Abstract
RationaleThis study evaluates the lymphatic drainage patterns and determines the accuracy of the sentinel lymph node biopsy (SLNB) in patients diagnosed with a cT1-2N0 OSCC and a history of neck surgery or radiotherapy in three Dutch head and neck centers. Materials and MethodsRetrospective analysis of 53 cT1-2N0 OSCC patients, who underwent SLNB between 2007 and 2016, after a history of neck surgery or radiotherapy. Ten patients had previous treatment of the neck only contralateral from the current tumour. These ten patients were not used for the analysis of lymphatic drainage patterns. The 43 patients with previous ipsilateral or bilateral treatment of the neck had a history of ipsilateral SLN extirpation (n = 9; 21%), neck dissection (n = 16; 37%), radiotherapy (n = 10; 23%), or combined neck dissection and radiotherapy (n = 8; 19%). ResultsSLNs were detected in 45 patients, resulting in an identification rate of 85% (45/53). Three patients (7%) had at least one positive SLN. One patient (1/45; 2%) was diagnosed with regional recurrence during the follow-up after a negative SLNB (sensitivity 75%, negative predictive value 98%). The first SLN was detected in level I-III in 58% of the patients, unexpected drainage patterns were observed in 30% (first SLN level IV 9% and level V 5% and contralateral neck in well-lateralized tumours 16%). In 12% no lymphatic drainage pattern was visible. ConclusionsSLNB seems to be a reliable procedure for neck staging of cT1-2N0 OSCC patients with a previously treated neck. SLNB determines the individual lymphatic drainage patterns, enabling visualization of unexpected drainage pattern variability in 30% of these patients.
Highlights
Presence of lymphatic metastases in the neck is consistently observed as main prognostic factor in patients with oral squamous cell carcinoma (OSCC) [1,2,3]
In this study unexpected lymphatic drainage patterns were found in 30% of the patients and no drainage was found in 12% of the patients
As a result of the previous treatment, lymphatic drainage patterns could be disrupted resulting in aberrant drainage patterns compared to primary OSCC
Summary
Presence of lymphatic metastases in the neck is consistently observed as main prognostic factor in patients with oral squamous cell carcinoma (OSCC) [1,2,3]. Sentinel lymph node biopsy (SLNB) proved to be reliable as diagnostic staging modality for detection of occult lymph node metastases: in a large recent meta-analysis a pooled sensitivity of 87% (95% CI 85–89%), a negative predictive value of 94% (95% CI 93%-95%) and an AUC of 0.98 (95% CI 0.97–0.99) were found [4]. These meta-analysis results are based on patients with primary OSCC. Despite the relatively common local recurrences and second primary tumours in head and neck cancer, only one study of Flach et al reported about the accuracy of the SLNB in 22 patients with a previously treated neck [5]
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