Diagnostic value of sentinel lymph node biopsy for cT1/T2N0 tongue squamous cell carcinoma: a meta-analysis

Abstract

The aim of this study was to systematically evaluate the diagnostic value of the sentinel lymph node biopsy (SLNB) for cT1/T2N0 tongue squamous cell carcinoma (TSCC) patients. A comprehensive and systematic literature review was performed by searching the Embase and PubMed databases for English language articles published up to December 2016. The pooled overall sentinel lymph node (SLN) detection rate, sensitivity and negative predictive value (NPV) were used to evaluate the diagnostic value of SLNB which used neck dissection or follow-up as a reference test. The Q test and I statistic were used to assess the heterogeneity across the studies. Subgroup analyses were performed in consideration of higher contribution of different clinical characteristics on the SLNB diagnostic value. Begg's linear regression and Egger's regression tests were conducted to evaluate the publication bias. Thirty-five studies (with 1084 patients) were included. The pooled SLN detection rate was 98% (95% CI 97-100%). The pooled overall sensitivity and NPV of SLNB were 0.92 (95% CI 0.88-0.95) and 0.96 (95% CI 0.94-0.97), respectively. The subgroup analyses demonstrated that higher extracted number of patients (n ≥ 30) from the included studies achieved a more stable NPV than lower number of patients. SLNB can effectively predict the status of regional lymph nodes in cT1/T2N0 TSCC patients. With high sensitivity and NPV, SLNB can guide the treatment of SLNB-positive patients with neck dissections and those with negative SLNBs with follow-ups in order to avoid unnecessary surgical morbidity.

Health-related quality of life in patients with T1N0 oral squamous cell carcinoma: selective neck dissection compared with wait and watch surveillance

“…Others have shown SLNB has no survival disadvantage in the T1 and T2 N0 OSCC group compared to SND. 2,11 There is some evidence to suggest SLNB in this setting may be associated with better functional outcomes and HRQoL than SND but evidence is weak. 12,13 It is possible that SLNB maintains the survival advantage of SND but retaining the HRQoL advantages of W&W. Neither assumption is yet certain.…”

A Review of Controversial Issues in the Management of Head and Neck Cancer: A Swiss Multidisciplinary and Multi-Institutional Patterns of Care Study—Part 1 (Head and Neck Surgery)

“…Beyond difficulties accepting new techniques, if the morbidity associated with elective supra-omohyoid selective neck dissection was considerable, oncologic head and neck surgeons would have had adopted SLNB readily. However, around half of the centers probably consider that convincing data of such superiority is lacking (30, 31). Probably the main advantage of SLNB is the more thorough pathologic examination of the lymph nodes most at risk, but the exact oncologic significance of micro-metastasis in HNSCC remains to be determined.…”

Exploring the role of intraoperative frozen section of the sentinel lymph node in the management of early-staged oral tongue cancers

“…Another recent meta-analysis of SLNB focusing exclusively on oral tongue cancers, including 35 studies (with 1084 patients) reported a pooled SLN detection rate, was 98% (95% CI 97%–100%). [22] The pooled overall sensitivity and NPV of SLNB were 0.92 (95% CI 0.88–0.95) and 0.96 (95% CI 0.94–0.97), respectively. The subgroup analyses demonstrated that studies that recruited a higher number of patients ( n = 30) were able to achieve a more stable NPV than the studies with a lower number of patients.…”

“…The subgroup analyses demonstrated that studies that recruited a higher number of patients ( n = 30) were able to achieve a more stable NPV than the studies with a lower number of patients. [22]…”