High rate of unexpected lymphatic drainage patterns and a high accuracy of the sentinel lymph node biopsy in oral cancer after previous neck treatment

Inne J. den Toom, Koos Boeve, Stijn van Weert, Elisabeth Bloemena, Adrienne H. Brouwers, Otto S. Hoekstra, Bart de Keizer, Bert van der Vegt, Stefan M. Willems, C. René Leemans, Max J. H. Witjes, Remco de Bree

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Rationale: This study evaluates the lymphatic drainage patterns and determines the accuracy of the sentinel lymph node biopsy (SLNB)in patients diagnosed with a cT1-2N0 OSCC and a history of neck surgery or radiotherapy in three Dutch head and neck centers. Materials and Methods: Retrospective analysis of 53 cT1-2N0 OSCC patients, who underwent SLNB between 2007 and 2016, after a history of neck surgery or radiotherapy. Ten patients had previous treatment of the neck only contralateral from the current tumour. These ten patients were not used for the analysis of lymphatic drainage patterns. The 43 patients with previous ipsilateral or bilateral treatment of the neck had a history of ipsilateral SLN extirpation (n = 9; 21%), neck dissection (n = 16; 37%), radiotherapy (n = 10; 23%), or combined neck dissection and radiotherapy (n = 8; 19%). Results: SLNs were detected in 45 patients, resulting in an identification rate of 85% (45/53). Three patients (7%)had at least one positive SLN. One patient (1/45; 2%)was diagnosed with regional recurrence during the follow-up after a negative SLNB (sensitivity 75%, negative predictive value 98%). The first SLN was detected in level I-III in 58% of the patients, unexpected drainage patterns were observed in 30% (first SLN level IV 9% and level V 5% and contralateral neck in well-lateralized tumours 16%). In 12% no lymphatic drainage pattern was visible. Conclusions: SLNB seems to be a reliable procedure for neck staging of cT1-2N0 OSCC patients with a previously treated neck. SLNB determines the individual lymphatic drainage patterns, enabling visualization of unexpected drainage pattern variability in 30% of these patients.
Original languageEnglish
Pages (from-to)68-72
JournalOral Oncology
Volume94
DOIs
Publication statusPublished - 1 Jul 2019

Cite this

@article{ecd140ba5eeb48d49678faf06a86708a,
title = "High rate of unexpected lymphatic drainage patterns and a high accuracy of the sentinel lymph node biopsy in oral cancer after previous neck treatment",
abstract = "Rationale: This study evaluates the lymphatic drainage patterns and determines the accuracy of the sentinel lymph node biopsy (SLNB)in patients diagnosed with a cT1-2N0 OSCC and a history of neck surgery or radiotherapy in three Dutch head and neck centers. Materials and Methods: Retrospective analysis of 53 cT1-2N0 OSCC patients, who underwent SLNB between 2007 and 2016, after a history of neck surgery or radiotherapy. Ten patients had previous treatment of the neck only contralateral from the current tumour. These ten patients were not used for the analysis of lymphatic drainage patterns. The 43 patients with previous ipsilateral or bilateral treatment of the neck had a history of ipsilateral SLN extirpation (n = 9; 21{\%}), neck dissection (n = 16; 37{\%}), radiotherapy (n = 10; 23{\%}), or combined neck dissection and radiotherapy (n = 8; 19{\%}). Results: SLNs were detected in 45 patients, resulting in an identification rate of 85{\%} (45/53). Three patients (7{\%})had at least one positive SLN. One patient (1/45; 2{\%})was diagnosed with regional recurrence during the follow-up after a negative SLNB (sensitivity 75{\%}, negative predictive value 98{\%}). The first SLN was detected in level I-III in 58{\%} of the patients, unexpected drainage patterns were observed in 30{\%} (first SLN level IV 9{\%} and level V 5{\%} and contralateral neck in well-lateralized tumours 16{\%}). In 12{\%} no lymphatic drainage pattern was visible. Conclusions: SLNB seems to be a reliable procedure for neck staging of cT1-2N0 OSCC patients with a previously treated neck. SLNB determines the individual lymphatic drainage patterns, enabling visualization of unexpected drainage pattern variability in 30{\%} of these patients.",
author = "{den Toom}, {Inne J.} and Koos Boeve and {van Weert}, Stijn and Elisabeth Bloemena and Brouwers, {Adrienne H.} and Hoekstra, {Otto S.} and {de Keizer}, Bart and {van der Vegt}, Bert and Willems, {Stefan M.} and Leemans, {C. Ren{\'e}} and Witjes, {Max J. H.} and {de Bree}, Remco",
year = "2019",
month = "7",
day = "1",
doi = "10.1016/j.oraloncology.2019.05.007",
language = "English",
volume = "94",
pages = "68--72",
journal = "Oral Oncology",
issn = "1368-8375",
publisher = "Elsevier Limited",

}

High rate of unexpected lymphatic drainage patterns and a high accuracy of the sentinel lymph node biopsy in oral cancer after previous neck treatment. / den Toom, Inne J.; Boeve, Koos; van Weert, Stijn; Bloemena, Elisabeth; Brouwers, Adrienne H.; Hoekstra, Otto S.; de Keizer, Bart; van der Vegt, Bert; Willems, Stefan M.; Leemans, C. René; Witjes, Max J. H.; de Bree, Remco.

In: Oral Oncology, Vol. 94, 01.07.2019, p. 68-72.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - High rate of unexpected lymphatic drainage patterns and a high accuracy of the sentinel lymph node biopsy in oral cancer after previous neck treatment

AU - den Toom, Inne J.

AU - Boeve, Koos

AU - van Weert, Stijn

AU - Bloemena, Elisabeth

AU - Brouwers, Adrienne H.

AU - Hoekstra, Otto S.

AU - de Keizer, Bart

AU - van der Vegt, Bert

AU - Willems, Stefan M.

AU - Leemans, C. René

AU - Witjes, Max J. H.

AU - de Bree, Remco

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Rationale: This study evaluates the lymphatic drainage patterns and determines the accuracy of the sentinel lymph node biopsy (SLNB)in patients diagnosed with a cT1-2N0 OSCC and a history of neck surgery or radiotherapy in three Dutch head and neck centers. Materials and Methods: Retrospective analysis of 53 cT1-2N0 OSCC patients, who underwent SLNB between 2007 and 2016, after a history of neck surgery or radiotherapy. Ten patients had previous treatment of the neck only contralateral from the current tumour. These ten patients were not used for the analysis of lymphatic drainage patterns. The 43 patients with previous ipsilateral or bilateral treatment of the neck had a history of ipsilateral SLN extirpation (n = 9; 21%), neck dissection (n = 16; 37%), radiotherapy (n = 10; 23%), or combined neck dissection and radiotherapy (n = 8; 19%). Results: SLNs were detected in 45 patients, resulting in an identification rate of 85% (45/53). Three patients (7%)had at least one positive SLN. One patient (1/45; 2%)was diagnosed with regional recurrence during the follow-up after a negative SLNB (sensitivity 75%, negative predictive value 98%). The first SLN was detected in level I-III in 58% of the patients, unexpected drainage patterns were observed in 30% (first SLN level IV 9% and level V 5% and contralateral neck in well-lateralized tumours 16%). In 12% no lymphatic drainage pattern was visible. Conclusions: SLNB seems to be a reliable procedure for neck staging of cT1-2N0 OSCC patients with a previously treated neck. SLNB determines the individual lymphatic drainage patterns, enabling visualization of unexpected drainage pattern variability in 30% of these patients.

AB - Rationale: This study evaluates the lymphatic drainage patterns and determines the accuracy of the sentinel lymph node biopsy (SLNB)in patients diagnosed with a cT1-2N0 OSCC and a history of neck surgery or radiotherapy in three Dutch head and neck centers. Materials and Methods: Retrospective analysis of 53 cT1-2N0 OSCC patients, who underwent SLNB between 2007 and 2016, after a history of neck surgery or radiotherapy. Ten patients had previous treatment of the neck only contralateral from the current tumour. These ten patients were not used for the analysis of lymphatic drainage patterns. The 43 patients with previous ipsilateral or bilateral treatment of the neck had a history of ipsilateral SLN extirpation (n = 9; 21%), neck dissection (n = 16; 37%), radiotherapy (n = 10; 23%), or combined neck dissection and radiotherapy (n = 8; 19%). Results: SLNs were detected in 45 patients, resulting in an identification rate of 85% (45/53). Three patients (7%)had at least one positive SLN. One patient (1/45; 2%)was diagnosed with regional recurrence during the follow-up after a negative SLNB (sensitivity 75%, negative predictive value 98%). The first SLN was detected in level I-III in 58% of the patients, unexpected drainage patterns were observed in 30% (first SLN level IV 9% and level V 5% and contralateral neck in well-lateralized tumours 16%). In 12% no lymphatic drainage pattern was visible. Conclusions: SLNB seems to be a reliable procedure for neck staging of cT1-2N0 OSCC patients with a previously treated neck. SLNB determines the individual lymphatic drainage patterns, enabling visualization of unexpected drainage pattern variability in 30% of these patients.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/31178214

U2 - 10.1016/j.oraloncology.2019.05.007

DO - 10.1016/j.oraloncology.2019.05.007

M3 - Article

VL - 94

SP - 68

EP - 72

JO - Oral Oncology

JF - Oral Oncology

SN - 1368-8375

ER -