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Sentinel Lymph Node Biopsy in Assessing Drainage Patterns in Squamous Cell Carcinomas

By: Joseph Fanelli
Posted: Monday, January 28, 2019

Sentinel lymph node biopsy may be helpful in clarifying unexpected bilateral or contralateral metastatic drainage patterns in patients with oral squamous cell carcinomas, according to prospective study findings published in the European Journal of Cancer. Jacob Mølstrøm, MD, of the Odense University Hospital in Denmark, and colleagues concluded that completion neck dissection of levels I to III in patients who have a positive sentinel lymph node biopsy might be sufficient in most patients with oral squamous cell carcinomas.

“In our cohort, 8 of 55 patients with occult metastasis would have been missed by elective neck dissection of the ipsilateral neck,” the authors concluded.

For the study, 220 patients with clinical T1-2N0 oral squamous cell carcinomas who underwent preoperative lymphoscintigraphy followed by gamma probe–guided sentinel lymph node biopsy were enrolled. Patients with positive sentinel nodes were treated with completion neck dissection, and excised lymph nodes were grouped into the neck level.

The sentinel node detection rate by lymphoscintigraphy was 99.1%, whereas 71.5% (15 of 21 patients) with midline tumors experienced bilateral lymphatic drainage on lymphoscintigraphy. Of patients with lateralized tumors, 45 of 199 (22.6%) had unexpected bilateral or contralateral drainage patterns on lymphoscintigraphy.

The researchers found that 55 patients (25%) were sentinel lymph node biopsy–positive, with metastases found in 72 of 781 (9.2%) of the excised sentinel nodes. Metastatic involvement of the neck and level IV was observed in only patients with anterior tongue cancer. No patients experienced level V involvement.

Disclosure: The study authors’ disclosure information may be found at ejcancer.com.

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