Abstract
Purpose: Cervical nodal status is one of the most important denominator of prognosis in oral cavity squamous cell carcinoma. Management of clinically negative cervical node is controversial and practice varies from institution to institution. But in most of the institutions Early oral malignancy with negative neck nodes is usually managed with elective neck dissection. Sentinel node biopsy can reduce the adverse events of neck dissection. Purpose of current study is to assess outcome of the procedure in our setup.
Materials and Method: This single institutional observational study was carried out in a tertiary care centre in north India Prior approval from hospital’s Scientific and Ethical committee. Total 40 Patients with early OSCC [clinical T1, T2, N0] were included over a period of 20months. Single tracer SLNB using unfiltered 99mTc-sulfur colloid were performed followed by selective neck dissection. Nodal status determined on haematoxylin and eosin testing. Data analysed at the end of study period.
Results: Sentinel nodes were successfully harvested in 92.5 % cases. Average 2.4 sentinel nodes were harvested per person. In 42 % cases nodes were found in neck level II. A false negative rate of 0.11, accuracy of 0.89 and NPV of 0.86 were recorded. Highest number of false negative rate recorded in clinical stage T1 and in tongue respectively. In all three FOM cases detection of SLN failed due to shine through effect of radio colloid.
Conclusion: Results showed that SLNB is technically feasible in a centre like us where sentinel lymph node biopsies are already being performed. The outcome of the procedure is comparable to the existing literature.
Keywords: Sentinel Lymph node biopsy, Oral squamous cell carcinoma, Elective neck dissection.
References
- Chaturvedi AK, Anderson WF, Lortet-Tieulent J, Curado MP, Ferlay J, Franceschi S, et al. Worldwide trends in incidence rates for oral cavity and oropharyngeal cancers. J ClinOncol Off J Am SocClinOncol. 2013 Dec 20;31(36):4550–9.
- Byakodi R, Byakodi S, Hiremath S, Byakodi J, Adaki S, Marathe K, et al. Oral cancer in India: an epidemiologic and clinical review. J Community Health. 2012 Apr;37(2):316–9.
- D’Cruz AK, Vaish R, Kapre N, Dandekar M, Gupta S, Hawaldar R, et al. Elective versus Therapeutic Neck Dissection in Node-Negative Oral Cancer. N Engl J Med. 2015 Aug 6;373(6):521
- Stefanicka P, Profant M, Duchaj B, Valach M, Gal V, Dolezal P, et al. Sentinel lymph node radiolocalization and biopsy in oral cavity and oropharynx mucosal squamous cell carcinoma. Bratisl Lekárske Listy. 2010;111(11):590–4.
- Trivedi NP, Ravindran HK, Sundram S, Iyer S, Kekatpure V, Durah S, et al. Pathologic evaluation of sentinel lymph nodes in oral squamous cell carcinoma. Head Neck. 2010 Nov;32(11):1437–43.
- Ross GL, Soutar DS, Gordon MacDonald D, Shoaib T, Camilleri I, Roberton AG, et al. Sentinel node biopsy in head and neck cancer: preliminary results of a multicenter trial. Ann SurgOncol. 2004 Jul;11(7):690–6.
- Schilling C, Stoeckli SJ, Haerle SK, Broglie MA, Huber GF, Sorensen JA, et al. Sentinel European Node Trial (SENT): 3-year results of sentinel node biopsy in oral cancer. Eur J Cancer OxfEngl 1990. 2015 Dec;51 (18):2777–84.
- Antonio JK, Santini S, Politi D, Sulfaro S, Spaziante R, Alberti A, et al. Sentinel lymph node biopsy in squamous cell carcinoma of the head and neck: 10 years of experience. ActaOtorhinolaryngol Ital OrganoUff Della Soc Ital Otorinolaringol E ChirCerv-facc. 2012 Feb;32(1):18–25.
- Thompson CF, St John MA, Lawson G, Grogan T, Elashoff D, Mendelsohn AH. Diagnostic value of sentinel lymph node biopsy in head and neck cancer: a meta-analysis. Eur Arch Oto-Rhino-Laryngol Off J Eur Fed Oto-Rhino-LaryngolSoc EUFOS AffilGerSoc Oto-Rhino-Laryngol - Head Neck Surg. 2013 Jul;270(7):2115–22.
- Alkureishi LWT, Ross GL, Shoaib T, Soutar DS, Robertson AG, Thompson R, et al. Sentinel node biopsy in head and neck squamous cell cancer: 5-year follow-up of a European multicenter trial. Ann SurgOncol. 2010 Sep;17(9):2459–64.
- Koopal SA, Tiebosch AT, Albertus Piers D, Plukker JT, SchraffordtKoops H, Hoekstra HJ. Frozen section analysis of sentinel lymph nodes in melanoma patients. Cancer. 2000 Oct 15;89(8):1720–5.
- Weiser MR, Montgomery LL, Susnik B, Tan LK, Borgen PI, Cody HS. Is routine intraoperative frozen-section examination of sentinel lymph nodes in breast cancer worthwhile? Ann SurgOncol. 2000 Oct;7(9):651–5.
- Werner JA, Dünne AA, Ramaswamy A, Dalchow C, Behr T, Moll R, et al. The sentinel node concept in head and neck cancer: solution for the controversies in the N0 neck? Head Neck. 2004 Jul;26(7):603–11.
- Atula T, Shoaib T, Ross GL, Gray HW, Soutar DS. How many sentinel nodes should be harvested in oral squamous cell carcinoma? Eur Arch Oto-Rhino-Laryngol Off J Eur Fed Oto-Rhino-LaryngolSoc EUFOS AffilGerSoc Oto-Rhino-Laryngol - Head Neck Surg. 2008 Jul;265 Suppl 1:S19-23.
- Valsecchi ME, Silbermins D, de Rosa N, Wong SL, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in patients with melanoma: a meta-analysis. J ClinOncol Off J Am SocClinOncol. 2011 Apr 10;29(11):1479–87.
- Ganly I, Goldstein D, Carlson DL, Patel SG, O’Sullivan B, Lee N, et al. Long-term regional control and survival in patients with “low-risk,” early stage oral tongue cancer managed by partial glossectomy and neck dissection without postoperative radiation: the importance of tumor thickness. Cancer. 2013 Mar 15;119(6):1168–76.
Corresponding Author
Dr Tapan Sarma
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