Utility of Head and Neck Cutaneous Squamous Cell Carcinoma Sentinel Node Biopsy: A Systematic Review. (February 2014)

• Record Type: Journal Article
• Authors: Ahmed, Mostafa M.; Moore, Brian A.; Schmalbach, Cecelia E.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 150:Number 2(2014:Feb.)
• Page Start: 180
• Page End: 187
• Publication Date: 2014-02
• Subjects: sentinel node -- cutaneous squamous cell carcinoma -- skin cancer; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599813511949
• Languages: English
• ISSNs: 0194-5998

Abstract

Objective: Sentinel lymph node biopsy (SLNB) is standard of care for melanoma, but its role in cutaneous squamous cell carcinoma (cSCC) has not been established. Study objectives include: (1) analyze the feasibility and reliability SLNB for head and neck (H&N) cSCC and (2) identify risk factors associated with a positive SLN. Data Sources: MEDLINE, PubMed, Cochrane, and ASCO databases searches conducted (1946-2013). Review Methods: Using the PRISM model, a comprehensive systematic review of H&N cSCC SLNB studies with associated recurrence rates was conducted. Dual-blinded data extraction identify primary outcomes (successful SLN harvest and false omission rate) and secondary outcomes (risk factors associated with a +SLN). Results: Two hundred twenty-one articles were screened; 73 patients from 11 publications met inclusion criteria (3 case series; 8 prospective cohorts). Studies ranged from 1 to 15 patients (median 5). Median age was 74 years. Median follow-up was 21.5 months. Average tumor size was 3.09 cm. At least 1 SLN was identified in 100% of patients (median 2). Ten (13.5%) had a positive SLN; no additional metastatic nodes were identified in 9 patients receiving completion lymphadenectomy. Tumor diameter was not associated with SLN status ( P = .09; 95% CI, –.27 to 3.02). Risk factors (tumor depth, perineural invasion, location, differentiation) were not consistently recorded. Three of 63 (4.76%) failed regionally following a negative SLNB. Conclusion: H&N cSCC SLNB is feasible and reliable for staging, with a false omission rate of 4.7% mirroring melanoma. Prospective studies documenting high risk features are required to further define its role.