Sentinel node biopsy in early oral squamous cell carcinomas: Long-term follow-up and nodal failure analysis

Surgical consensus guidelines on sentinel node biopsy (SNB) in patients with oral cancer

“…Although SNB may be considered a less invasive procedure than elective neck dissection (END) with an improved morbidity profile, this is misleading as SNB is a diagnostic test which should be followed by therapeutic treatment in the case of a positive result. In the significantly medically compromised patient, SNB is not simply an alternative choice to END.…”

“…END is the current “gold standard” to which SNB is compared, although END is not error proof. The recurrence rate in the neck after a pN0 END has been reported to be 9%‐18%, and up to 20% in the case of a pathologically positive END . Disease recurrence after END not infrequently occurs in the contralateral neck (30%‐39%); this may be as a result of altered lymphatic drainage following surgery or simply that the tumor primary lymphatic drainage was not only to the ipsilateral neck.…”

“…Disease recurrence after END not infrequently occurs in the contralateral neck (30%‐39%); this may be as a result of altered lymphatic drainage following surgery or simply that the tumor primary lymphatic drainage was not only to the ipsilateral neck. There are currently no prospective randomized studies comparing survival outcome for SNB vs END, but SNB appears to have an advantage in accurately mapping both sides of the neck (up to 13% contralateral drainage in well‐lateralized tumors), early detection of both micrometastasis, and extra‐capsular deposits (up to 58% metastatic deposits are isolated tumor cells (ITCs) or micrometastasis), allowing a higher salvage rate after recurrence (43% vs 91%). The detailed pathological evaluation that SNB allows provides information on micrometastasis (multiple on occasion) and ECS that can be overlooked by standard histological evaluation of a neck dissection.…”

Sentinel Node for Accurate Diagnosis of the Head and Neck Carcinoma

“…We often see many smaller lymph nodes on a very narrow area and if we would rely on the gamma-ray detector only, we could easily misidentify the sentinel lymph node. We can observe that after the removal of the sentinel lymph node, only the patients with regional recurrent disease have a very poor prognosis [32]. The possibility for recurrence is greatly increased if we have a larger number of metastatic sentinel lymph nodes.…”

“…The possibility for recurrence is greatly increased if we have a larger number of metastatic sentinel lymph nodes. Micrometastases and isolated tumor cells do not have a larger influence on the possible recurrence [32]. The reason for this could be an overlooked true sentinel lymph node and the possible changes of lymph drainage and metastases found at unpredictable locations later on.…”