaging plays a crucial role in lymphatic mapping of oral cancer. This evaluation represents a subanalysis of the original multicenter SENT trial data set, involving 434 patients with T1-T2, N0, and M0 oral squamous cell carcinoma. The impact of acquisition techniques, tracer injection timing relative to surgery, and causes of false-negative rate were assessed. METHODS: Three to 24 hours before surgery, all patients received a dose of Tc-nanocolloid (10-175 MBq), followed by lymphoscintigraphy. According to institutional protocols, all patients underwent preoperative dynamic/static scan and/or SPECT/CT. RESULTS: Lymphoscintigraphy identified 723 lymphatic basins. 1398 sentinel lymph nodes (SNs) were biopsied (3.2 SN per patient; range, 1-10). Dynamic scan allowed the differentiation of sentinel nodes from second tier lymph nodes. SPECT/CT allowed more accurate anatomical localization and estimated SN depth more efficiently. After pathological examination, 9.9% of the SN excised (138 of 1398 SNs) showed metastases. The first neck level (NL) containing SN+ was NL I in 28.6%, NL IIa in 44.8%, NL IIb in 2.8%, NL III in 17.1%, and NL IV in 6.7% of positive patients. Approximately 96% of positive SNs were localized in the first and second lymphatic basin visualized using lymphoscintigraphy. After neck dissection, the SN+ was the only lymph node containing metastasis in approximately 80% of patients. CONCLUSIONS: Best results were observed using a dynamic scan in combination with SPECT/CT. A shorter interval between tracer injection, imaging, and surgery resulted in a lower false-negative rate. At least 2 NLs have to be harvested, as this may increase the detection of lymphatic metastases.