Challenges and outcomes in establishing a sentinel lymph node biopsy service for oral squamous cell carcinoma in a regional district specialist hospital

Centralised pathology service for sentinel node biopsy in oral cavity cancer: The Southeast England Consortium experience

“…Given the labour‐intensive nature of histological evaluation of sentinel nodes in OSCC, it is unreasonable for pathology departments to subsume this work without appropriate additional equipment and staffing resources. As such, histopathology capacity limitations are likely to hinder the expansion of SLNB services 15 . Against this background, the Southeast England Consortium for SLNB in OSCC was established to expand the accessibility of the technique in this part of the United Kingdom.…”

“…However, due to logistic challenges such as training of the multidisciplinary team and compliance to stringent regulatory protocols, SLNB is currently only limited to a few centres. Furthermore, since histological evaluation of sentinel nodes requires serial step sections with immunohistochemistry of the entire lymph node, the considerable burden on pathology services limits the wide availability of this technique 15,16 …”

“…Furthermore, since histological evaluation of sentinel nodes requires serial step sections with immunohistochemistry of the entire lymph node, the considerable burden on pathology services limits the wide availability of this technique. 15,16 The Southeast England Consortium for SLNB in OSCC was established in 2016 primarily for the purpose of widening the availability and providing quality assurance of the procedure. This model comprises four regional surgical head and neck cancer departments utilising a centralised pathology service.…”

Serial step sections at narrow intervals with immunohistochemistry are required for accurate histological assessment of sentinel lymph node biopsy in oral squamous cell carcinoma

“…The benefits of SLNB over END are only apparent if the sensitivity of the former exceeds 83.7% 13 . However, while SSS and IHC increases the sensitivity rates of SLNB, this results in considerable burden on histopathology services and may explain the lack of widespread availability and reluctance to implement this technique 28 . In this context, some groups have suggested that simplifying the laboratory procedure with fewer section levels may be clinically expedient 29,30 .…”

“…13 However, while SSS and IHC increases the sensitivity rates of SLNB, this results in considerable burden on histopathology services and may explain the lack of widespread availability and reluctance to implement this technique. 28 In this context, some groups have suggested that simplifying the laboratory procedure with fewer section levels may be clinically expedient. 29,30 For example, Bell et al reported that a single H&E and IHC section of the SN was sufficient to provide an acceptable negative predictive value for the nodal basin status in a cohort of 35 patients.…”