Sentinel Node Biopsy: High-Tech Method of Predicting Neck Status

We concluded that the sentinel node biopsy technique is valid in principle for oral cavity cancer in the sense that if you inject you do get mapping to the appropriate lymph node, Dr. Civantos said. We need to define the population to whom we want to apply this. Given the limitations of this model in reproducing a true sentinel node biopsy, we still recommend caution. We must document local recurrence rates in the neck after sentinel node biopsy alone.

Strategy for Using Sentinel Node Biopsy

He said that doctors who are considering using the sentinel node biopsy strategy should approach the practice carefully. Nobody should just start doing this procedure, he said. The way to get into this is to start injecting, getting a map, and taking out sentinel nodes and then continuing with a selective neck dissection. Essentially, after some initial instruction, you develop expertise through this technique. The combination of sentinel node biopsy with selective neck dissection allows you to upstage patients and to map the lymphatics so you can do a more thorough neck dissection. At the same time you can develop expertise in the minimally invasive procedure.

You want to counsel your patients regarding the potential for re-exploration and talk to them about which way they would rather go. You want to counsel them about the small risk of false negatives and that they do need to be followed, he said.

Dr. Civantos noted that there have been more than 60 single institutional studies of sentinel node biopsy for oral cancer; 200 international conference documents have been reported; a meta-analysis has been published; and a European multi-institutional study has also been reported. All these studies have reported predictive values of 90 percent to 100 percent, meaning that if you get a negative sentinel node there is a less than 5 percent chance of missing cancer. You combine that with a group that already has low risk to begin with and it can be safe and give you a little bit of reassurance, he said.

The major concern had been related to the fact that a false negative in a highly curative patient is a big deal, and we are more nervous about the watchful waiting approach, so we should be cautious about sentinel node biopsies, too, he said.

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