Relevance of Sentinel Nodes in Atypical Territories in Surgically Treated Patients With T1-2N0 Oral Squamous Cell Carcinoma

Abstract

Objectives

To assess the usefulness of sentinel lymph node biopsy (SLNB) in patients with early-stage oral squamous cell carcinoma (OSCC).

Materials and Methods

Seventy-five patients (mean age 62 years) diagnosed with cT1-2 N0 underwent SLNB with ^99mTc, lymphoscintigraphy/SPECT–CT, and gamma probe detection with intraoperative histological examination of the resected sentinel lymph nodes (SLNs). Elective neck dissection was performed during the same surgical procedure of primary tumor resection when malignant deposits were detected microscopically.

Results

The rate of occult metastases was 10.1% (26 out of 258 SLNs) and 24% (18 out of 75 patients). In 61 cases of well-lateralized tumors, metastases were detected in 11.1% (23 out of 208 SLNs), with an 11.5% metastatic rate in necks with ipsilateral drainage and 1.0% in necks with contralateral drainage patterns. In 28 patients with SLNs removed beyond Levels I–III, the rate of skip metastasis was 1.3%. The SLNB procedure for the detection of metastasis in patients with OSCC stage cT1-2 N0 showed a sensitivity of 94.7%, a specificity of 100%, a negative predictive value of 98.2%, a positive predictive value of 100%, and an overall diagnostic accuracy of 98.7%.

Conclusions

The analysis of atypical SLN plays an important role in refining the characterization of cervical involvement and tailoring the therapeutic approach to the actual extent of the disease.