title: Sentinel Lymph Node Biopsy in Oral and Oropharyngeal Squamous Cell Carcinoma: Statistical Validation and Impact of Micrometastasis Involvement on the Neck Dissection Decision.
abstract: OBJECTIVE
  To evaluate the effectiveness of sentinel lymph node biopsy (SLNB) as an optimal staging method in oral and oropharyngeal squamous cell carcinoma (OOSCC) and the impact of the extent of SLN involvement on the decision for neck dissection (ND).
  
  
  METHODS
  A prospective cohort study was performed in 96 consecutive patients with stage T1 to T4N0M0 OOSCC (mean follow-up, 62.9 months). SLN localization was determined using cervical lymphoscintigraphy and single-photon emission computed tomography. Patients underwent SLNB examination and ND. The ND specimen was investigated by hematoxylin and eosin (H&E) staining and the SLNs were investigated using H&E staining and step-serial sectioning and cytokeratin antibodies AE1 and AE3. The statistical study calculated the sensitivity and negative predictive value (NPV). The sample size of 96 patients was calculated for a 95% confidence interval with an accuracy of ±2% and an estimated a priori sensitivity of 99% compared with the benchmark. The impact of extent of SLN involvement on the decision for ND was analyzed by χ(2) test. A logistic regression model was used to assess the association of predictor variables with SLN involvement and neck disease.
  
  
  RESULTS
  The diagnostic accuracy, sensitivity, NPV, and negative likelihood ratio were 95%, 88%, 94%, and 0.06. The statistical comparison between the extent of metastatic involvement of the SLN and neck disease was important for SLN macrometastasis (odds ratio = 11.9), but not for SLN micrometastasis (odds ratio = 0.93).
  
  
  CONCLUSIONS
  SLNB examination is an excellent staging method in OOSCC. The present data indicate a very small risk of additional lymph node metastasis with SLN micrometastasis.
authors: Staff Surgeon, Department of Oral and Maxillofacial Surgery, Virgen Macarena University Hospital, Seville, Spain. Electronic address: clarasalazarf@gmail.com.
authors: Clara Isabel
authors: CI
authors: Salazar-Fernandez
authors: Staff Surgeon, Department of Oral and Maxillofacial Surgery, Virgen Macarena University Hospital, Seville, Spain.
authors: Silvia
authors: S
authors: Gallana-Alvarez
authors: Medical Staff, Department of Pathology, Virgen Macarena University Hospital, Seville, Spain.
authors: Sofía
authors: S
authors: Pereira
authors: Medical Staff, Department of Nuclear Medicine, Virgen Macarena University Hospital, Seville, Spain.
authors: Teresa
authors: T
authors: Cambill
authors: Professor and Staff Surgeon, Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, Seville, Spain.
authors: Pedro
authors: P
authors: Infante-Cossio
authors: Staff Surgeon, Department of Oral and Maxillofacial Surgery, Virgen Macarena University Hospital, Seville, Spain.
authors: Javier
authors: J
authors: Herce-Lopez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007633:Keratins / Q000032:analysis; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D061305:Lymphoscintigraphy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery*; D037981:Neck Dissection / Q000379:methods*; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data*; D013667:Technetium; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
chemical_list: D019275:Radiopharmaceuticals; D007633:Keratins; D013667:Technetium