Sentinel Node Biopsy for Oral and Oropharyngeal Squamous Cell Carcinoma of the Head and Neck

Issue: Vol.7, No.4 - October 2008

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  1. Dr Sandro J. Stoeckli
    Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurichrnrn

Objectives: The objective of this prospective series of patients is to present the experience in a large consecutive cohort undergoing sentinel node biopsy (SNB) for early (T1 and T2) squamous cell carcinoma of the oral cavity and oropharynx. The aims were to assess the technical feasibility of SNB, to validate SNB against elective neck dissection, and to report the results of the clinical application of the SNB concept.

Study design: prospective consecutive cohort analysis

Patients and methods: Between 2000 and 2006 a total number of 79 patients were included for this study. Lymphatic mapping was performed with preoperative lympho-scintigraphy and intra-operative use of a hand held gamma probe. Twenty-eight patients were assessed for feasibility and validation. The SNB was done in context with an elective neck dissection in these patients. Fifty-one patients were evaluated in an observational trial. These patients underwent SNB, and elective neck dissection only in case of positive SNB.

Results: Feasibility and validation: The sentinel node detection rate with the lympho-scintigraphy was 93%, with the gamma probe 100%. The negative predictive value of a negative SNB was 100%. Thirty-two percent of the patients were upstaged as a result of a positive SNB.

Clinical application: Forty percent of the patients were upstaged as a result of a positive SNB. Intra-operative frozen section analysis showed a negative predictive value of 83%. Only two patients (6%) with negative SNB experienced a neck recurrence, the negative predictive value of SNB for the remaining neck was therefore 94%. Patients with positive SNB were treated successfully with elective neck dissection and no postoperative radiation employed.

Conclusions: SNB is technically feasible and reproducible with a high sentinel node detection and excision rate. Validation against the standard of reference revealed a perfect 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 with a clinically negative neck.

There is increasing evidence supporting the concept of SNB for early oral and oropharyngeal carcinoma. SNB may become the standard of care in the near future.

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