Sentinel Lymph Node Biopsy vs. Elective Neck Dissection in Patients with T1/T2 N0 Oral Squamous Cell Carcinoma: A Matched Pair Analysis

Abstract

Background: The management of the clinically and radiological negative neck in patients with early squamous cell carcinoma of head and neck (HNSCC) is still controversial. As approximately 20 to 30% of these patients harbor occult neck disease, most of them is submitted to elective neck dissection with no benefit in great majority of those cases. Sentinel lymph node biopsy (SLB) is a potential method for staging of lymphatic metastasis in HNSCC and the status of the sentinel node predicts the presence of metastasis in the remainder of the nodes within the nodal basin. Objective: To evaluate the neck recurrence rate of patients with early stage (T1/T2) HNSCC of the oral cavity with clinically negative necks (cN0), in patients submitted to sentinel lymph node biopsy (SNB) or elective neck dissection (END). Methods: Clinical retrospective comparison of two patient cohorts of early stage oral cancer tested for primary tumor resection and SNB without subsequent END or primary tumor resection with END. Those comparisons were made by a matched pair analysis. Results: The current study included 52 patients with early stage oral cancer; 30 in the SNB group and 22 in the control group (END). Both SNB and END groups had similar performance regarding the recurrence rate of neck, without significant difference between both groups. Conclusion: Neck recurrence rates were similar between groups of patients in which SNB or END was performed. the gold standard approach for staging the cervical lymph nodes in patients with HNSCC. END is simultaneously a therapeutic and staging procedure that may be beneficial for patients who are subsequently found to harbor occult disease. However, these situations occurs in approximately 25% of those cases, leading to the possibility of 75% of the remains patients are being over treated [13,14]. There was a prospective randomized study in the literature to compare elective ipsilateral radical neck dissection versus observation in the treatment of stage I to II oral tongue carcinoma in India [15]. Another prospective randomized study of T1-3N0M0 of mixed oral tongue and floor of mouth carcinomas was conducted in France comparing observation and elective ipsilateral radical neck dissection [16]. These 2 prospective randomized studies did not show any survival benefit of elective radical neck dissection, but it has to be noted that those papers had a limitations regarding to the number of patients included. Another prospective randomized study of selective neck dissection (levels I, II, III) versus observation for N0 neck of stage I to II oral tongue carcinoma shows that the 5-year disease-specific survival rate was 87% for the observation group and was 89% for the END group; the 2% difference was not significant [16].