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Original Investigation |

Sentinel Node Biopsy in Lieu of Neck Dissection for Staging Oral Cancer

Nestor Rigual, MD1,2; Thom Loree, MD3; Jennifer Frustino, DDS, PhD4,5; Vijayvel Jayaprakash, MBBS, PhD1,5; David Cohan, MD1; Maureen Sullivan, DDS5; M. Abraham Kuriakose, MD1
[+] Author Affiliations
1Department of Head and Neck Surgery/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York
2Photodynamic Therapy Center, Roswell Park Cancer Institute, Buffalo, New York
3Department of Plastic and Reconstructive Surgery, Erie County Medical Center Corporation, Buffalo, New York
4Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Boston, Massachusetts
5Department of Dentistry and Maxillofacial Prosthetics, Roswell Park Cancer Institute, Buffalo, New York
JAMA Otolaryngol Head Neck Surg. 2013;139(8):779-782. doi:10.1001/jamaoto.2013.3863.
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Importance  Neck dissection is the standard staging procedure to ascertain the pathologic status of cervical lymph nodes in patients with oral cavity squamous cell carcinoma (OSCC), but it results in multiple morbidities.

Objective  To examine outcomes of patients with OSCC who underwent sentinel node biopsy (SNB) as the sole neck staging procedure.

Design  Retrospective review of patients who underwent SNB during the period 2005 through 2011.

Setting  National Cancer Institute–designated comprehensive cancer center.

Participants  Thirty-eight patients with clinically T1 or T2N0 OSCC.

Interventions  Preoperative lymphoscintigraphy with intraoperative gamma probe localization was used. Sentinel lymph nodes were serially sectioned, formalin fixed, and examined at 3 levels. All patients with positive SNB results underwent neck dissection, and the patients with negative SNB results were observed clinically.

Main Outcomes and Measures  Sensitivity and predictive value of SNB, recurrence rates, and disease-specific survival rates.

Results  There were 18 T1 and 20 T2 tumors. Five patients had positive SNB results, of whom 3 had additional positive nodes on subsequent neck dissection. Two of 33 patients with negative SNB results developed a regional recurrence. The sensitivity and negative predictive value for staging the neck with SNB alone were 71% (5 of 7) and 94% (31 of 33), respectively. Mean follow-up was 31 months. The mean disease-free survival duration for patients with positive and negative SNB results was 30 and 65 months, respectively (P = .08). The disease-specific survival rate for patients with positive and negative SNB results was 80% and 91%, respectively. There was no significant difference in disease-specific survival between patients with true-negative and false-negative SNB results (34 vs 44 months; P = .38).

Conclusions and Relevance  The majority of patients with positive results on SNB had additional positive nodes on neck dissection. A low rate of isolated neck recurrence was found in patients with negative results on SNB. Individuals with negative results on SNB exhibited better overall and disease-specific survival than those with positive results.

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