Jacob Mølstrøm1, Mark Grønne2, Anders Green3, Vivi Bakholdt2, Jens Ahm Sørensen2. 1. Department of Plastic and Reconstructive Surgery, Odense University Hospital, Denmark. Electronic address: jacob.molstrom@rsyd.dk. 2. Department of Plastic and Reconstructive Surgery, Odense University Hospital, Denmark. 3. Odense Patient Data Exploratory Network, OPEN, Department of Clinical Research, Odense University Hospital, Denmark.
Abstract
OBJECTIVE: The objective is to investigate the topographical distribution of sentinel nodes (SNs) and lymph node metastases in T1-2cN0 oral squamous cell carcinomas (OSCCs). METHODS: The study entailed a prospective enrolment of 220 patients with clinical T1-2N0 OSCCs who underwent preoperative lymphoscintigraphy (LSG) followed by gamma probe-guided sentinel lymph node biopsy (SLNB). Patients with positive SNs were treated with completion neck dissection. Excised lymph nodes were grouped into the neck level according to the international guidelines. RESULTS: The SN detection rate by LSG was 99.1%. Patients with midline tumours had bilateral lymphatic drainage on LSG in 15/21 (71.5%). There were 45/199 (22.6%) patients with lateralised tumours that had unexpected bilateral or contralateral drainage patterns on LSG. Fifty-five patients (25.0%) were SLNB positive, and metastases were found in 72/781 (9.2%) of the excised SNs. Metastatic involvement of neck level IV was rare and only observed in patients with anterior tongue cancer. No patients had level V involvement. Eleven patients developed isolated cervical recurrences, with no new primary tumour as origin. The SLNB procedure ensured an overall sensitivity of 83.3% and a negative predictive value of 93.3%. CONCLUSION: Completion neck dissection of level I-III in SLNB-positive patients might be sufficient in most patients with OSCC except patients with anterior tongue cancer, but further studies are needed to support this potential therapeutic algorithm. Our study showed that SLNB was helpful in clarifying unexpected bilateral or contralateral metastatic drainage patterns. In our cohort, 8/55 patients with occult metastasis would have been missed by elective neck dissection of the ipsilateral neck.
OBJECTIVE: The objective is to investigate the topographical distribution of sentinel nodes (SNs) and lymph node metastases in T1-2cN0 oral squamous cell carcinomas (OSCCs). METHODS: The study entailed a prospective enrolment of 220 patients with clinical T1-2N0 OSCCs who underwent preoperative lymphoscintigraphy (LSG) followed by gamma probe-guided sentinel lymph node biopsy (SLNB). Patients with positive SNs were treated with completion neck dissection. Excised lymph nodes were grouped into the neck level according to the international guidelines. RESULTS: The SN detection rate by LSG was 99.1%. Patients with midline tumours had bilateral lymphatic drainage on LSG in 15/21 (71.5%). There were 45/199 (22.6%) patients with lateralised tumours that had unexpected bilateral or contralateral drainage patterns on LSG. Fifty-five patients (25.0%) were SLNB positive, and metastases were found in 72/781 (9.2%) of the excised SNs. Metastatic involvement of neck level IV was rare and only observed in patients with anterior tongue cancer. No patients had level V involvement. Eleven patients developed isolated cervical recurrences, with no new primary tumour as origin. The SLNB procedure ensured an overall sensitivity of 83.3% and a negative predictive value of 93.3%. CONCLUSION: Completion neck dissection of level I-III in SLNB-positive patients might be sufficient in most patients with OSCC except patients with anterior tongue cancer, but further studies are needed to support this potential therapeutic algorithm. Our study showed that SLNB was helpful in clarifying unexpected bilateral or contralateral metastatic drainage patterns. In our cohort, 8/55 patients with occult metastasis would have been missed by elective neck dissection of the ipsilateral neck.
Authors: Åsa Kågedal; Eric Hjalmarsson; Pedro Farrajota Neves da Silva; Krzysztof Piersiala; Susanna Kumlien Georén; Gregori Margolin; Eva Munck-Wikland; Ola Winqvist; Valtteri Häyry; Lars Olaf Cardell Journal: Sci Rep Date: 2020-12-18 Impact factor: 4.379
Authors: Rutger Mahieu; Inne J den Toom; Koos Boeve; Daphne Lobeek; Elisabeth Bloemena; Maarten L Donswijk; Bart de Keizer; W Martin C Klop; C René Leemans; Stefan M Willems; Robert P Takes; Max J H Witjes; Remco de Bree Journal: Front Oncol Date: 2021-04-23 Impact factor: 6.244
Authors: Remco de Bree; Bart de Keizer; Francisco J Civantos; Robert P Takes; Juan P Rodrigo; Juan C Hernandez-Prera; Gyorgy B Halmos; Alessandra Rinaldo; Alfio Ferlito Journal: Eur Arch Otorhinolaryngol Date: 2020-12-28 Impact factor: 2.503