Page 50 - Sentinel lymph node biopsy in oral cavity cancer - Inne J. den Toom

Chapter 3 ABSTRACT Background Sentinel lymph node biopsy (SLNB) has been introduced as 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 Retrospective, multicenter cohort study, including 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) was 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 di- vided 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 absence of randomized clinical trials, this study provides the highest available evidence that in oral cancer, SLNB is as accurate as END to detect occult lymph node metastases, except for floor of mouth tumours. 48