Department of Clinical Sciences Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden.
Medical Unit Head Neck Lung and Skin cancer, Department of Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden.
Cancer Med. 2023 Jun;12(11):12524-12534. doi: 10.1002/cam4.5966. Epub 2023 Apr 21.
Sentinel lymph node biopsy (SLNB) is used to improve the staging of and guide treatment in patients with early-stage T1-T2 N0 oral squamous cell carcinoma (OSCC). The role of sentinel nodes (SNs) and the use of SN-technique in advanced OSCC (T3-T4 and/or N+) remain to be evaluated. This study investigates the nodal drainage and the rate of positive SNs (SNs+) in all stages of OSCC.
In total, 85 patients with T1-T4 OSCC diagnosed 2019-2021 were included. We used a prolonged interval between peritumoral injection of radionuclide and SPECT-CT to include all SNs.
Patients with advanced OSCC presented a higher proportion of contralateral lymphatic drainage and a higher rate of SN+ compared to patients with early-stage disease. T3-T4 and N+ tumors presented a tendency for a higher rate of contralateral lymphatic drainage compared to T1-T2 and N0 tumors (p = 0.1). The prevalence of positive nodes (SNs+) was higher among patients with advanced disease, T3-T4 versus T1-T2 (p = 0.0398).
SN-assisted ND enables identification and removal of all SNs + and has the potential for more accurate staging and could possibly give prognostic advantages regarding regional recurrence for all OSCC patients, especially among those with advanced disease. The precise localization of the SNs + also suggests that a more individualized ND approach might be possible in the future even for patients with advanced OSCC.
前哨淋巴结活检 (SLNB) 用于改善 T1-T2N0 期口腔鳞状细胞癌 (OSCC) 患者的分期并指导治疗。在晚期 OSCC (T3-T4 和/或 N+) 中，前哨淋巴结 (SN) 的作用和 SN 技术的应用仍有待评估。本研究调查了所有 OSCC 分期的淋巴结引流和阳性 SN (SN+) 率。
共纳入 2019 年至 2021 年诊断为 T1-T4 OSCC 的 85 例患者。我们使用放射性核素肿瘤周围注射和 SPECT-CT 之间的延长间隔时间来包括所有 SN。
与早期疾病患者相比，晚期 OSCC 患者表现出更高比例的对侧淋巴引流和更高的 SN+率。与 T1-T2 和 N0 肿瘤相比，T3-T4 和 N+肿瘤的对侧淋巴引流率有更高的趋势（p=0.1）。与早期疾病患者相比，晚期疾病患者中阳性淋巴结 (SNs+) 的患病率更高，T3-T4 与 T1-T2 相比（p=0.0398）。
SN 辅助 ND 能够识别和切除所有 SNs+，具有更准确分期的潜力，并可能为所有 OSCC 患者，特别是晚期疾病患者，提供区域复发的预后优势。SNs+的精确定位还表明，即使对于晚期 OSCC 患者，未来也可能采用更个体化的 ND 方法。
