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Sentinel lymph node biopsy for early oral cancers: Westmead Hospital experience
Author(s) -
AbdulRazak Muzib,
Chung Hsiang,
Wong Eva,
Palme Carsten,
Veness Michael,
Farlow David,
Coleman Hedley,
Morgan Gary
Publication year - 2016
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13853
Subject(s) - medicine , sentinel node , neck dissection , sentinel lymph node , biopsy , surgery , radiology , dissection (medical) , head and neck cancer , cancer , general surgery , breast cancer , radiation therapy
Background Sentinel lymph node biopsy (SLNB) has become an alternative option to elective neck dissection (END) for early oral cavity squamous cell carcinoma (OCSCC) outside of Australia. We sought to assess the technical feasibility of SLNB and validate its accuracy against that of END in an Australian setting. Methods We performed a prospective cohort study consisting of 30 consecutive patients with cT 1 ‐ 2 N 0 OCSCC referred to the Head and Neck Cancer Service, Westmead Hospital, Sydney, between 2011 and 2014. All patients underwent SLNB followed by immediate selective neck dissection (levels I–III). Results A total of 30 patients were diagnosed with an early clinically node‐negative OCSCC (seven cT1 and 23 cT2), with the majority located on the oral tongue. A median of three (range: 1–14) sentinel nodes were identified on lymphoscintigraphy, and all sentinel nodes were successfully retrieved, with 50% having a pathologically positive sentinel node. No false‐negative sentinel nodes were identified using selective neck dissection as the gold standard. The negative predictive value (NPV) of SLNB was 100%, with 40% having a sentinel node identified outside the field of planned neck dissection on lymphoscintigraphy. Of these, one patient had a positive sentinel node outside of the ipsilateral supraomohyoid neck dissection template. Conclusion SLNB for early OCSCC is technically feasible in an Australian setting. It has a high NPV and can potentially identify at‐risk lymphatic basins outside the traditional selective neck dissection levels even in well‐lateralized lesions.