Topographical distribution of sentinel nodes and metastases from T1–T2 oral squamous cell carcinomas

Mølstrøm, Jacob; Grønne, Mark; Green, Anders; Bakholdt, Vivi; Sørensen, Jens Ahm

doi:10.1016/j.ejca.2018.10.021

Cited by 35 publications

(31 citation statements)

References 33 publications

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“…when was selective neck dissection chosen or how meticulous was the pathologist in search for LN in the received sample. Therefore, the sentinel node biopsy in OSCC is a promising approach to www.nature.com/scientificreports/ improve oral cancer management 30 . With our method, 1-4 lymph nodes per patient were included in analysis and provided reliable and consistent results.…”

Section: Discussionmentioning

confidence: 99%

Activation of T helper cells in sentinel node predicts poor prognosis in oral squamous cell carcinoma

Kågedal

Hjalmarsson

Silva

et al. 2020

Sci Rep

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Recurrence in oral squamous cell carcinoma (OSCC) significantly reduces overall survival. Improved understanding of the host’s immune status in head and neck cancer may facilitate identification of patients at higher risk of recurrence and improve patients’ selection for ongoing clinical trials assessing the effectiveness of immune checkpoint inhibitors (CPI). We aimed to investigate Sentinel Node-derived T-cells and their impact on survival. We enrolled prospectively 28 OSCC patients treated at Karolinska University Hospital, Stockholm, Sweden with primary tumour excision and elective neck dissection. On top of the standard treatment, the enrolled patients underwent sentinel node procedure. T cells derived from Sentinel nodes, non-sentinel nodes, primary tumour and PBMC were analyzed in flow cytometry. Patients who developed recurrence proved to have significantly lower level of CD4+ CD69+ in their sentinel node (31.38 ± 6.019% vs. 43.44 ± 15.33%, p = 0.0103) and significantly higher level of CD8+ CD HLA-DR+ (38.95 ± 9.479% vs. 24.58 ± 11.36%, p = 0.0116) compared to disease-free individuals. Survival analysis of studied population revealed that patients with low proportion of CD4+ CD69+ had significantly decreased disease-free survival (DFS) of 19.7 months (95% CI 12.6–26.9) compared with 42.6 months (95% CI 40.1–45.1) in those with high CD4+ CD69+ proportion in their Sentinel Nodes (log-rank test, p = 0.033). Our findings demonstrate that characterization of T-cell activation in Sentinel Node serves as a complementary prognostic marker. Flow cytometry of Sentinel Node may be useful in both patients’ surveillance and selection for ongoing CPI clinical trials in head and neck cancer.

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Section: Discussionmentioning

confidence: 99%

Activation of T helper cells in sentinel node predicts poor prognosis in oral squamous cell carcinoma

Kågedal

Hjalmarsson

Silva

et al. 2020

Sci Rep

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“…The mean number of SLNs detected by lymphoscintigraphy or single-photon emission CT with CT (SPECT/CT) was 2 to 3 in N0 early oral cancer [5, 10, 12], and the most common location of SLNs was level I to III using RI [29]. Regarding the location of SLNs detected by CTL, Honda et al [2] reported SLNs at level I to III; in our study, SLNs were at level I to II and in the sublingual region.…”

Section: Discussionmentioning

confidence: 99%

CT lymphography for sentinel lymph node mapping of clinically N0 early oral cancer

et al. 2019

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BackgroundThe objectives of this retrospective study were to evaluate the usefulness of computed tomography lymphography (CTL) and to clarify the optimal timing of CTL in sentinel lymph node (SLN) mapping of clinically N0 early oral cancer.MethodsTwenty patients with clinically N0 early oral cancer underwent CTL with a 128 multi-detector row CT scanner to detect SLN the day before resection of primary tumor and SLN biopsy with indocyanine green (ICG) fluorescence guidance. CT scanning was performed in the first 10 patients at 2, 5, and 10 min after submucosal injection of iopamidol and in the remaining 10 patients at 2, 3.5, 5, and 10 min after the injection of contrast medium. We evaluated the SLN detection rate at each scan timing and the number and location of SLNs. We evaluated whether CTL-enhanced SLNs could be identified intraoperatively as ICG fluorescent lymph nodes.ResultsSLNs were detected by CTL in 19 of the 20 patients (95.0%), and the mean number of SLNs was 2 (range, 1–4). All SLNs were located on the ipsilateral side; 35 of 37 SLNs were located at level I and II, and 2 SLNs were lingual lymph nodes. All SLNs could be detected 2 min and 3.5–5 min after contrast medium injection, and CTL-enhanced SLNs could be identified intraoperatively as fluorescent lymph nodes.ConclusionsCTL could facilitate the detection of SLNs in early oral cancer, and the optimal timing of CT scanning was at 2 and 5 min after injection of contrast medium.

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“…In 28.5% of patients with midline tumors, only unilateral lymphatic drainage on lymphoscintigraphy was observed. Patients with lateralized OSCC had unexpected bilateral or contralateral drainage patterns in 22.6% and contralateral positive SLNs in 9%, which would have been missed by elective neck dissection of the ipsilateral neck [11].…”

Section: Contralateral Neckmentioning

confidence: 99%

What is the role of sentinel lymph node biopsy in the management of oral cancer in 2020?

Bree

Keizer

Civantos

et al. 2020

Eur Arch Otorhinolaryngol

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Approximately 70–80% of patients with cT1-2N0 oral squamous cell carcinoma (OSCC) ultimately prove to have no cancer in the cervical lymphatics on final pathology after selective neck dissection. As a result, sentinel lymph node biopsy (SLNB) has been adopted during the last decade as a diagnostic staging method to intelligently identify patients who would benefit from formal selective lymphadenectomy or neck irradiation. While not yet universally accepted, SLNB is now incorporated in many national guidelines. SLNB offers a less invasive alternative to elective neck dissection (END), and has some advantages and disadvantages. SLNB can assess the individual drainage pattern and, with step serial sectioning and immunohistochemistry (IHC), can enable the accurate detection of micrometastases and isolated tumor cells (ITCs). Staging of the neck is improved relative to END with routine histopathological examination. The improvements in staging are particularly notable for the contralateral neck and the pretreated neck. However, for floor of mouth (FOM) tumors, occult metastases are frequently missed by SLNB due to the proximity of activity from the primary site to the lymphatics (the shine through phenomenon). For FOM cancers, it is advised to perform either elective neck dissection or superselective neck dissection of the preglandular triangle of level I. New tracers and techniques under development may improve the diagnostic accuracy of SLNB for early-stage OSCC, particularly for FOM tumors. Treatment of the neck (either neck dissection or radiotherapy), although limited to levels I–IV, remains mandatory for any positive category of metastasis (macrometastasis, micrometastasis, or ITCs). Recently, the updated EANM practical guidelines for SLN localization in OSCC and the surgical consensus guidelines on SLNB in patients with OSCC were published. In this review, the current evidence and results of SLNB in early OSCC are presented.

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Topographical distribution of sentinel nodes and metastases from T1–T2 oral squamous cell carcinomas

Cited by 35 publications

References 33 publications

Activation of T helper cells in sentinel node predicts poor prognosis in oral squamous cell carcinoma

Activation of T helper cells in sentinel node predicts poor prognosis in oral squamous cell carcinoma

CT lymphography for sentinel lymph node mapping of clinically N0 early oral cancer

What is the role of sentinel lymph node biopsy in the management of oral cancer in 2020?

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