title: Sentinel lymph node biopsy for early oral cancers: Westmead Hospital experience.
abstract: BACKGROUND
  Sentinel lymph node biopsy (SLNB) has become an alternative option to elective neck dissection (END) for early oral cavity squamous cell carcinoma (OCSCC) outside of Australia. We sought to assess the technical feasibility of SLNB and validate its accuracy against that of END in an Australian setting.
  
  
  METHODS
  We performed a prospective cohort study consisting of 30 consecutive patients with cT1-2N0OCSCC referred to the Head and Neck Cancer Service, Westmead Hospital, Sydney, between 2011 and 2014. All patients underwent SLNB followed by immediate selective neck dissection (levels I-III).
  
  
  RESULTS
  A total of 30 patients were diagnosed with an early clinically node-negative OCSCC (seven cT1 and 23 cT2), with the majority located on the oral tongue. A median of three (range: 1-14) sentinel nodes were identified on lymphoscintigraphy, and all sentinel nodes were successfully retrieved, with 50% having a pathologically positive sentinel node. No false-negative sentinel nodes were identified using selective neck dissection as the gold standard. The negative predictive value (NPV) of SLNB was 100%, with 40% having a sentinel node identified outside the field of planned neck dissection on lymphoscintigraphy. Of these, one patient had a positive sentinel node outside of the ipsilateral supraomohyoid neck dissection template.
  
  
  CONCLUSIONS
  SLNB for early OCSCC is technically feasible in an Australian setting. It has a high NPV and can potentially identify at-risk lymphatic basins outside the traditional selective neck dissection levels even in well-lateralized lesions.
authors.affiliation: Head and Neck Cancer Service, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.|The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Muzib
authors.initials: M
authors.lastname: Abdul-Razak
authors.affiliation: Head and Neck Cancer Service, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.
authors.forename: Hsiang
authors.initials: H
authors.lastname: Chung
authors.affiliation: Head and Neck Cancer Service, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.
authors.forename: Eva
authors.initials: E
authors.lastname: Wong
authors.affiliation: Head and Neck Cancer Service, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.|The University of Sydney, Sydney, New South Wales, Australia.|Sydney Head and Neck Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.
authors.forename: Carsten
authors.initials: C
authors.lastname: Palme
authors.affiliation: Head and Neck Cancer Service, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.|The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Veness
authors.affiliation: Department of Nuclear Medicine, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Farlow
authors.affiliation: Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Hedley
authors.initials: H
authors.lastname: Coleman
authors.affiliation: Head and Neck Cancer Service, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.|The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Gary
authors.initials: G
authors.lastname: Morgan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000556:secondary; D009367:Neoplasm Staging; D009517:New South Wales / Q000453:epidemiology; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D014057:Tomography, X-Ray Computed
keywords: head and neck neoplasm; lymphatic metastasis; mouth neoplasm; sentinel lymph node biopsy; squamous cell carcinoma