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Kansara S, Oral E, Sarkar I, Sandulache V, Mualla R, Walvekar RR, Ryan W, Ha P. Rate of occult metastasis in lip squamous cell carcinoma: A systematic review and meta-analysis. Head Neck 2024. [PMID: 38497534 DOI: 10.1002/hed.27747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/12/2024] [Accepted: 03/12/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVES The rate of occult metastasis in lip cancer is poorly studied. Management of the regional nodal basin in lip cancer is thus controversial. This study sought to understand the true rate of micrometastasis in lip cancer. MATERIALS AND METHODS Systematic review and meta-analysis was conducted of English language studies reporting lip cancer sentinel node biopsy results. Studies were obtained from the PubMed database between the years 2000 and 2023 using the search terms "sentinel node biopsy" and "squamous cell carcinoma." Random effect and fixed effect meta-analyses were performed. RESULTS Thirteen studies met inclusion criteria. Low heterogeneity was noted among the studies, as indicated by the I2 inconsistency test (I2 = 0%). The rate of occult metastasis ranged between 0 and 33% (mean 9%). A total of 189 lip sentinel node biopsies had been performed. Of these, 21 revealed occult nodal metastasis (11.1%, 95% CI 7.36%-16.44%). One step, generalized linear mixed modeling revealed the true rate of occult nodal metastasis to be 10% (95% CI (0.0504, 0.1746), p < 0.0001). CONCLUSION The rate of occult metastasis in lip cancer approaches the threshold for elective management of the regional nodal basin. Sentinel node biopsy is optimally suited for management of high-risk early T stage lip cancer.
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Affiliation(s)
- Sagar Kansara
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Evrim Oral
- School of Public Health, Biostatistics and Data Science Program, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Indrani Sarkar
- School of Public Health, Biostatistics and Data Science Program, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Vlad Sandulache
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Rula Mualla
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Rohan R Walvekar
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - William Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Patrick Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
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Vuity D, McMahon J, Hislop S, McCaul J, Wales C, Ansell M, Thomson E, McGarvie J, McLaughlin I, Nicol A, McLellan D. Sentinel lymph node biopsy for early oral cancer - accuracy and considerations in patient selection. Br J Oral Maxillofac Surg 2022; 60:830-836. [PMID: 35331563 DOI: 10.1016/j.bjoms.2021.12.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/03/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
Sentinel lymph node biopsy (SLNB) for staging oral squamous cell carcinoma (OSCC) patients presenting with early (T1 and T2 N0) disease in preference to elective neck dissection (END) remains controversial worldwide. A retrospective analysis of 145 patients who underwent sentinel lymph node biopsy for a previously untreated early oral cancer between 2010 and 2020 was performed. The primary outcome measures were predictors of occult metastases, accuracy of SLNB and disease specific plus overall survival. The negative predictive value, the false negative rate, and sensitivity for SLNB were 97%, 7.8%, and 92%, respectively. Depth of invasion (DOI) was a significant predictor of N status, overall survival, and disease specific survival. There was a significant difference in the incidence of the neck node metastasis in patients with DOI <5mm compared to those with DOI >5mm. For tumours >5mm there was a moderate to good correlation between radiological depth on contrast enhanced computed tomography (CECT) and histopathological DOI. Preoperative estimation of DOI may be a useful tool in the counselling of patients in the selection of either SLNB or END for N staging purposes in early OSCC.
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Affiliation(s)
- Drazsen Vuity
- Department of Oral and Maxillofacial Surgery, University Hospital Crosshouse, Kilmarnock Rd, Crosshouse, Kilmarnock KA2 0BE, UK.
| | - Jeremy McMahon
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - Stuart Hislop
- Department of Oral and Maxillofacial Surgery, University Hospital Crosshouse, Kilmarnock Rd, Crosshouse, Kilmarnock KA2 0BE, UK
| | - James McCaul
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - Craig Wales
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - Mark Ansell
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - Ewen Thomson
- Department of Oral and Maxillofacial Surgery, Forth Valley Royal Hospital, Stirling Rd, Larbert FK5 4WR, UK
| | - Jim McGarvie
- Department of Medical Physics, University Hospital Crosshouse, Kilmarnock Rd, Crosshouse, Kilmarnock KA2 0BE, UK
| | - Ian McLaughlin
- Department of Radiology & Nuclear Medicine, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - Alice Nicol
- Department of Nuclear Medicine, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - Douglas McLellan
- Department of Pathology, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
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Analysis of the Efficiency and Prognostic Value of the Sentinel Node Technique in Oral Squamous Cell Carcinoma after Seven Years. ACTA ACUST UNITED AC 2021; 57:medicina57101092. [PMID: 34684129 PMCID: PMC8540189 DOI: 10.3390/medicina57101092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/07/2021] [Accepted: 10/10/2021] [Indexed: 11/16/2022]
Abstract
Background and objectives: The purpose of this study was to analyse the diagnostic and prognostic efficiency of the sentinel lymph node biopsy technique (SLNB). Materials and Methods: This is a prospective observational study performed by the Hospital Complex in Santiago de Compostela (CHUS) in Spain, between February 2013 and June 2020. The study included 60 patients, who had been diagnosed with OSCC in stage T1/T2N0M0. Results: 10 patients (16.7%) presented with SN+ (sentinel node positive). The majority (80%) only presented subcapsular affection, however one case also presented with extracapsular affection. Using the Kaplan–Meier curves, we determined that the average survival estimation for SN− patients was 74.0 months (CI95% 67.6–80.5) and it was 45.4 months (CI95% 10.9–24.0) for SN+ patients (p = 0.002). SN+ patients presented an OR = 11.000 (CI95% 2.393–50.589, p = 0.002) for cancer-related mortality. In terms of the diagnostic performance of the SN (sentinel node) test, a 55% sensitivity, a 100% specificity, 100% PPV and a 84% NPV were obtained. The analysis using ROC (receiver operating characteristic) curves revealed an AUC = 0.671 (CI95% 0.492–0.850, p = 0.046). Conclusions: SLNB seems to be an adequate technique for the detection of hidden metastases.
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King C, Elsherif N, Kirwan R, Schilling C, Hall G, Morgan P, Collins L, Sandison A, Odell E, Thavaraj S. Serial step sections at narrow intervals with immunohistochemistry are required for accurate histological assessment of sentinel lymph node biopsy in oral squamous cell carcinoma. Head Neck 2021; 43:2985-2993. [PMID: 34128276 DOI: 10.1002/hed.26784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/21/2021] [Accepted: 06/07/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy is an accurate staging modality in early oral squamous cell carcinoma (OSCC), but its accuracy relies on labor-intensive histopathology protocols. We sought to determine whether serial step sections with immunohistochemistry (SSSIHC) at narrow intervals of the entire SLN are required to accurately exclude metastasis. METHODS Consecutive SLN biopsies over a 13-year period were retrospectively evaluated. If the index section was negative for carcinoma, the entire SLN was subjected to SSSIHC at 150 μm intervals. The first section level and total number of section levels to contain carcinoma were recorded. RESULTS One hundred and eighteen SLN+ from 90 patients were included. SSSIHC upstaged the nodal status in 19.5% of patients. Metastasis was identified in 16.7% and 10.2% beyond section levels 4 and 6, respectively. Among SLNs requiring SSSIHC, 47.5% contained carcinoma in a single section level. CONCLUSION SSSIHC of the entire SLN at 150 μm intervals are required to identify occult metastasis in OSCC.
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Affiliation(s)
- Claire King
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nusaybah Elsherif
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ruaidhrí Kirwan
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Clare Schilling
- Head & Neck Surgery, University College London Hospital, London, UK.,Head and Neck Academic Centre, University College London, London, UK
| | - Gillian Hall
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Peter Morgan
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Oral, Dental and Craniofacial Science, King's College London, London, UK
| | - Lisette Collins
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ann Sandison
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Edward Odell
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Oral, Dental and Craniofacial Science, King's College London, London, UK
| | - Selvam Thavaraj
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Oral, Dental and Craniofacial Science, King's College London, London, UK
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