Elective Neck Dissection or Sentinel Lymph Node Biopsy in Early Stage Oral Cavity Cancer Patients: The Dutch Experience

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Abstract

Background: Sentinel lymph node biopsy (SLNB) has been introduced as a diagnostic staging modality for detection of occult metastases in patients with early stage oral cancer. Comparisons regarding accuracy to the routinely used elective neck dissection (END) are lacking in literature. Methods: A retrospective, multicenter cohort study included 390 patients staged by END and 488 by SLNB. Results: The overall sensitivity (84% vs. 81%, p = 0.612) and negative predictive value (NPV) (93%, p = 1.000) were comparable between END and SLNB patients. The END cohort contained more pT2 tumours (51%) compared to the SLNB cohort (23%) ( p < 0.001). No differences were found for sensitivity and NPV between SLNB and END divided by pT stage. In floor-of-mouth (FOM) tumours, SLNB had a lower sensitivity (63% vs. 92%, p = 0.006) and NPV (90% vs. 97%, p = 0.057) compared to END. Higher disease-specific survival (DSS) rates were found for pT1 SLNB patients compared to pT1 END patients (96% vs. 90%, p = 0.048). Conclusion: In the absence of randomized clinical trials, this study provides the highest available evidence that, in oral cancer, SLNB is as accurate as END in detecting occult lymph node metastases, except for floor-of-mouth tumours.

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Most cited references 42

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Head and Neck cancers-major changes in the American Joint Committee on cancer eighth edition cancer staging manual.

William M Lydiatt, Snehal Patel, Brian O'Sullivan … (2017)

Answer questions and earn CME/CNE The recently released eighth edition of the American Joint Committee on Cancer (AJCC) Staging Manual, Head and Neck Section, introduces significant modifications from the prior seventh edition. This article details several of the most significant modifications, and the rationale for the revisions, to alert the reader to evolution of the field. The most significant update creates a separate staging algorithm for high-risk human papillomavirus-associated cancer of the oropharynx, distinguishing it from oropharyngeal cancer with other causes. Other modifications include: the reorganizing of skin cancer (other than melanoma and Merkel cell carcinoma) from a general chapter for the entire body to a head and neck-specific cutaneous malignancies chapter; division of cancer of the pharynx into 3 separate chapters; changes to the tumor (T) categories for oral cavity, skin, and nasopharynx; and the addition of extranodal cancer extension to lymph node category (N) in all but the viral-related cancers and mucosal melanoma. The Head and Neck Task Force worked with colleagues around the world to derive a staging system that reflects ongoing changes in head and neck oncology; it remains user friendly and consistent with the traditional tumor, lymph node, metastasis (TNM) staging paradigm. CA Cancer J Clin 2017;67:122-137. © 2017 American Cancer Society.

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Elective versus Therapeutic Neck Dissection in Node-Negative Oral Cancer.

Anil K. D’Cruz, Richa Vaish, Neeti Kapre … (2015)

Whether patients with early-stage oral cancers should be treated with elective neck dissection at the time of the primary surgery or with therapeutic neck dissection after nodal relapse has been a matter of debate.

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Use of decision analysis in planning a management strategy for the stage N0 neck.

R Isaacs, Markus Weiss, Louis B. Harrison (1994)

There are three major strategies in the treatment of patients with a stage N0 neck with squamous cell cancer of the head and neck: elective neck dissection, elective neck irradiation, and observation. Each has appropriate salvage strategies in the event of local recurrence. We used decision analysis to determine the optimal strategy for neck treatment as a function of the probability of occult cervical metastasis. We used the bibliographies of current articles and books to access clinical studies of patients with stage N0 neck cancer. Studies that included large numbers of patients and contained a minimum 2-year follow-up, with results analyzed in terms of outcome as a function of stage of neck disease, were included. Specific data points were extracted from the studies independently by multiple observers, and mean values were used in the decision analysis. A decision tree was constructed with use of a computer model to compare the three management strategies. Probabilities of each of the possible events depicted in the trees were inserted into the tree structure. These probabilities were gleaned from the literature as described above. A sensitivity analysis was performed to determine the optimal threshold for treatment of the neck. A patient with primary squamous cell carcinoma of the head and neck and stage N0 neck status should be observed if the probability of occult cervical metastasis is less than 20%. If the probability is greater than 20%, treatment of the neck is warranted. The treatment plan should ideally involve a single modality of therapy; both neck dissection and radiation therapy are quite efficacious in the clinical context, and the decision of which one to employ should be driven by the treatment of the primary lesion. Decision analysis is useful in complex clinical situations.

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Journal

Journal ID (nlm-ta): Cancers (Basel)

Journal ID (iso-abbrev): Cancers (Basel)

Journal ID (publisher-id): cancers

Title: Cancers

Publisher: MDPI

ISSN (Electronic): 2072-6694

Publication date (Electronic): 03 July 2020

Publication date Collection: July 2020

Volume: 12

Issue: 7

Electronic Location Identifier: 1783

Affiliations

[1 ]Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; i.j.dentoom@ 123456umcutrecht.nl

[2 ]Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; j.boeve@ 123456umcg.nl (K.B.); m.j.h.witjes@ 123456umcg.nl (M.J.H.W.)

[3 ]Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands

[4 ]Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; daphne.lobeek@ 123456radboudumc.nl

[5 ]Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam UMC/Academic Centre for Dentistry (ACTA), 1081 HV Amsterdam, The Netherlands; e.bloemena@ 123456amsterdamumc.nl

[6 ]Department of Pathology, Amsterdam UMC (location VU Medical Center), 1081 HV Amsterdam, The Netherlands

[7 ]Department of Nuclear Medicine, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands; m.donswijk@ 123456nki.nl

[8 ]Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; b.dekeizer@ 123456umcutrecht.nl

[9 ]Department of Head and Neck Surgery, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands; m.klop@ 123456nki.nl

[10 ]Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC (location VU University Medical Center), 1081 HV Amsterdam, The Netherlands; cr.leemans@ 123456amsterdamumc.nl

[11 ]Department of Pathology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; s.m.willems-4@ 123456umcutrecht.nl

[12 ]Department of Pathology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands

[13 ]Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; robert.takes@ 123456radboudumc.nl

Author notes

[* ]Correspondence: r.debree@ 123456umcutrecht.nl ; Tel.: +31-88-7550819

[†]

Both authors contributed equally to this study.

Author information

Elisabeth Bloemena https://orcid.org/0000-0002-0221-9538

Maarten L. Donswijk https://orcid.org/0000-0003-2028-9713

Bart de Keizer https://orcid.org/0000-0002-6270-9483

Robert P. Takes https://orcid.org/0000-0003-4784-0499

Remco de Bree https://orcid.org/0000-0001-7128-5814

Article

Publisher ID: cancers-12-01783

DOI: 10.3390/cancers12071783

PMC ID: 7407164

PubMed ID: 32635357

SO-VID: e4fbda3b-baeb-4ea8-a07e-5bbe88ed57a8

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

Elective Neck Dissection or Sentinel Lymph Node Biopsy in Early Stage Oral Cavity Cancer Patients: The Dutch Experience

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Most cited references 42

Head and Neck cancers-major changes in the American Joint Committee on cancer eighth edition cancer staging manual.

Elective versus Therapeutic Neck Dissection in Node-Negative Oral Cancer.

Use of decision analysis in planning a management strategy for the stage N0 neck.

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