Topographical distribution of sentinel nodes and metastases from T1–T2 oral squamous cell carcinomas. (January 2019)

• Record Type: Journal Article
• Authors: Mølstrøm, Jacob; Grønne, Mark; Green, Anders; Bakholdt, Vivi; Sørensen, Jens Ahm
• Is Part Of: European journal of cancer. Volume 107(2019)
• Page Start: 86
• Page End: 92
• Publication Date: 2019-01
• Subjects: Oral cavity cancer -- Sentinel lymph node biopsy -- Oral squamous cell carcinoma -- Lymph node metastasis -- Elective neck dissection -- Topographical distribution -- Lymphoscintigraphy -- Recurrence; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2018.10.021
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Objective: The objective is to investigate the topographical distribution of sentinel nodes (SNs) and lymph node metastases in T1-2cN0 oral squamous cell carcinomas (OSCCs). Methods: The study entailed a prospective enrolment of 220 patients with clinical T1-2N0 OSCCs who underwent preoperative lymphoscintigraphy (LSG) followed by gamma probe–guided sentinel lymph node biopsy (SLNB). Patients with positive SNs were treated with completion neck dissection. Excised lymph nodes were grouped into the neck level according to the international guidelines. Results: The SN detection rate by LSG was 99.1%. Patients with midline tumours had bilateral lymphatic drainage on LSG in 15/21 (71.5%). There were 45/199 (22.6%) patients with lateralised tumours that had unexpected bilateral or contralateral drainage patterns on LSG. Fifty-five patients (25.0%) were SLNB positive, and metastases were found in 72/781 (9.2%) of the excised SNs. Metastatic involvement of neck level IV was rare and only observed in patients with anterior tongue cancer. No patients had level V involvement. Eleven patients developed isolated cervical recurrences, with no new primary tumour as origin. The SLNB procedure ensured an overall sensitivity of 83.3% and a negative predictive value of 93.3%. Conclusion: Completion neck dissection of level I–III in SLNB-positive patients might be sufficient in most patients with OSCC except patients with anterior tongue cancer, but further studies are needed to support this potential therapeutic algorithm. Our study showed that SLNB was helpful in clarifying unexpected bilateral or contralateral metastatic drainage patterns. In our cohort, 8/55 patients with occult metastasis would have been missed by elective neck dissection of the ipsilateral neck. Highlights: Sentinel lymph node biopsy procedure can assess the individual drainage pattern. Most occult metastases are located in neck level I–III. The sentinel node biopsy approach is promising for individual surgical planning. The regional recurrence rate in our sentinel node-negative patients is equal to the rate after elective neck dissection reported previously. 8/55 (14.5%) patients with occult metastasis would have been missed by conservative elective neck dissection treatment of the ipsilateral neck.