title: Sentinel lymph node biopsy in clinically N0 T1-T2 staged oral cancer: the Dutch multicenter trial.
abstract: OBJECTIVE
  Results of the Dutch multi-institutional trial on sentinel lymph node (SLN) biopsy in oral cancer.
  
  
  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%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: gb.flach@vumc.nl.
authors.forename: Géke B
authors.initials: GB
authors.lastname: Flach
authors.affiliation: 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.
authors.forename: E
authors.initials: E
authors.lastname: Bloemena
authors.affiliation: Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
authors.forename: W Martin C
authors.initials: WM
authors.lastname: Klop
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Center, Utrecht, The Netherlands.
authors.forename: Robert J J
authors.initials: RJ
authors.lastname: van Es
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Center, Groningen, The Netherlands.
authors.forename: Kees-Pieter
authors.initials: KP
authors.lastname: Schepman
authors.affiliation: Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Otto S
authors.initials: OS
authors.lastname: Hoekstra
authors.affiliation: Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Castelijns
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: C René
authors.initials: CR
authors.lastname: Leemans
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: r.bree@vumc.nl.
authors.forename: Remco
authors.initials: R
authors.lastname: de Bree
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D061305:Lymphoscintigraphy; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology*; D009426:Netherlands; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy
keywords: Follow-up; Lymph node metastases; Oral squamous cell carcinoma; Sentinel lymph node biopsy; Survival