Sentinel Lymph Node Biopsy in Clinically N0 Gingivo-Buccal Squamous Cell Carcinoma: A Prospective Feasibility Study

In regions with high prevalence of gingivo-buccal squamous cell carcinoma (GBSCC), supraomohyoid neck dissection (SOND) remains the norm for the N0 neck, despite low nodal positivity, especially with low-staged primaries. Sentinel lymph node biopsy (SLNB) may offer an alternative with potential morbidity reduction.

To evaluate the feasibility and oncologic safety of SLNB in N0 necks with primary GBSCC.

This prospective study included consecutive patients with clinically T1-T3 N0 GBSCC undergoing primary surgery. Following trans-oral resection of the primary wherever possible, SLNB was performed using preoperative radiocolloid injection and SPECT imaging, followed by intraoperative localization using a gamma probe and frozen section analysis. A SOND was then performed in all cases.

Of the 39 patients in the study, sentinel nodes were identified in all patients. In 36, both on radionuclide imaging and intraoperatively, while in 3, only intraoperatively with a gamma probe. Out of a total of 746 nodes dissected, 14 positive nodes were found, of which 12 were sentinel nodes, detected in 8 patients. The two non-sentinel positive nodes were found in SLNB-positive necks. Observed sensitivity and specificity were 100% in this cohort; however, due to limited sample size, results should be interpreted cautiously. At a median follow-up of 27 months, 36 of 39 patients were NED (no evidence of disease), and 3 were DOD (dead of disease).

SLNB with primary GBSCC demonstrated adequate diagnostic accuracy and appeared oncologically safe, with the potential to reduce unnecessary elective neck dissections without compromising outcomes.