Follow-up after intraoperative sentinel node biopsy of N0 neck oral cancer patients

Abstract

The objective of the study was to evaluate the validity of sentinel node (SN) biopsy in early oral cancer patients focusing on the accuracy of intraoperative diagnoses of SN status, recurrences in follow-up and impact on patient survival. Previously untreated N0 oral cancer patients were candidates for the study. Using a radioisotope method, an intraoperative SN biopsy was performed. Patients with a positive frozen section of SN underwent immediate neck dissection as a single-stage procedure; they were followed in our outpatient clinic. Forty-five cT1-2N0 patients with squamous cell carcinoma were analyzed. There were seven patients with positive SN, five of whom were detected by intraoperative frozen section analysis. The sensitivity, specificity and accuracy of the intraoperative frozen section analysis of SN were 71.4, 100 and 95.6%, respectively. There were 13 recurrences in the course of all patients treated. Those with positive SN showed a tendency toward recurrence. Three patients with negative SN suffered from delayed ipsilateral neck recurrence. These were considered false negatives at a rate of 7.9%. The 5-year overall survival rate of all patients was 91.1%. SN-positive patient survival was significantly poorer than that of SN-negative patients. Positive SN had a negative impact on the survival. SN biopsy was shown to be a valuable method for determining the neck status of early oral cancer patients. The concordance rate of intraoperative multislice frozen section analysis of SN and patient neck status at the time of operation was 95.6%. SN-positive patients exhibited a tendency toward cancer recurrence. There were three cases of false negatives not conforming to the SN concept and their rate was 7.9%. Positive SN had a negative impact on patient survival.

Histopathological mapping of metastatic tumor cells in sentinel lymph nodes of oral and oropharyngeal squamous cell carcinomas

“…These results were significantly lower compared to Terada et al, who used the multislice technique analyzing the sentinel lymph nodes by 2‐mm sections. In a follow‐up article of the same authors, the sensitivity of the intraoperative frozen section analysis of sentinel lymph node was with 74% significantly lower but in accordance with a recent study by Yoshimoto et al who reported a sensitivity of 70%. In none of these publications was the mean number of slices needed outlined.…”

Minimally invasive surgery for laryngopharyngeal cancer: Multicenter feasibility study of a combination strategy involving transoral surgery and real‐time indocyanine green fluorescence‐navigated sentinel node navigation surgery

“…Although a recent meta‐analysis of SNNS for early oral cancer based on 66 studies with 3566 patients confirms high pooled sensitivity (87%) and a high negative predictive value (94%), most evidence in HNSCC are oral/oropharyngeal cancer . RN tracer has drawbacks with regard to its strict regulations, complicated procedure, and imaging, especially in laryngopharyngeal cancers .…”

“…With respect to SNNS in HNSCC, although early oral and oropharyngeal cancers have been the most studied cancers, there have been few reports on laryngopharyngeal cancer . One reason for this drawback is that radionucleotide (RN) tracers, which are major tracers for SNNS in HNSCC, cannot be administered in the operation room (OR).…”

Primary Tumor-Secreted Lymphangiogenic Factors Induce Pre-Metastatic Lymphvascular Niche Formation at Sentinel Lymph Nodes in Oral Squamous Cell Carcinoma

“…In practice, if the SLNs are negative, a morbid regional lymph node dissection can be avoided. Although some reported the overall sensitivity of SLN biopsy > 90% in OSCC, it is not yet possible to say whether the results of SLN identification are consistent and reliable [ 10 , 16 , 17 ].…”