den Toom Inne J, Boeve Koos, Lobeek Daphne, Bloemena Elisabeth, Donswijk Maarten L, de Keizer Bart, Klop W Martin C, Leemans C René, Willems Stefan M, Takes Robert P, Witjes Max J H, de Bree Remco
Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands.
Cancers (Basel). 2020 Jul 3;12(7):1783. doi: 10.3390/cancers12071783.
Sentinel lymph node biopsy (SLNB) has been introduced as a 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.
A retrospective, multicenter cohort study included 390 patients staged by END and 488 by SLNB.
The overall sensitivity (84% vs. 81%, = 0.612) and negative predictive value (NPV) (93%, = 1.000) were comparable between END and SLNB patients. The END cohort contained more pT2 tumours (51%) compared to the SLNB cohort (23%) ( < 0.001). No differences were found for sensitivity and NPV between SLNB and END divided by pT stage. In floor-of-mouth (FOM) tumours, SLNB had a lower sensitivity (63% vs. 92%, = 0.006) and NPV (90% vs. 97%, = 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%, = 0.048).
In the absence of randomized clinical trials, this study provides the highest available evidence that, in oral cancer, SLNB is as accurate as END in detecting occult lymph node metastases, except for floor-of-mouth tumours.
前哨淋巴结活检（SLNB）已被引入作为检测早期口腔癌患者隐匿性转移的诊断分期方法。文献中缺乏与常规使用的选择性颈清扫术（END）准确性的比较。
一项回顾性多中心队列研究纳入了390例通过END分期的患者和488例通过SLNB分期的患者。
END组和SLNB组患者的总体敏感性（84%对81%，P = 0.612）和阴性预测值（NPV）（93%，P = 1.000）相当。与SLNB组（23%）相比，END组包含更多pT2期肿瘤（51%）（P < 0.001）。按pT分期划分，SLNB组和END组在敏感性和NPV方面未发现差异。在口底（FOM）肿瘤中，与END相比，SLNB的敏感性（63%对92%，P = 0.006）和NPV（90%对97%，P = 0.057）较低。与pT1期END患者相比，pT1期SLNB患者的疾病特异性生存率（DSS）更高（96%对90%，P = 0.048）。
在缺乏随机临床试验的情况下，本研究提供了现有最高证据表明，在口腔癌中，除口底肿瘤外，SLNB在检测隐匿性淋巴结转移方面与END一样准确。
