Need for intensive histopathologic analysis to determine lymph node metastases when using sentinel node biopsy in oral cancer

Anders Bilde; Christian von Buchwald; Marianne Hamilton Therkildsen; Jann Mortensen; Jørgen Kirkegaard; Birgitte Charabi; Lena Specht; Anders Bilde; Christian von Buchwald; Marianne Hamilton Therkildsen; Jann Mortensen; Jørgen Kirkegaard; Birgitte Charabi; Lena Specht

doi:10.1097/MLG.0b013e31815d8e15

Need for intensive histopathologic analysis to determine lymph node metastases when using sentinel node biopsy in oral cancer

Anders Bilde, Christian von Buchwald, Marianne Hamilton Therkildsen, Jann Mortensen, Jørgen Kirkegaard, Birgitte Charabi, Lena Specht, Anders Bilde, Christian von Buchwald, Marianne Hamilton Therkildsen, Jann Mortensen, Jørgen Kirkegaard, Birgitte Charabi, Lena Specht

51 Citations (Scopus)

Abstract

OBJECTIVE: To determine the predictive value of sentinel node biopsy (SNB)-assisted neck dissection in patients with oral squamous cell carcinoma (SCC) stage T1 to 2N0M0 and to determine the incidence of subclinical metastases. STUDY DESIGN: Prospective cohort study. METHODS: Fifty-one patients with clinically N0 neck underwent SNB-assisted neck dissection. The localization of the sentinel node (SN) was determined using dynamic and planar lymphoscintigraphy and single photon emission computed tomography-computed tomography. Histopathologic examination of the harvested SN was performed using step-serial sectioning with hematoxylin-eosin (H&E) and immunohistochemistry on formalin-fixed, paraffin-embedded tissue. RESULTS: A total of 181 SNs were excised with a median of 3 (range 1-7) SNs per patient. Four percent (2 of 51) of patients with subclinical (occult) lymph node metastasis would have been identified using routine H&E staining, whereas the 18% (9 of 49) were upstaged as a result of additional histopathology when the H&E evaluation was negative. Overall, the incidence of subclinical metastases was 22% (11 of 51). CONCLUSION: In this study, SNB-assisted neck dissection proved to be technically feasible in identifying subclinical metastasis, thus accurately staging the neck with a high degree of sensitivity in patients with oral SCC T1 to 2N0M0 when additional histopathology was performed. The vast majority of patients in this study would have been spared selective neck dissection had reliance on SNB been used and selective neck dissection performed only in the case of a positive SN. Future studies should focus on determining whether SNB alone reduces patient morbidity and whether this is as equally effective in the treatment of cervical nodal metastases as compared with selective neck dissection in patients with oral SCC.

Original language	English
Journal	Laryngoscope
Volume	118
Issue number	3
Pages (from-to)	408-14
Number of pages	7
ISSN	0023-852X
DOIs	https://doi.org/10.1097/MLG.0b013e31815d8e15 https://doi.org/10.1097/MLG.0b013e31815d8e15
Publication status	Published - 1 Mar 2008

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Bilde, A., von Buchwald, C., Therkildsen, M. H., Mortensen, J., Kirkegaard, J., Charabi, B., Specht, L., Bilde, A., von Buchwald, C., Therkildsen, M. H., Mortensen, J., Kirkegaard, J., Charabi, B., & Specht, L. (2008). Need for intensive histopathologic analysis to determine lymph node metastases when using sentinel node biopsy in oral cancer. Laryngoscope, 118(3), 408-14. https://doi.org/10.1097/MLG.0b013e31815d8e15, https://doi.org/10.1097/MLG.0b013e31815d8e15

Bilde, A, von Buchwald, C, Therkildsen, MH, Mortensen, J, Kirkegaard, J, Charabi, B , Specht, L, Bilde, A, von Buchwald, C, Therkildsen, MH, Mortensen, J, Kirkegaard, J, Charabi, B & Specht, L 2008, 'Need for intensive histopathologic analysis to determine lymph node metastases when using sentinel node biopsy in oral cancer', Laryngoscope, vol. 118, no. 3, pp. 408-14. https://doi.org/10.1097/MLG.0b013e31815d8e15, https://doi.org/10.1097/MLG.0b013e31815d8e15

@article{37de10804c7c11df928f000ea68e967b,

title = "Need for intensive histopathologic analysis to determine lymph node metastases when using sentinel node biopsy in oral cancer",

abstract = "OBJECTIVE: To determine the predictive value of sentinel node biopsy (SNB)-assisted neck dissection in patients with oral squamous cell carcinoma (SCC) stage T1 to 2N0M0 and to determine the incidence of subclinical metastases. STUDY DESIGN: Prospective cohort study. METHODS: Fifty-one patients with clinically N0 neck underwent SNB-assisted neck dissection. The localization of the sentinel node (SN) was determined using dynamic and planar lymphoscintigraphy and single photon emission computed tomography-computed tomography. Histopathologic examination of the harvested SN was performed using step-serial sectioning with hematoxylin-eosin (H&E) and immunohistochemistry on formalin-fixed, paraffin-embedded tissue. RESULTS: A total of 181 SNs were excised with a median of 3 (range 1-7) SNs per patient. Four percent (2 of 51) of patients with subclinical (occult) lymph node metastasis would have been identified using routine H&E staining, whereas the 18% (9 of 49) were upstaged as a result of additional histopathology when the H&E evaluation was negative. Overall, the incidence of subclinical metastases was 22% (11 of 51). CONCLUSION: In this study, SNB-assisted neck dissection proved to be technically feasible in identifying subclinical metastasis, thus accurately staging the neck with a high degree of sensitivity in patients with oral SCC T1 to 2N0M0 when additional histopathology was performed. The vast majority of patients in this study would have been spared selective neck dissection had reliance on SNB been used and selective neck dissection performed only in the case of a positive SN. Future studies should focus on determining whether SNB alone reduces patient morbidity and whether this is as equally effective in the treatment of cervical nodal metastases as compared with selective neck dissection in patients with oral SCC.",

author = "Anders Bilde and {von Buchwald}, Christian and Therkildsen, {Marianne Hamilton} and Jann Mortensen and J{\o}rgen Kirkegaard and Birgitte Charabi and Lena Specht and Anders Bilde and {von Buchwald}, Christian and Therkildsen, {Marianne Hamilton} and Jann Mortensen and J{\o}rgen Kirkegaard and Birgitte Charabi and Lena Specht",

note = "Keywords: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Humans; Lymphatic Metastasis; Male; Middle Aged; Mouth Neoplasms; Predictive Value of Tests; Prospective Studies; Sentinel Lymph Node Biopsy",

year = "2008",

month = mar,

day = "1",

doi = "10.1097/MLG.0b013e31815d8e15",

language = "English",

volume = "118",

pages = "408--14",

journal = "Laryngoscope",

issn = "0023-852X",

publisher = "JohnWiley & Sons, Inc.",

number = "3",

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TY - JOUR

T1 - Need for intensive histopathologic analysis to determine lymph node metastases when using sentinel node biopsy in oral cancer

AU - Bilde, Anders

AU - von Buchwald, Christian

AU - Therkildsen, Marianne Hamilton

AU - Mortensen, Jann

AU - Kirkegaard, Jørgen

AU - Charabi, Birgitte

AU - Specht, Lena

AU - Bilde, Anders

AU - von Buchwald, Christian

AU - Therkildsen, Marianne Hamilton

AU - Mortensen, Jann

AU - Kirkegaard, Jørgen

AU - Charabi, Birgitte

AU - Specht, Lena

N1 - Keywords: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Humans; Lymphatic Metastasis; Male; Middle Aged; Mouth Neoplasms; Predictive Value of Tests; Prospective Studies; Sentinel Lymph Node Biopsy

PY - 2008/3/1

Y1 - 2008/3/1

N2 - OBJECTIVE: To determine the predictive value of sentinel node biopsy (SNB)-assisted neck dissection in patients with oral squamous cell carcinoma (SCC) stage T1 to 2N0M0 and to determine the incidence of subclinical metastases. STUDY DESIGN: Prospective cohort study. METHODS: Fifty-one patients with clinically N0 neck underwent SNB-assisted neck dissection. The localization of the sentinel node (SN) was determined using dynamic and planar lymphoscintigraphy and single photon emission computed tomography-computed tomography. Histopathologic examination of the harvested SN was performed using step-serial sectioning with hematoxylin-eosin (H&E) and immunohistochemistry on formalin-fixed, paraffin-embedded tissue. RESULTS: A total of 181 SNs were excised with a median of 3 (range 1-7) SNs per patient. Four percent (2 of 51) of patients with subclinical (occult) lymph node metastasis would have been identified using routine H&E staining, whereas the 18% (9 of 49) were upstaged as a result of additional histopathology when the H&E evaluation was negative. Overall, the incidence of subclinical metastases was 22% (11 of 51). CONCLUSION: In this study, SNB-assisted neck dissection proved to be technically feasible in identifying subclinical metastasis, thus accurately staging the neck with a high degree of sensitivity in patients with oral SCC T1 to 2N0M0 when additional histopathology was performed. The vast majority of patients in this study would have been spared selective neck dissection had reliance on SNB been used and selective neck dissection performed only in the case of a positive SN. Future studies should focus on determining whether SNB alone reduces patient morbidity and whether this is as equally effective in the treatment of cervical nodal metastases as compared with selective neck dissection in patients with oral SCC.

AB - OBJECTIVE: To determine the predictive value of sentinel node biopsy (SNB)-assisted neck dissection in patients with oral squamous cell carcinoma (SCC) stage T1 to 2N0M0 and to determine the incidence of subclinical metastases. STUDY DESIGN: Prospective cohort study. METHODS: Fifty-one patients with clinically N0 neck underwent SNB-assisted neck dissection. The localization of the sentinel node (SN) was determined using dynamic and planar lymphoscintigraphy and single photon emission computed tomography-computed tomography. Histopathologic examination of the harvested SN was performed using step-serial sectioning with hematoxylin-eosin (H&E) and immunohistochemistry on formalin-fixed, paraffin-embedded tissue. RESULTS: A total of 181 SNs were excised with a median of 3 (range 1-7) SNs per patient. Four percent (2 of 51) of patients with subclinical (occult) lymph node metastasis would have been identified using routine H&E staining, whereas the 18% (9 of 49) were upstaged as a result of additional histopathology when the H&E evaluation was negative. Overall, the incidence of subclinical metastases was 22% (11 of 51). CONCLUSION: In this study, SNB-assisted neck dissection proved to be technically feasible in identifying subclinical metastasis, thus accurately staging the neck with a high degree of sensitivity in patients with oral SCC T1 to 2N0M0 when additional histopathology was performed. The vast majority of patients in this study would have been spared selective neck dissection had reliance on SNB been used and selective neck dissection performed only in the case of a positive SN. Future studies should focus on determining whether SNB alone reduces patient morbidity and whether this is as equally effective in the treatment of cervical nodal metastases as compared with selective neck dissection in patients with oral SCC.

U2 - 10.1097/MLG.0b013e31815d8e15

DO - 10.1097/MLG.0b013e31815d8e15

M3 - Journal article

C2 - 18043487

SN - 0023-852X

VL - 118

SP - 408

EP - 414

JO - Laryngoscope

JF - Laryngoscope

IS - 3

ER -

Need for intensive histopathologic analysis to determine lymph node metastases when using sentinel node biopsy in oral cancer

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