Biopsy of the sentinel lymph node in oral squamous cell carcinoma: analysis of error in 100 consecutive cases

Abstract

UK national guidelines in 2016 recommended that sentinel lymph node biopsy should be offered to patients with early oral cancer (T1-T2 N0) in which the primary site can be reconstructed directly. This study describes the pitfalls that can be avoided in the technique of biopsy to improve outcomes. We retrospectively analysed the data from 100 consecutive patients and recorded any adverse events. Lymphatic drainage of tracer failed in two patients as a result of procedural errors. Two patients with invaded nodes developed recurrence after total neck dissection, one after micrometastases had been diagnosed, and the other as a result of extranodal spread that had led to understaging and therefore undertreatment. Two results would not have been mistakenly classified as clear if all the harvested nodes had been analysed histologically according to the protocol. The disease-specific (96%) and disease-free (92%) survival were better than expected for a group of whom a third had stage 3 disease. If all harvested nodes had been analysed by the correct protocol then two of the three nodes wrongly designated clear would have been detected, two deaths potentially avoided, and the false-negative rate would have fallen from 8.3% to 2.7%. We conclude that minor deviations from protocol can result in a detrimental outcome for the patient.

Usefulness of Sentinel Lymph Node Biopsy for Oral Cancer: A Systematic Review and Meta‐Analysis

“…Two authors individually collected data from included articles in forms commensurate with each other. Diagnostic accuracy, represented by DOR, summary receiver operating characteristic (SROC) curve, and area under the curve (AUC), was calculated 1,5,11–102 . DOR was calculated as (true positive [TP]/false positive [FP])/(false negative [FN]/true negative [TN]) to assess diagnostic accuracy with 95% confidence intervals (CIs).…”

Efficacy of different sentinel lymph node biopsy protocols in oral squamous cell carcinoma: Systematic review and meta‐analysis

“…Out of the 23 1,17–38 articles, 15 were prospective 1,18,19,21,24–28,30–32,34,37,38 and eight were retrospective 18,20,22,23,29,33,35,36 . All of the articles considered tumors on the tongue, as well as other locations in the oral cavity.…”

Analysis of the Efficiency and Prognostic Value of the Sentinel Node Technique in Oral Squamous Cell Carcinoma after Seven Years

“…SNLB is based on the early detection and correct staging of neck lymph node involvement, since multiple studies have shown that lymph node involvement is decisive for patient survival [3][4][5][6]. In addition, it is not only crucial for survival, but it is also a factor that will determine the patient's quality of life, when taking into consideration the side effects of the other different treatment options [14].…”

“…In the early stage of OSCC (T1-T2/NO) the presence of metastasis lymph nodes reduces the patient's survival by 50% and it is one of the most important adverse indicators of the disease's prognosis [3][4][5]. Furthermore, it has been calculated that there is a risk of ganglionic affectation in around 20-30% of the cases [2,[6][7][8]; therefore, the correct staging of lymph nodes is crucial for the patient's therapeutic development. Given that modern image techniques (ultrasound, computed tomography, positron emission tomography and magnetic resonance imaging) [9,10] and physical palpation are not sensitive enough to be able to determine the definitive position of the lymph node, associated surgical techniques must be used [4,[11][12][13].…”

“…The therapeutic management of OSCC in T1-T2/NO remains a controversial topic. One of the most historically recognised techniques, which is also used in staging, is the lateral neck dissection (3,5,10); a technique that has produced better survival rates than those attained when enforcing the "watch and wait" approach [6]; nonetheless, 70-80% of the patients who are subjected to this technique do not receive any kind of benefit [11,13] given that they do not present with hidden metastatic lymph nodes [14] and, as a result, these patients are exposed to a series of associated postoperative risks, such as shoulder pain and spinal nerve damage [4] that reduce their quality of life [8].…”