CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2020; 24(02): e125-e131
DOI: 10.1055/s-0039-1695762
Original Research
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Can Sentinel Lymph Node Biopsy Predict Various Levels of Echelon Nodes in Oral Cancers?

1   Department of Otolaryngology, Head & Neck Surgery, Post-Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
,
Jaimanti Bakshi
1   Department of Otolaryngology, Head & Neck Surgery, Post-Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
,
Naresh Kumar Panda
1   Department of Otolaryngology, Head & Neck Surgery, Post-Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
,
Roshan Verma
1   Department of Otolaryngology, Head & Neck Surgery, Post-Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
,
Anish Bhattacharya
2   Department of Nuclear Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
,
Amanjit Bal
3   Department of Pathology, Post-Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
› Author Affiliations
Further Information

Publication History

06 June 2019

20 June 2019

Publication Date:
04 November 2019 (online)

Abstract

Introduction The efficacy of sentinel node biopsy in early stage oral cancer is well established. Its evolving role can be reinforced by further studies.

Objective Analyzing the predictability of the levels of echelon nodes for various oral cavity tumor subsites on sentinel node biopsy.

Methods A prospective study of 20 patients with stage I/II oral squamous cell carcinoma who underwent sentinel node biopsy-guided neck dissection between January 2017 and 2018 at our institute. The procedure included radiotracer injection, imaging (lymphoscintigraphy, single photon emission computed tomography-computed tomography), and gamma probe application. Sentinel node detection on imaging and gamma probe were compared.

Results Out of 20 patients, 13 (65%) had carcinoma of the tongue, 6 (30%) had buccal mucosa carcinoma, and 1 (5%) had retromolar trigone carcinoma. The mean age of the patients was 52.3 years. A total of 13 (65%) patients were male, and 7 (35%) were female. The sentinel node identification rates with imaging and gamma probe were of 70% and 100% respectively. In tongue and retromolar trigone primaries, the most common first-echelon nodes in both modalities were levels IIA and IB respectively. For buccal mucosa primaries, first-echelon nodes were detected only with the gamma probe, which was level IB. On imaging, second-echelon nodes were detected only for tongue primaries, and had equivalent incidence of levels II, III, and IV. On the gamma probe, level IIA, followed by III, and IV for the tongue, and level IIA were the most common second-echelon nodes for the buccal mucosa. Third-echelon nodes were detected only with the gamma probe for tongue carcinoma at level IV.

Conclusion The combined use of imaging and gamma probe provides the best results, with high identification rate and predictability of echelon levels.

 
  • References

  • 1 Woolgar JA. Detailed topography of cervical lymph-node metastases from oral squamous cell carcinoma. Int J Oral Maxillofac Surg 1997; 26 (01) 3-9
  • 2 Nieweg OE, Tanis PJ, Kroon BB. The definition of a sentinel node. Ann Surg Oncol 2001; 8 (06) 538-541
  • 3 Ziessman HA, O'Malley JP, Thrall JH. Oncology: Non-positron emission tomography. Nuclear medicine-the requisites. In: Fahey FH. , editors. Philadelphia: Saunders Elsevier; 2014: 281-283
  • 4 Bluemel C, Herrmann K, Giammarile F. , et al. EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma. Eur J Nucl Med Mol Imaging 2015; 42 (11) 1750-1766
  • 5 Ziessman HA, O'Malley JP, Thrall JH. Radiation detection and instrumentation. Nuclear medicine-the requisites. In: Fahey FH. , editors. Philadelphia: Saunders Elsevier; 2014: 42-44
  • 6 Ziessman HA, O'Malley JP, Thrall JH. Radiopharmaceuticals. Single-Photon Emission Computed Tomography, Positron Emission Tomography, and Hybrid Imaging. In: Fahey FH. , editors. Philadelphia: Saunders Elsevier; 2014: 56-57
  • 7 De Carvalho GM, Dias VG, Kohler H, Chone CT, Guimaraes AC, Crespo AN. Sentinel Lymph Node Biopsy vs. Elective Neck Dissection in Patients with T1/T2 N0 Oral Squamous Cell Carcinoma: A Matched Pair Analysis. Int J Oral Craniofac Sci. 2016; 2 (01) 047-051
  • 8 Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. Oral Oncol 2009; 45 (4-5): 309-316
  • 9 Alkureishi LW, Ross GL, Shoaib T. , et al. Does tumor depth affect nodal upstaging in squamous cell carcinoma of the head and neck?. Laryngoscope 2008; 118 (04) 629-634
  • 10 Schilling C, Stoeckli SJ, Haerle SK. , et al. Sentinel European Node Trial (SENT): 3-year results of sentinel node biopsy in oral cancer. Eur J Cancer 2015; 51 (18) 2777-2784
  • 11 den Toom IJ, van Schie A, van Weert S. , et al. The added value of SPECT-CT for the identification of sentinel lymph nodes in early stage oral cancer. Eur J Nucl Med Mol Imaging 2017; 44 (06) 998-1004
  • 12 Hassan O, Taha MS, Mehairy HE. Sentinel lymph node biopsy versus elective neck dissection in evaluation of cN0 neck in patients with oral and oropharyngeal squamous cell carcinoma. Systematic review and meta-analysis study. Egypt J Ear Nose Throat Allied Sciences. 2015; 16: 25-34
  • 13 Liu M, Wang SJ, Yang X, Peng H. Diagnostic Efficacy of Sentinel Lymph Node Biopsy in Early Oral Squamous Cell Carcinoma: A Meta-Analysis of 66 Studies. PLoS One 2017; 12 (01) e0170322