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

Abstract

Background:The present study aims to explore the role of sentinel lymph node biopsy (SLNB) with intraoperative frozen section in the management of early-staged oral tongue cancers.Materials and Methods:Fifty-two patients with clinical stages cT1/2N0 oral tongue cancers were included in the present study. The curative surgery was preceded by the performance of an SLNB using a dual technique.Results:The identification rate of sentinel lymph node (SLN) in this study was 98.07%. The sensitivity, specificity, positive predictive value (PPV), and the negative predictive value (NPV) of SLNB were 88.2%, 100%, 100%, and 94.5%, respectively. Further, the sensitivity, specificity, PPV, and the NPV of intraoperative frozen section of the SLN were 70.5%, 100%, 100%, and 87.5%, respectively.Conclusions:The addition of intraoperative frozen section could identify 70.5% of patients with occult metastasis. An intraoperative frozen section assessment of sentinel node has the potential to change the overall management of patients with early-oral tongue cancers.

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).…”

Sentinel Node Biopsy in Oral Cancer—Indications, Analysis, and Outcomes—Reply

“…With regard to quality-oflife outcomes, Garrel et al 2 reported significantly improved neck and shoulder function in the SLNB group compared with the END group up to their 2-year analysis, at which time point there was no statistical difference. We await the outcome of NRG-HN006 5 to confirm these findings definitively, although reporting on survival outcome is not likely to be available until the next decade.…”

“…Some studies have suggested that SLNB frozen section is not as effective for identifying micromestases, 4 while others have found that it changes management in 71% of cases, avoiding a second operation and expediting care. 5 False-negative rates from frozen section have been reported to be as low as 7%, but this is in the context of multislice frozen section as opposed to a simple bisection technique. 6 While variability may exist in how the specimen is processed, many clinicians continue to use frozen section during SLNB for oral cavity cancer to avoid a second procedure.…”

“…FS is not standard practice, nor included in the NRG-HN006 protocol. 5 It is important to highlight the variability in FS technique for sentinel nodes in the literature. This ranges from single to multislice FSs, with and without confirmatory conventional histopathological serial sectioning on the remaining nodal tissue.…”

Sentinel Node Biopsy in Oral Cancer—Indications, Analysis, and Outcomes

“…With regard to quality-oflife outcomes, Garrel et al 2 reported significantly improved neck and shoulder function in the SLNB group compared with the END group up to their 2-year analysis, at which time point there was no statistical difference. We await the outcome of NRG-HN006 5 to confirm these findings definitively, although reporting on survival outcome is not likely to be available until the next decade.…”