Sentinel lymph node biopsy in oral and oropharyngeal squamous cell carcinoma: current status and unresolved challenges

Abstract

Because imaging with ultrasound, computed tomography, magnetic resonance imaging or positron emission tomography is unreliable for preoperative lymph node staging of early-stage oral and oropharyngeal squamous cell carcinoma (OSCC), elective neck dissection has been typically performed. The targeted sampling of sentinel lymph nodes (SLN) identified by lymphoscintigraphy and detected by gamma probe has become an effective alternative for the selection of patients for regional nodal resection. With careful consideration to technique, high SLN detection rates have been reported. Advanced techniques including intraoperative handheld gamma camera imaging and freehand single photon emission computed tomography (SPECT) are expected to increase surgical confidence in these procedures. This review gives an update on SLN biopsy in patients with OSCC including clinical standards and controversial aspects.

AHNS Series: Do you know your guidelines? Evidence‐based management of oral cavity cancers

“…Good diagnostic accuracy in identification of these metastases by SNLB have been demonstrated by multiple long-term experience studies. 53 Studies have also demonstrated that SLNB can decrease the rate of occult metastases to lymph nodes from 40% to 8%. 54 Alvarez Am ezaga et al 55 performed a meta-analysis of available data that demonstrated sensitivity and specificity of 93% and 100%, respectively.…”

“…A positive SLNB should be followed by a neck dissection. Good diagnostic accuracy in identification of these metastases by SNLB have been demonstrated by multiple long‐term experience studies . Studies have also demonstrated that SLNB can decrease the rate of occult metastases to lymph nodes from 40% to 8% .…”

“…The NCCN guidelines recommend that if an SNLB is performed, it should be done at centers that have significant expertise with the technique, as studies have shown much better levels of accuracy with increasing expertise. 3,53 Using SLNB has been shown to be less accurate for the floor of the mouth cancers. 3 Moreover, SLNB is not recommended in more advanced T3/T4 disease due to unreliable accuracy in this patient population.…”

“…Using SLNB has been shown to be less accurate for the floor of the mouth cancers . Moreover, SLNB is not recommended in more advanced T3/T4 disease due to unreliable accuracy in this patient population …”

Preoperative assessment of CD44‐mediated depth of invasion as predictor of occult metastases in early oral squamous cell carcinoma

“…This method has become the standard‐of‐care in many tertiary referral centers, mostly in Europe . However, it can be resource‐ and time‐consuming …”