Sentinel Node Biopsy in the Management of Oral and Oropharyngeal Squamous Cell Carcinoma

The management of the clinically negative (N0) neck in small oral and
oropharyngeal cancer is controversial issue. When there is merely a high
likelihood of occult lymph node metastases, the choice is between elective
treatment and watchful waiting. Because of the risk for under- and
overtreatment a sensitive and specific diagnostic technique is warranted. At
the VUmc US-guided fine needle aspiration cytology (USgFNAC) is routinely used
for the detection of occult lymph node metastases. The technique of sentinel
node biopsy (SNB) is a promising diagnostic technique which is nowadays
routinely used in other tumor types.

Evaluation and comparison of SNB and USgFNAC in the management of clinical
negative neck in patients planned for transoral excision of oral and
oropharyngeal squamous cell carcinoma.

This is an observational non-randomized multicenter trial approved by EORTC. No
randomization is performed, because a randomized trial would have to test a
non-inferiority hypothesis and would require over 1000 patients. In the VU
medical center USgFNAC is added for comparison.

Sentinel node biopsy procedure which includes injection of
radiolabeled-colloid, lymphoscintigraphy using a gamma camera and surgical
excision of the sentinel lymph node(s) during anesthesia for panendoscopy

In current clinical practice these patients undergo USgFNAC and/or further
imaging like CT, MRI or PET. Lymphoscintigraphy and sentinel node biopsy are
procedures which are used routinely in other tumor types. In the literature on
head and neck cancer no serious adverse events have been reported using these
techniques. Through a more extensive diagnostic work-up for staging the neck
the chance of missing occult lymph node metastases is decreased.