Diagnostic Efficacy of Sentinel Lymph Node Biopsy in Early Oral Squamous Cell Carcinoma: A Meta-Analysis of 66 Studies

Abstract

ObjectivesThe diagnostic efficacy of sentinel lymph node biopsy(SLNB) in early oral squamous cell carcinoma(OSCC) still remains controversial. This meta-analysis was conducted to assess the diagnostic value of SLNB in clinically neck-negative T1-2 OSCC.MethodsA systematic literature search for relevant literature published up to September 11, 2016 was conducted in PubMed, Embase, Web of Science, Cochrane Library and ClinicalTrials, and the reference lists of eligible studies were examined. Data from different studies were pooled to estimate the summary sentinel lymph node(SLN) identification rate, sensitivity, negative predictive value. Summary receiver operator characteristic curve(SROC) was plotted and area under the SROC curve (AUC) was calculated to evaluate the overall diagnostic efficacy. Threshold effect was assessed with use of the spearman correlation coefficient. Between-study heterogeneity was tested using the Q tests and the I2 statistics. Subgroup analyses were conducted in view of the greater effect of different study characteristics on diagnostic efficacy of SLN. Deeks’ funnel plot asymmetry test was performed to evaluate publication bias. Sensitivity analysis was evaluated through omitting studies one by one and comparing the pooled results of random-effects model and fixed-effects model. All analyses were performed using Review Manager (version 5.3.5), Meta-DiSc (version 1.4), Comprehensive Meta Analysis (version 2.0) and STATA (version 12).Results66 studies comprising 3566 patients with cT1-2N0 OSCC were included in this meta-analysis. The pooled SLN identification rate was 96.3%(95% CI: 95.3%-97.0%). The pooled sensitivity was 0.87 (95% CI: 0.85–0.89), pooled negative predictive value was 0.94 (95% CI: 0.93–0.95), and AUC was 0.98 (95% CI: 0.97–0.99). Subgroup analyses indicated that SLN assessment with immunohistochemistry(IHC) achieved a significantly higher sensitivity than without IHC.ConclusionsThis meta-analysis suggests that SLNB has a high diagnostic accuracy in cT1-2N0 oral squamous cell carcinoma, and is an ideal alternative to elective neck dissection. Furthermore, the use of IHC can significantly improve SLNB diagnostic sensitivity for early OSCC.

Sentinel lymph node biopsy for management of the N0 neck in oral cavity squamous cell carcinoma

“…However, the capacity of SNB to be used in lieu of ND has been under investigation. A recent meta‐analysis which included 3566 patients, found the sensitivity and negative predictive value of SNB to be 87% and 94%, respectively . Additional prospective and retrospective studies have all provided results consistent with this meta‐analysis …”

“…SNB is usually successful in identifying occult metastasis. This study's SLN detection rate, DSS, DFS, and recurrence rate correlate to a recent meta‐analysis …”

“…Recurrence, regardless of site, appears to bear with it undesirable OS, and continues to be a significant challenge in the management of head and neck cancer. However, SNB carries a comparable overall recurrence rate to other management modalities …”

“…An initial study conducted at our medical center, with 33 patients, found that the sensitivity and negative predictive value to determine OSCC staging by SNB alone was 71% and 94%, respectively . Studies indicate SNB is more cost effective and is less invasive and patient favored . SNB attempts to avoid the morbidity associated with a ND.…”

Endoscopic sentinel lymph node biopsy using indocyanine green‐neomannosyl human serum albumin

“…Sentinel lymph node biopsy using conventional radioisotopes is widely used to avoid unnecessary surgery in low‐risk HNSS patients. This procedure has satisfactory sensitivity and specificity for detection of micrometastasis to cervical lymph nodes but has the disadvantages of leaving visible scars on the neck and radiation exposure . These disadvantages are why endoscopic sentinel lymph node biopsy with advanced endoscopic equipment and new tracers are needed for head and neck surgery.…”