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Original Investigation |

Sentinel Lymph Node Biopsy for Cutaneous Squamous Cell Carcinoma on the Head and Neck ONLINE FIRST

Alison B. Durham, MD1; Lori Lowe, MD1,2; Kelly M. Malloy, MD3; Jonathan B. McHugh, MD2; Carol R. Bradford, MD3; Heather Chubb, MS1; Timothy M. Johnson, MD1,3,4; Scott A. McLean, MD, PhD3
[+] Author Affiliations
1Department of Dermatology, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor
2Department of Pathology, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor
3Department of Otolaryngology, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor
4Division of Plastic Surgery, Department of Surgery, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor
JAMA Otolaryngol Head Neck Surg. Published online July 20, 2016. doi:10.1001/jamaoto.2016.1927
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Importance  Metastasis of cutaneous squamous cell carcinoma (SCC) to the nodal basin is associated with a poor prognosis. The role of sentinel lymph node biopsy (SLNB) for regional staging in patients diagnosed with SCC is unclear.

Objective  To evaluate a single institution’s experience with use of SLNB for regional staging of SCC on the head and neck.

Design, Setting, and Participants  A retrospective review of 53 patients who were diagnosed with SCC on the head and neck, at high risk for nodal metastasis based on National Comprehensive Cancer Network (NCCN) risk factors, and treated with wide local excision (WLE) and SLNB from December 1, 2010, through January 30, 2015, in a single academic referral center was performed. The follow-up period ended November 5, 2015. Sentinel lymph node biopsy paraffin blocks were retrieved and processed retrospectively with serial sectioning and immunohistochemical analysis (IHC) in cases with nodal recurrence following a negative SLNB.

Main Outcomes and Measures  Sentinel node (SN) identification rate, SLNB positivity rate, local recurrence, regional nodal recurrence, and distant recurrence.

Results  In 53 patients with 54 tumors the SN identification rate was 94%. The SLNB positivity rate was 11.3%. On more thorough tissue processing and IHC, metastatic SCC was identified in 2 of 5 (40%) cases previously deemed negative. After reclassification of these cases, the adjusted SLNB positivity rate was 15.1%. The adjusted rate of false omission was 7.1% (95% CI, 2%-19%). Nodal disease developed in 20.8% overall. Angiolymphatic invasion (Cohen d, 3.52; 95% CI, 1.83-5.21), perineural invasion (Cohen d, 0.81; 95% CI, 0.09-1.52), and clinical size (Cohen d, 0.83; 95% CI, 0.05-1.63) were associated with the presence of nodal disease.

Conclusions and Relevance  Rigorous study of SLNB for cutaneous SCC incorporating prospectively-collected comprehensive data sets based on standardized treatment algorithms is justified with potential to modify clinical practice. Our study demonstrates the critical importance of serial sectioning and IHC of the SLNB specimen for accurate diagnosis. Use of the NCCN guidelines may facilitate identification of patients with SCC at high risk for nodal metastasis.

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Figure 1.
Histopathologic Image

Deeper section into the block demonstrates a focus of metastatic squamous cell carcinoma involving the subcapsular sinus (black arrowhead) and parenchyma (asterisk) of sentinel lymph node. Hematoxylin-eosin stain (original magification ×200).

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Figure 2.
Immunostain

Focus of metastatic squamous cell carcinoma in sentinel lymph node staining with pancytokeratin immunostain (original magnification ×100).

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