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European Archives of Oto-Rhino-Laryngology
Published in: European Archives of Oto-Rhino-Laryngology 9/2021

01-09-2021 | Oral Cancer | Review Article

What is the role of sentinel lymph node biopsy in the management of oral cancer in 2020?

Authors: Remco de Bree, Bart de Keizer, Francisco J. Civantos, Robert P. Takes, Juan P. Rodrigo, Juan C. Hernandez-Prera, Gyorgy B. Halmos, Alessandra Rinaldo, Alfio Ferlito

Published in: European Archives of Oto-Rhino-Laryngology | Issue 9/2021

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Abstract

Approximately 70–80% of patients with cT1-2N0 oral squamous cell carcinoma (OSCC) ultimately prove to have no cancer in the cervical lymphatics on final pathology after selective neck dissection. As a result, sentinel lymph node biopsy (SLNB) has been adopted during the last decade as a diagnostic staging method to intelligently identify patients who would benefit from formal selective lymphadenectomy or neck irradiation. While not yet universally accepted, SLNB is now incorporated in many national guidelines. SLNB offers a less invasive alternative to elective neck dissection (END), and has some advantages and disadvantages. SLNB can assess the individual drainage pattern and, with step serial sectioning and immunohistochemistry (IHC), can enable the accurate detection of micrometastases and isolated tumor cells (ITCs). Staging of the neck is improved relative to END with routine histopathological examination. The improvements in staging are particularly notable for the contralateral neck and the pretreated neck. However, for floor of mouth (FOM) tumors, occult metastases are frequently missed by SLNB due to the proximity of activity from the primary site to the lymphatics (the shine through phenomenon). For FOM cancers, it is advised to perform either elective neck dissection or superselective neck dissection of the preglandular triangle of level I. New tracers and techniques under development may improve the diagnostic accuracy of SLNB for early-stage OSCC, particularly for FOM tumors. Treatment of the neck (either neck dissection or radiotherapy), although limited to levels I–IV, remains mandatory for any positive category of metastasis (macrometastasis, micrometastasis, or ITCs). Recently, the updated EANM practical guidelines for SLN localization in OSCC and the surgical consensus guidelines on SLNB in patients with OSCC were published. In this review, the current evidence and results of SLNB in early OSCC are presented.
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Metadata
Title
What is the role of sentinel lymph node biopsy in the management of oral cancer in 2020?
Authors
Remco de Bree
Bart de Keizer
Francisco J. Civantos
Robert P. Takes
Juan P. Rodrigo
Juan C. Hernandez-Prera
Gyorgy B. Halmos
Alessandra Rinaldo
Alfio Ferlito
Publication date
01-09-2021
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Oto-Rhino-Laryngology / Issue 9/2021
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-020-06538-y

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