Sentinel Lymph Node Biopsy Accurately Stages the Regional Lymph Nodes for T1-T2 Oral Squamous Cell Carcinomas: Results of a Prospective Multi-Institutional Trial
Sentinel Lymph Node Biopsy Accurately Stages the Regional Lymph Nodes for T1-T2 Oral Squamous Cell Carcinomas: Results of a Prospective Multi-Institutional Trial
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DOI：
10.1200/jco.2008.20.8777
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发表时间：
2010-03-10
影响因子：
45.3
通讯作者：
Myers, Jeffrey N.
中科院分区：
文献类型：
--
作者：
Civantos, Francisco J.;Zitsch, Robert P.;Myers, Jeffrey N.
目的 通过前哨淋巴结病理状态与完成颈清扫术内淋巴结病理状态的相关性来测试前哨淋巴结活检 (SLNB) 对 T1 或 T2、临床 N0 口腔癌的有效性。 方法 这项前瞻性、合作性团体试验涉及 25 个机构，历时 3 年。研究人员对 140 名 T1 和 T2 期、N0 期浸润性口腔癌患者进行了研究，其中包括 95 例舌癌、26 例口底癌和 19 例其他口腔癌。该研究排除了直径小于6毫米或微小浸润的病灶。使用影像学检查来排除不可触及的肉眼结节疾病。患者接受了Tc-99m-硫胶体注射、核成像、窄幅前哨淋巴结活检和完成选择性颈清扫术。主要终点是SLNB的阴性预测值（NPV）。结果在106例常规苏木精和伊红染色发现病理和临床淋巴结阴性的SLNB中，100例患者没有发现其他病理阳性淋巴结，对应的NPV为94%。通过额外的切片和免疫组织化学，NPV 提高至 96%。在 40 例确诊的颈部转移患者中，真阳性率为 90.2%，舌肿瘤的真阳性率优于口底肿瘤。对于 T1 病灶，100% 正确识别转移灶。 结论 对于 T1 或 T2 N0 口腔鳞状细胞癌，由不同经验水平的外科医生进行的 SLNB 结合分步切片和免疫组织化学，正确预测了 96% 患者的病理阴性颈部（NPV，96%）。
Purpose The validity of sentinel lymph node biopsy (SLNB) for T1 or T2, clinically N0, oral cancer was tested by correlation of sentinel node pathologic status with that of nodes within the completion neck dissection.Methods This prospective, cooperative group trial involved 25 institutions over a 3-year period. One hundred forty patients with invasive oral cancers, stage T1 and T2, N0 including 95 cancers of the tongue, 26 of the floor of mouth, and 19 other oral cancers were studied. The study excluded lesions with diameter smaller than 6 mm or minimal invasion. Imaging was used to exclude nonpalpable gross nodal disease. Patients underwent injection of the lesion with Tc-99m-sulfur colloid, nuclear imaging, narrow-exposure SLNB, and completion selective neck dissection. The major end point was the negative-predictive value (NPV) of SLNB.Results In the 106 SLNBs, which were found to be pathologically and clinically node-negative by routine hematoxylin and eosin stain, 100 patients were found to have no other pathologically positive nodes, corresponding to a NPV of 94%. With additional sectioning and immunohistochemistry, NPV was improved to 96%. In the forty patients with proven cervical metastases, the true-positive rate was 90.2% and was superior for tongue tumors relative to floor of mouth. For T1 lesions, metastases were correctly identified in 100%.Conclusion For T1 or T2 N0 oral squamous cell carcinoma, SLNB with step sectioning and immunohistochemistry, performed by surgeons of mixed experience levels, correctly predicted a pathologically negative neck in 96% of patients (NPV, 96%).