Sentinel European Node Trial (SENT): 3-year results of sentinel node biopsy in oral cancer

Clare Schilling, Sandro J Stoeckli, Stephan K Haerle, Martina A Broglie, Gerhard F Huber, Jens Ahm Sorensen, Vivi Bakholdt, Annelise Krogdahl, Christian von Buchwald, Anders Bilde, Lars R Sebbesen, Edward Odell, Benjamin Gurney, Michael O'Doherty, Remco de Bree, Elisabeth Bloemena, Geke B Flach, Pedro M Villarreal, Manuel Florentino Fresno Forcelledo, Luis Manuel Junquera Gutiérrez, Julio Alvarez Amézaga, Luis Barbier, Joseba Santamaría-Zuazua, Augusto Moreira, Manuel Jacome, Maurizio Giovanni Vigili, Siavash Rahimi, Girolamo Tartaglione, Georges Lawson, Marie-Cecile Nollevaux, Cesare Grandi, Davide Donner, Emma Bragantini, Didier Dequanter, Philippe Lothaire, Tito Poli, Enrico M Silini, Erinco Sesenna, Giles Dolivet, Romina Mastronicola, Agnes Leroux, Isabel Sassoon, Philip Sloan, Mark McGurk
European Journal of Cancer 2015, 51 (18): 2777-84

PURPOSE: Optimum management of the N0 neck is unresolved in oral cancer. Sentinel node biopsy (SNB) can reliably detect microscopic lymph node metastasis. The object of this study was to establish whether the technique was both reliable in staging the N0 neck and a safe oncological procedure in patients with early-stage oral squamous cell carcinoma.

METHODS: An European Organisation for Research and Treatment of Cancer-approved prospective, observational study commenced in 2005. Fourteen European centres recruited 415 patients with radiologically staged T1-T2N0 squamous cell carcinoma. SNB was undertaken with an average of 3.2 nodes removed per patient. Patients were excluded if the sentinel node (SN) could not be identified. A positive SN led to a neck dissection within 3 weeks. Analysis was performed at 3-year follow-up.

RESULTS: An SN was found in 99.5% of cases. Positive SNs were found in 23% (94 in 415). A false-negative result occurred in 14% (15 in 109) of patients, of whom eight were subsequently rescued by salvage therapy. Recurrence after a positive SNB and subsequent neck dissection occurred in 22 patients, of which 16 (73%) were in the neck and just six patients were rescued. Only minor complications (3%) were reported following SNB. Disease-specific survival was 94%. The sensitivity of SNB was 86% and the negative predictive value 95%.

CONCLUSION: These data show that SNB is a reliable and safe oncological technique for staging the clinically N0 neck in patients with T1 and T2 oral cancer. EORTC Protocol 24021: Sentinel Node Biopsy in the Management of Oral and Oropharyngeal Squamous Cell Carcinoma.

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