Sentinel node biopsy in node negative early oral cancers: Solution to the conundrum!

Area of Science:

• Oncology
• Surgical Pathology
• Nuclear Medicine

Background:

• Management of the node-negative neck in early oral cancers remains debated.
• Elective neck dissection (END) offers survival benefits but leads to overtreatment in 50-70% of patients, causing significant morbidity.
• Current imaging and prediction models lack the diagnostic accuracy to safely omit neck dissection.

Purpose of the Study:

• To evaluate the oncological safety and functional outcomes of sentinel node biopsy (SNB) compared to END.
• To discuss the limitations hindering widespread SNB adoption and propose solutions for global feasibility.

Main Methods:

• Review of recent randomized controlled trials comparing SNB and END.
• Analysis of diagnostic accuracy of imaging and prediction models.
• Discussion of SNB's infrastructure, cost, staffing, and pathology protocol requirements.

Main Results:

• Two large randomized controlled trials indicate SNB is oncologically safe and spares unnecessary neck dissections.
• SNB demonstrates reduced morbidity compared to END, with functional outcomes improving over one year.
• Widespread SNB acceptance is limited by infrastructure, cost, multidisciplinary collaboration needs, and labor-intensive pathology.

Conclusions:

• SNB is a viable, oncologically sound alternative to END for select early oral cancer patients.
• Addressing SNB's logistical and resource challenges is crucial for broader clinical implementation.
• Further research into cancer biology and novel solutions is needed to enhance SNB's global applicability.