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Sentinel Node Biopsy in Head and Neck Squamous Cell Cancer: 5-Year Follow-Up of a European Multicenter Trial

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Sentinel node biopsy (SNB) may represent an alternative to elective neck dissection for the staging of patients with early head and neck squamous cell carcinoma (HNSCC). To date, the technique has been successfully described in a number of small single-institution studies. This report describes the long-term follow-up of a large European multicenter trial evaluating the accuracy of the technique.

Methods

A total of 227 SNB procedures were carried out across 6 centers, of which 134 were performed in clinically T1/2 N0 patients. All patients underwent SNB with preoperative lymphoscintigraphy, intraoperative blue dye, and handheld gamma probe. Sentinel nodes were evaluated with hematoxylin and eosin (H&E) staining, step-serial sectioning (SSS), and immunohistochemistry (IHC). There were 79 patients who underwent SNB as the sole staging tool, while 55 patients underwent SNB-assisted elective neck dissection.

Results

Sentinel nodes were successfully identified in 125 of 134 patients (93%), with a lower success rate observed for floor-of-mouth tumors (FoM; 88% vs. 96%, P = 0.138). Also, 42 patients were upstaged (34%); of these, 10 patients harbored only micrometastatic disease. At a minimum follow-up of 5 years, the overall sensitivity of SNB was 91%. The sensitivity and negative predictive values (NPV) were lower for patients with FoM tumors compared with other sites (80% vs. 97% and 88% vs. 98%, respectively, P = 0.034).

Conclusions

Sentinel node biopsy is a reliable and reproducible means of staging the clinically N0 neck for patients with cT1/T2 HNSCC. It can be used as the sole staging tool for the majority of these patients, but cannot currently be recommended for patients with tumors in the floor of the mouth.

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Authors and Affiliations

  1. Plastic Surgery Unit, Canniesburn Hospital, Glasgow, UK

    Lee W. T. Alkureishi MRCS, Taimur Shoaib FRCS (Plast), David S. Soutar ChM & Richard Thompson MD

  2. Plastic Surgery Unit, Christie Hospital, Wilmslow, UK

    Gary L. Ross FRCS (Plast)

  3. Beatson West of Scotland Cancer Centre, Glasgow, UK

    A. Gerry Robertson FRCR

  4. Department of Oral Pathology, University of Sheffield, Sheffield, UK

    Keith D. Hunter FRCPath

  5. Odense University Hospital, Odense, Denmark

    Jens A. Sorensen PhD, Jorn Thomsen MD & Annelise Krogdahl DMSc

  6. Hospital de Cruces, Universidad del Pais Vasco/EHU, Bilbao, Spain

    Julio Alvarez MD, Luis Barbier MD & Joseba Santamaria MD

  7. University Hospital of Parma, Parma, Italy

    Tito Poli MD & Enrico Sesenna ChM

  8. Johann Wolfgang Goethe University Medical School, Frankfurt, Germany

    Adorjan F. Kovács PhD & Frank Grünwald MD

  9. Azienda Ospedaliera “S. Maria degli Angeli, Pordenone, Italy

    Luigi Barzan MD, Sandro Sulfaro MD & Franco Alberti MD

Authors
  1. Lee W. T. Alkureishi MRCS
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  2. Gary L. Ross FRCS (Plast)
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  3. Taimur Shoaib FRCS (Plast)
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  4. David S. Soutar ChM
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  6. Richard Thompson MD
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  9. Jorn Thomsen MD
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  10. Annelise Krogdahl DMSc
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  11. Julio Alvarez MD
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  14. Tito Poli MD
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  16. Adorjan F. Kovács PhD
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  17. Frank Grünwald MD
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  18. Luigi Barzan MD
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  20. Franco Alberti MD
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Corresponding author

Correspondence to Lee W. T. Alkureishi MRCS.

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Alkureishi, L.W.T., Ross, G.L., Shoaib, T. et al. Sentinel Node Biopsy in Head and Neck Squamous Cell Cancer: 5-Year Follow-Up of a European Multicenter Trial. Ann Surg Oncol 17, 2459–2464 (2010). https://doi.org/10.1245/s10434-010-1111-3

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  • DOI: https://doi.org/10.1245/s10434-010-1111-3

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