Abstract

Early stage oral cavity squamous cell carcinoma (OCSCC) has a significant risk of subclinical nodal metastases, which is the strongest independent prognostic factor for regional recurrence and survival. However current preoperative imaging modalities are unable to identify patients with micrometastases, and an observation strategy has been associated with inferior outcomes when compared to an elective neck dissection. Sentinel lymph node biopsy provides a safe and accurate staging procedure to select the patients who benefit from an elective neck dissection, while avoiding unnecessary surgery in the patients who are node negative. There is recent Level II evidence demonstrating equivalent oncological outcomes when compared with elective neck dissection. However, a multidisciplinary approach is required including reliable mapping of the sentinel lymph node, precise surgical technique and comprehensive histopathological analysis to ensure accurate results are obtained.

Highlights

  • Stage oral cavity squamous cell carcinoma (T1N0 or T2N0) has a significant risk of between 20 and 44% [1–3] of harbouring subclinical nodal metastases

  • Superior outcomes have been published in a prospective randomised controlled trial (RCT) involving patients with early oral cavity squamous cell carcinoma (OCSCC) (T1/T2 tumours) without clinical evidence of nodal metastases, when they underwent an elective neck dissection (END) compared to observation followed by neck dissection in the setting of nodal relapse [14]

  • OCSCCs have a risk of subclinical nodal metastases to the draining cervical lymph nodes, which has a negative impact on the patient’s prognosis and survival

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Summary

Introduction

Stage oral cavity squamous cell carcinoma (T1N0 or T2N0) has a significant risk of between 20 and 44% [1–3] of harbouring subclinical nodal metastases. The presence of nodal metastases has been shown to be the strongest independent prognostic factor for predicting a poor outcome [4–6]. The only way to identify this was to perform an elective neck dissection (END), this is unnecessary in the majority (60–80%) of patients who do not harbour occult nodal metastases, and has an associated morbidity [1]. This chapter will present the histopathological factors that have been used to risk stratify patients for an END, as well as the multifaceted technique and role of sentinel lymph node biopsy (SLNB) as a staging procedure for patients with OCSCC

Histopathological factors
Benefit of elective neck dissection
Technique of sentinel lymph node biopsy
Histopathological analysis
Accuracy in predicting neck status
Outcomes following sentinel lymph node biopsy
Future directions
Findings
Conclusion

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