Positive Sentinel Lymph Nodes are a Negative Prognostic Factor for Survival in T1–2 Oral/Oropharyngeal Cancer: A Long-Term Study on 103 Patients

Excerpt

Detection and treatment of occult nodal metastasis and management of the clinically N0 neck have posed a challenge in head and neck squamous cell carcinoma (HNSCC). In an attempt to translate successful staging strategies employed in breast carcinoma and melanoma, sentinel node biopsy (SNB) has been investigated in the context of HNSCC over the past decade. The concept of sentinel node biopsy relies on the theory that the first-echelon node/s (sentinel node) will harbor the lymphatic flow from the tumor, and pathologic evaluation of this node will accurately reflect the nodal staging.1‐3 In particular, early-stage oral-cavity and oropharyngeal cancers have been targeted for studies evaluating the utility of sentinel node biopsy, and the incidence of occult metastatic disease to the cervical lymph nodes is approximately 20–30% in low-stage oral-cavity cancers.4‐6 Most investigations have focused on the possibility that accurate SNB may facilitate avoidance of staging neck dissections, particularly in patients with low-stage T1–2 oral-cavity cancer that would avoid postoperative radiotherapy with low-risk primary tumor and pathologically negative neck. …