Elective Neck Dissection or Sentinel Lymph Node Biopsy in Early Stage Oral Cavity Cancer Patients: The Dutch Experience.

Inne J Den Toom,Koos Boeve,Maarten L Donswijk,C René Leemans,Stefan M Willems,Max J.H Witjes,Daphne Lobeek,Bart De Keizer,Robert P Takes,W Martin C Klop,Elisabeth Bloemena,Remco De Bree

doi:10.3390/cancers12071783

Abstract

Background: Sentinel lymph node biopsy (SLNB) has been introduced as a diagnostic staging modality for detection of occult metastases in patients with early stage oral cancer. Comparisons regarding accuracy to the routinely used elective neck dissection (END) are lacking in literature. Methods: A retrospective, multicenter cohort study included 390 patients staged by END and 488 by SLNB. Results: The overall sensitivity (84% vs. 81%, p = 0.612) and negative predictive value (NPV) (93%, p = 1.000) were comparable between END and SLNB patients. The END cohort contained more pT2 tumours (51%) compared to the SLNB cohort (23%) (p < 0.001). No differences were found for sensitivity and NPV between SLNB and END divided by pT stage. In floor-of-mouth (FOM) tumours, SLNB had a lower sensitivity (63% vs. 92%, p = 0.006) and NPV (90% vs. 97%, p = 0.057) compared to END. Higher disease-specific survival (DSS) rates were found for pT1 SLNB patients compared to pT1 END patients (96% vs. 90%, p = 0.048). Conclusion: In the absence of randomized clinical trials, this study provides the highest available evidence that, in oral cancer, SLNB is as accurate as END in detecting occult lymph node metastases, except for floor-of-mouth tumours.

Highlights

In early stage oral squamous cell carcinoma (OSCC), 20–30% of the patients are diagnosed with occult metastases despite advances in imaging modalities [1,2,3,4]
390 (44%) elective neck dissection (END) patients and 488 (56%) Sentinel lymph node biopsy (SLNB) patients were used for analysis
This study presents the accuracy in staging of the cN0 neck and survival rates of both END and SLNB in two large retrospective cohorts

Summary

Introduction

In early stage (cT1-2N0) oral squamous cell carcinoma (OSCC), 20–30% of the patients are diagnosed with occult metastases despite advances in imaging modalities [1,2,3,4]. Early stage OSCC patients underwent either watchful waiting or an elective neck dissection (END). Sentinel lymph node biopsy (SLNB) was introduced in OSCC as a less invasive alternative with lower morbidity rates compared to an END [9]. In early stage OSCC, the most recent meta-analysis reported a pooled sensitivity of 87% and a pooled negative predictive value of 94% for the SLNB procedure in detecting occult metastasis [10]. Sentinel lymph node biopsy (SLNB) has been introduced as a diagnostic staging modality for detection of occult metastases in patients with early stage oral cancer. Comparisons regarding accuracy to the routinely used elective neck dissection (END) are lacking in literature

Methods

Results

Discussion

Conclusion