Mørch Therese, Tvedskov Jesper F, Wessel Irene, Charabi Birgitte W, Jakobsen Kathrine K, Grønhøj Christian, Kiss Katalin, Lelkaitis Giedrius, Mortensen Jann, Kjaer Andreas, von Buchwald Christian, Christensen Anders
Department of Otolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital-Rigshospitalet University of Copenhagen Copenhagen Denmark.
Department of Pathology, Copenhagen University Hospital-Rigshospitalet University of Copenhagen Copenhagen Denmark.
World J Otorhinolaryngol Head Neck Surg. 2024 Jan 5;10(4):261-269. doi: 10.1002/wjo2.157. eCollection 2024 Dec.
Staging of the cN0 neck with sentinel node biopsy (SNB) in early-stage oral squamous cell carcinoma (OSCC) is validated in patients with a previously untreated neck. We aimed to investigate the feasibility and diagnostic accuracy of SNB and unexpected drainage patterns in patients with cT1-T2N0 OSCC and a history of previous head and neck cancer comprising treatment of the neck, that is, surgery, radiotherapy, or both.
Fifty patients with a previously treated neck diagnosed with a new primary or recurrent cN0 OSCC between 2014 and 2021 were included and retrospectively analyzed. Feasibility was assessed by the rate of successfully performed SNB neck staging procedures. Based on follow-up data, the diagnostic performance of SNB was evaluated by calculation of negative predictive value (NPV) and false omission rate (FOR).
A SNB staging procedure was successfully performed in 76% (38/50) of the patients. Technical failures were due to the lack of drainage preoperatively or failure in intraoperative SN detection. In patients successfully staged with SNB, the rate of a positive SN was 13% (5/38). In the SNB-negative group, no patients were diagnosed with a regional node recurrence during follow-up, and the NPV and FOR were 100% and 0%, respectively. Unexpected lymphatic drainage occurred in 32% (12/38) of the patients.
SNB is technically feasible in cT1-2N0 OSCC patients with a previously treated neck with a high diagnostic accuracy. Importantly, SNB enables the detection of individual and unexpected lymphatic drainage patterns.
在早期口腔鳞状细胞癌（OSCC）患者中，对前哨淋巴结活检（SNB）用于cN0颈部分期在既往未治疗颈部的患者中进行验证。我们旨在研究SNB在cT1-T2N0 OSCC且有既往头颈癌颈部治疗史（即手术、放疗或两者皆有）患者中的可行性、诊断准确性及意外引流模式。
纳入2014年至2021年间50例既往颈部接受过治疗且诊断为新的原发性或复发性cN0 OSCC的患者，并进行回顾性分析。通过成功实施SNB颈部分期程序的比率评估可行性。基于随访数据，通过计算阴性预测值（NPV）和漏诊率（FOR）评估SNB的诊断性能。
76%（38/50）的患者成功实施了SNB分期程序。技术失败原因是术前无引流或术中前哨淋巴结检测失败。在通过SNB成功分期的患者中，前哨淋巴结阳性率为13%（5/38）。在SNB阴性组中，随访期间无患者被诊断为区域淋巴结复发，NPV和FOR分别为100%和0%。32%（12/38）的患者出现意外淋巴引流。
SNB在既往颈部接受过治疗的cT1-2N0 OSCC患者中技术上可行，诊断准确性高。重要的是，SNB能够检测个体及意外的淋巴引流模式。
