Sentinel node biopsy in head and neck squamous cell cancer: 5-year follow-up of a European multicenter trial.
BACKGROUND
Sentinel node biopsy (SNB) may represent an alternative to elective neck dissection for the staging of patients with early head and neck squamous cell carcinoma (HNSCC). To date, the technique has been successfully described in a number of small single-institution studies. This report describes the long-term follow-up of a large European multicenter trial evaluating the accuracy of the technique.


METHODS
A total of 227 SNB procedures were carried out across 6 centers, of which 134 were performed in clinically T1/2 N0 patients. All patients underwent SNB with preoperative lymphoscintigraphy, intraoperative blue dye, and handheld gamma probe. Sentinel nodes were evaluated with hematoxylin and eosin (H&E) staining, step-serial sectioning (SSS), and immunohistochemistry (IHC). There were 79 patients who underwent SNB as the sole staging tool, while 55 patients underwent SNB-assisted elective neck dissection.


RESULTS
Sentinel nodes were successfully identified in 125 of 134 patients (93%), with a lower success rate observed for floor-of-mouth tumors (FoM; 88% vs. 96%, P = 0.138). Also, 42 patients were upstaged (34%); of these, 10 patients harbored only micrometastatic disease. At a minimum follow-up of 5 years, the overall sensitivity of SNB was 91%. The sensitivity and negative predictive values (NPV) were lower for patients with FoM tumors compared with other sites (80% vs. 97% and 88% vs. 98%, respectively, P = 0.034).


CONCLUSIONS
Sentinel node biopsy is a reliable and reproducible means of staging the clinically N0 neck for patients with cT1/T2 HNSCC. It can be used as the sole staging tool for the majority of these patients, but cannot currently be recommended for patients with tumors in the floor of the mouth.
Alkureishi
Lee W T
LW
Plastic Surgery Unit, Canniesburn Hospital, Glasgow, UK. lee_alkureishi@hotmail.com
Ross
Gary L
GL
Shoaib
Taimur
T
Soutar
David S
DS
Robertson
A Gerry
AG
Thompson
Richard
R
Hunter
Keith D
KD
Sorensen
Jens A
JA
Thomsen
Jorn
J
Krogdahl
Annelise
A
Alvarez
Julio
J
Barbier
Luis
L
Santamaria
Joseba
J
Poli
Tito
T
Sesenna
Enrico
E
Kovács
Adorjan F
AF
Grünwald
Frank
F
Barzan
Luigi
L
Sulfaro
Sandro
S
Alberti
Franco
F
D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000601:surgery; D005060:Europe; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007124:Immunoenzyme Techniques; D008207:Lymphatic Metastasis; D011379:Prognosis; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate