Géke B Flach1, E Bloemena2, W Martin C Klop3, Robert J J van Es4, Kees-Pieter Schepman5, Otto S Hoekstra6, Jonas A Castelijns6, C René Leemans7, Remco de Bree8. 1. Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: gb.flach@vumc.nl. 2. Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands. 3. Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands. 4. Department of Oral and Maxillofacial Surgery, University Medical Center, Utrecht, The Netherlands. 5. Department of Oral and Maxillofacial Surgery, University Medical Center, Groningen, The Netherlands. 6. Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands. 7. Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands. 8. Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: r.bree@vumc.nl.
Abstract
OBJECTIVES: Results of the Dutch multi-institutional trial on sentinel lymph node (SLN) biopsy in oral cancer. PATIENTS AND METHODS: Patients were consecutively enrolled from 4 institutions, with T1/T2 oral cancer and cN0 neck based on palpation and ultrasound guided fine needle aspiration cytology. Lymphatic mapping consisted of preoperative lymphoscintigraphy. For intraoperative SLN detection a gamma-probe was used and in some patients additional blue dye. SLN negative patients were carefully observed, SLN positive patients were treated by neck dissection, radiotherapy or a combination of both. Endpoints of the study were risk of occult lymp node metastases, neck control, accuracy, 5-year disease-free survival (DFS), overall survival (OS) and disease-specific survival (DSS). RESULTS: Twenty of 62 patients (32%) had positive SLNs. Macrometastases were found in 9 patients, micrometastases in 8, and isolated tumour cells in 3 patients. Median follow-up was 52.5 months. Of the 42 SLN negative patients, 5 developed a regional recurrence of whom 4 patients could be successfully salvaged. DFS, OS and DSS of SLN negative patients were 72.0%, 92.7% and 97.4%, and for SLN positive patients these numbers were 73.7%, 79.7%, 85.0%, respectively (DFS: p=0.916, OS: p=0.134, DSS: p=0.059, respectively). Neck control rate was 97% in SLN negative and 95% in SLN positive patients. Sensitivity was 80% and negative predictive value 88%. CONCLUSION: SLN biopsy is able to reduce the risk of occult lymph node metastases in T1/T2 oral cancer patients from 40% to 8%, and enables excellent control of the neck.
OBJECTIVES: Results of the Dutch multi-institutional trial on sentinel lymph node (SLN) biopsy in oral cancer. PATIENTS AND METHODS: Patients were consecutively enrolled from 4 institutions, with T1/T2 oral cancer and cN0 neck based on palpation and ultrasound guided fine needle aspiration cytology. Lymphatic mapping consisted of preoperative lymphoscintigraphy. For intraoperative SLN detection a gamma-probe was used and in some patients additional blue dye. SLN negative patients were carefully observed, SLN positive patients were treated by neck dissection, radiotherapy or a combination of both. Endpoints of the study were risk of occult lymp node metastases, neck control, accuracy, 5-year disease-free survival (DFS), overall survival (OS) and disease-specific survival (DSS). RESULTS: Twenty of 62 patients (32%) had positive SLNs. Macrometastases were found in 9 patients, micrometastases in 8, and isolated tumour cells in 3 patients. Median follow-up was 52.5 months. Of the 42 SLN negative patients, 5 developed a regional recurrence of whom 4 patients could be successfully salvaged. DFS, OS and DSS of SLN negative patients were 72.0%, 92.7% and 97.4%, and for SLN positive patients these numbers were 73.7%, 79.7%, 85.0%, respectively (DFS: p=0.916, OS: p=0.134, DSS: p=0.059, respectively). Neck control rate was 97% in SLN negative and 95% in SLN positive patients. Sensitivity was 80% and negative predictive value 88%. CONCLUSION: SLN biopsy is able to reduce the risk of occult lymph node metastases in T1/T2 oral cancerpatients from 40% to 8%, and enables excellent control of the neck.
Authors: Pieter D de Veij Mestdagh; Marcel C J Jonker; Wouter V Vogel; Willem H Schreuder; Maarten L Donswijk; W Martin C Klop; Abrahim Al-Mamgani Journal: Eur Arch Otorhinolaryngol Date: 2018-06-28 Impact factor: 2.503
Authors: Christina Bluemel; Domenico Rubello; Patrick M Colletti; Remco de Bree; Ken Herrmann Journal: Eur J Nucl Med Mol Imaging Date: 2015-04-28 Impact factor: 9.236
Authors: Rutger Mahieu; Gerard C Krijger; F F Tessa Ververs; Remmert de Roos; Remco de Bree; Bart de Keizer Journal: Eur J Nucl Med Mol Imaging Date: 2021-04 Impact factor: 9.236
Authors: F M Crocetta; C Botti; C Pernice; D Murri; A Castellucci; M Menichetti; M Costantini; F Venturelli; M C Bassi; A Ghidini Journal: Eur Arch Otorhinolaryngol Date: 2020-05-30 Impact factor: 3.236