Page 39 - Sentinel lymph node biopsy in oral cavity cancer - Inne J. den Toom

Table 3 summarizes the recurrences during follow-up. In 3/26 (12%) SLNB positive patients a nodal metastasis recurred, for which additional treatment was indicated. In 2 of these patients the metastasis recurred in the dissected neck, the other patient with a well lateralized tumour developed nodal metastasis in the contralateral neck. Two of them died of disease after treatment, one patient (with metastasis in the dissected neck) remained disease free for 18 months. 2 Of the 61 SLNB negative patients, 2 patients (3%) developed regional metastasis in the neck after 3 and 51 months of follow-up, respectively. In the first patient, the metastasis was detected by USgFNAC during follow-up and after ND and postoperative radio- therapy this patient is alive and disease free. The other patient withdrew from follow-up visits (physical examination and repeated USgFNAC), but showed up after 51 months with a large ulcerative nodal metastasis (N3) in the neck. After salvage ND he refused adjuvant chemoradiation. He is still alive. The regional metastases of both patients were found in other neck levels compared to the SLNs. SPECT-CT was added to imaging procedure in 57/88 (65%) patients. In these 57 patients none of them developed a regional recurrence during follow-up (median 10 months). The sensitivity and negative predictive value (NPV) of SLNB were 93% (26/28) and 97% (59/61), respectively. Regarding primary tumour site, the accuracy of SLNB in floor of mouth (FOM) tumours compared to other tumour sites in the oral cavity appeared to be lower (sensitivity 86% vs. 95%, NPV 94% vs. 98%), although not statistically significant (p = 0.44 and p = 0.48 respectively) (Table 4). Table 4. Results of SLNB in T1-T2 oral carcinoma with separate analysis for floor of mouth carcinoma Tumour location FoM Other All SLNB + 06 20 26 N + 07 21 28 Sens. TN 86%* 16 95%* 43 93% 59 SLNB - NPV 17 94%** 44 98%** 61 97% SLNB, sentinel lymph node biopsy; N, nodal metastasis in the neck; Sens., sensitivity; TN, true negative; NPV, negative predictive value *: p = 0.44. sensitivity FOM compared with sensitivity other tumour sites **: p = 0.48. NPV FOM compared with NPV other tumour sites 37