Sentinel lymph node biopsy accurately stages the regional lymph nodes for T1-T2 oral squamous cell carcinomas

Results of a prospective multi-institutional trial

Francisco J. Civantos, Robert P. Zitsch, David E. Schuller, Amit Agrawal, Russell B Smith, Richard Nason, Guy Petruzelli, Christine G. Gourin, Richard J. Wong, Robert L. Ferris, Adel El Naggar, John A. Ridge, Randal C. Paniello, Kouros Owzar, Linda McCall, Douglas B. Chepeha, Wendell G. Yarbrough, Jeffrey N. Myers

Research output: Contribution to journalArticle

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Abstract

Purpose: The validity of sentinel lymph node biopsy (SLNB) for T1 or T2, clinically N0, oral cancer was tested by correlation of sentinel node pathologic status with that of nodes within the completion neck dissection. Methods: This prospective, cooperative group trial involved 25 institutions over a 3-year period. One hundred forty patients with invasive oral cancers, stage T1 and T2, N0 including 95 cancers of the tongue, 26 of the floor of mouth, and 19 other oral cancers were studied. The study excluded lesions with diameter smaller than 6 mm or minimal invasion. Imaging was used to exclude nonpalpable gross nodal disease. Patients underwent injection of the lesion with 99mTc-sulfur colloid, nuclear imaging, narrow-exposure SLNB, and completion selective neck dissection. The major end point was the negative-predictive value (NPV) of SLNB. Results: In the 106 SLNBs, which were found to be pathologically and clinically node-negative by routine hematoxylin and eosin stain, 100 patients were found to have no other pathologically positive nodes, corresponding to a NPV of 94%. With additional sectioning and immunohistochemistry, NPV was improved to 96%. In the forty patients with proven cervical metastases, the true-positive rate was 90.2% and was superior for tongue tumors relative to floor of mouth. For T1 lesions, metastases were correctly identified in 100%. Conclusion: For T1 or T2 N0 oral squamous cell carcinoma, SLNB with step sectioning and immunohistochemistry, performed by surgeons of mixed experience levels, correctly predicted a pathologically negative neck in 96% of patients (NPV, 96%).

Original languageEnglish (US)
Pages (from-to)1395-1400
Number of pages6
JournalJournal of Clinical Oncology
Volume28
Issue number8
DOIs
StatePublished - Mar 10 2010

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Sentinel Lymph Node Biopsy
Squamous Cell Carcinoma
Lymph Nodes
Mouth Neoplasms
Mouth Floor
Neck Dissection
Oral Stage
Immunohistochemistry
Tongue Neoplasms
Neoplasm Metastasis
Colloids
Hematoxylin
Eosine Yellowish-(YS)
Tongue
Sulfur
Coloring Agents
Neck
Injections
Neoplasms

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Sentinel lymph node biopsy accurately stages the regional lymph nodes for T1-T2 oral squamous cell carcinomas : Results of a prospective multi-institutional trial. / Civantos, Francisco J.; Zitsch, Robert P.; Schuller, David E.; Agrawal, Amit; Smith, Russell B; Nason, Richard; Petruzelli, Guy; Gourin, Christine G.; Wong, Richard J.; Ferris, Robert L.; El Naggar, Adel; Ridge, John A.; Paniello, Randal C.; Owzar, Kouros; McCall, Linda; Chepeha, Douglas B.; Yarbrough, Wendell G.; Myers, Jeffrey N.

In: Journal of Clinical Oncology, Vol. 28, No. 8, 10.03.2010, p. 1395-1400.

Research output: Contribution to journalArticle

Civantos, FJ, Zitsch, RP, Schuller, DE, Agrawal, A, Smith, RB, Nason, R, Petruzelli, G, Gourin, CG, Wong, RJ, Ferris, RL, El Naggar, A, Ridge, JA, Paniello, RC, Owzar, K, McCall, L, Chepeha, DB, Yarbrough, WG & Myers, JN 2010, 'Sentinel lymph node biopsy accurately stages the regional lymph nodes for T1-T2 oral squamous cell carcinomas: Results of a prospective multi-institutional trial', Journal of Clinical Oncology, vol. 28, no. 8, pp. 1395-1400. https://doi.org/10.1200/JCO.2008.20.8777
Civantos, Francisco J. ; Zitsch, Robert P. ; Schuller, David E. ; Agrawal, Amit ; Smith, Russell B ; Nason, Richard ; Petruzelli, Guy ; Gourin, Christine G. ; Wong, Richard J. ; Ferris, Robert L. ; El Naggar, Adel ; Ridge, John A. ; Paniello, Randal C. ; Owzar, Kouros ; McCall, Linda ; Chepeha, Douglas B. ; Yarbrough, Wendell G. ; Myers, Jeffrey N. / Sentinel lymph node biopsy accurately stages the regional lymph nodes for T1-T2 oral squamous cell carcinomas : Results of a prospective multi-institutional trial. In: Journal of Clinical Oncology. 2010 ; Vol. 28, No. 8. pp. 1395-1400.
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abstract = "Purpose: The validity of sentinel lymph node biopsy (SLNB) for T1 or T2, clinically N0, oral cancer was tested by correlation of sentinel node pathologic status with that of nodes within the completion neck dissection. Methods: This prospective, cooperative group trial involved 25 institutions over a 3-year period. One hundred forty patients with invasive oral cancers, stage T1 and T2, N0 including 95 cancers of the tongue, 26 of the floor of mouth, and 19 other oral cancers were studied. The study excluded lesions with diameter smaller than 6 mm or minimal invasion. Imaging was used to exclude nonpalpable gross nodal disease. Patients underwent injection of the lesion with 99mTc-sulfur colloid, nuclear imaging, narrow-exposure SLNB, and completion selective neck dissection. The major end point was the negative-predictive value (NPV) of SLNB. Results: In the 106 SLNBs, which were found to be pathologically and clinically node-negative by routine hematoxylin and eosin stain, 100 patients were found to have no other pathologically positive nodes, corresponding to a NPV of 94{\%}. With additional sectioning and immunohistochemistry, NPV was improved to 96{\%}. In the forty patients with proven cervical metastases, the true-positive rate was 90.2{\%} and was superior for tongue tumors relative to floor of mouth. For T1 lesions, metastases were correctly identified in 100{\%}. Conclusion: For T1 or T2 N0 oral squamous cell carcinoma, SLNB with step sectioning and immunohistochemistry, performed by surgeons of mixed experience levels, correctly predicted a pathologically negative neck in 96{\%} of patients (NPV, 96{\%}).",
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T1 - Sentinel lymph node biopsy accurately stages the regional lymph nodes for T1-T2 oral squamous cell carcinomas

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AU - Civantos, Francisco J.

AU - Zitsch, Robert P.

AU - Schuller, David E.

AU - Agrawal, Amit

AU - Smith, Russell B

AU - Nason, Richard

AU - Petruzelli, Guy

AU - Gourin, Christine G.

AU - Wong, Richard J.

AU - Ferris, Robert L.

AU - El Naggar, Adel

AU - Ridge, John A.

AU - Paniello, Randal C.

AU - Owzar, Kouros

AU - McCall, Linda

AU - Chepeha, Douglas B.

AU - Yarbrough, Wendell G.

AU - Myers, Jeffrey N.

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N2 - Purpose: The validity of sentinel lymph node biopsy (SLNB) for T1 or T2, clinically N0, oral cancer was tested by correlation of sentinel node pathologic status with that of nodes within the completion neck dissection. Methods: This prospective, cooperative group trial involved 25 institutions over a 3-year period. One hundred forty patients with invasive oral cancers, stage T1 and T2, N0 including 95 cancers of the tongue, 26 of the floor of mouth, and 19 other oral cancers were studied. The study excluded lesions with diameter smaller than 6 mm or minimal invasion. Imaging was used to exclude nonpalpable gross nodal disease. Patients underwent injection of the lesion with 99mTc-sulfur colloid, nuclear imaging, narrow-exposure SLNB, and completion selective neck dissection. The major end point was the negative-predictive value (NPV) of SLNB. Results: In the 106 SLNBs, which were found to be pathologically and clinically node-negative by routine hematoxylin and eosin stain, 100 patients were found to have no other pathologically positive nodes, corresponding to a NPV of 94%. With additional sectioning and immunohistochemistry, NPV was improved to 96%. In the forty patients with proven cervical metastases, the true-positive rate was 90.2% and was superior for tongue tumors relative to floor of mouth. For T1 lesions, metastases were correctly identified in 100%. Conclusion: For T1 or T2 N0 oral squamous cell carcinoma, SLNB with step sectioning and immunohistochemistry, performed by surgeons of mixed experience levels, correctly predicted a pathologically negative neck in 96% of patients (NPV, 96%).

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