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. 2020 Jul 3;12(7):1783.
doi: 10.3390/cancers12071783.

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

Inne J den Toom  1 , Koos Boeve  2   3 , Daphne Lobeek  4 , Elisabeth Bloemena  5   6 , Maarten L Donswijk  7 , Bart de Keizer  8 , W Martin C Klop  9 , C René Leemans  10 , Stefan M Willems  11   12 , Robert P Takes  13 , Max J H Witjes  2 , Remco de Bree  1
Affiliations

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

Inne J den Toom et al. Cancers (Basel). .

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.

Keywords: elective neck dissection; lymph node metastases; lymphatics; oral cancer; sentinel lymph node biopsy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Shine through phenomenon: Radiation flare of the primary tumour overshines the hotspot of a sentinel lymph node in close proximity to the primary tumour (arrow).
Figure 2
Figure 2
Survival analyses: Disease-specific survival between END and SLNB patients divided by T stage (A) and by anatomical location (B). Because of the low number of pT3 (n = 8) and pT4 (n = 2)-staged patients for each of the staging methods, these pT stages were excluded from the disease-specific survival analysis divided by T stage (A). Disease-specific survival analysis of the END and SLNB groups divided for true positives, true negatives and false negative patients (C). SLNB-staged patients with an FOM tumour were also divided by true positive, true negative and false negative patients (D). Regional recurrence free survival between END and SLNB patients divided by T stage (E) and by anatomical location (F). Abbreviations: END, elective neck dissection; SLNB, sentinel lymph node biopsy; FOM, floor of mouth.
See this image and copyright information in PMC

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