What is the role of sentinel lymph node biopsy in the management of oral cancer in 2020?
What is the role of sentinel lymph node biopsy in the management of oral cancer in 2020?
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2020年前哨淋巴结活检在口腔癌管理中的作用是什么？
DOI：
10.1007/s00405-020-06538-y
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发表时间：
2021-09
期刊：
影响因子：
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通讯作者：
Ferlito A
中科院分区：
文献类型：
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作者：
de Bree R;de Keizer B;Civantos FJ;Takes RP;Rodrigo JP;Hernandez-Prera JC;Halmos GB;Rinaldo A;Ferlito A
大约70%-80%的CT1-2N0口腔鳞状细胞癌(OSCC)患者在选择性颈淋巴清扫术后的最终病理证明没有颈部淋巴管癌。因此，前哨淋巴结活检(SLNB)作为一种诊断分期方法，在过去十年中已被采用，以智能地识别谁将受益于正规的选择性淋巴清扫或颈部放射治疗。虽然尚未被普遍接受，但SLNB现在已被纳入许多国家指南。SLNB为选择性颈淋巴清扫术提供了一种侵入性较小的选择(完)，并有一些优点和缺点。SLNB可以评估单个引流方式，并通过分步连续切片和免疫组织化学(IHC)，能够准确检测微转移和分离的肿瘤细胞(ITCs)。与常规组织病理学检查相比，颈部的分期有所改善。对侧颈部和经前处理的颈部在分期方面的改善尤其显著。然而，对于口底肿瘤(FOM)，SLNB往往会漏掉隐匿性转移，因为从原发部位到淋巴管的活动很近(穿透现象)。对于FOM癌，建议进行选择性颈淋巴清扫术或超选择性I节段腺前三角颈淋巴清扫术。新的示踪剂和正在开发的技术可能会提高SLNB对早期口腔鳞癌，特别是FOM肿瘤的诊断准确性。颈部治疗(颈淋巴清扫或放射治疗)，虽然限于I-IV级，但对于任何阳性转移类别(大转移、微转移或ITCs)仍然是强制性的。最近，最新的EANM口腔鳞状细胞癌SLN定位实用指南和口腔鳞癌患者SLNB手术共识指南问世。本文就SLNB在口腔鳞癌早期诊断中的应用进行综述。
Approximately 70–80% of patients with cT1-2N0 oral squamous cell carcinoma (OSCC) ultimately prove to have no cancer in the cervical lymphatics on final pathology after selective neck dissection. As a result, sentinel lymph node biopsy (SLNB) has been adopted during the last decade as a diagnostic staging method to intelligently identify patients who would benefit from formal selective lymphadenectomy or neck irradiation. While not yet universally accepted, SLNB is now incorporated in many national guidelines. SLNB offers a less invasive alternative to elective neck dissection (END), and has some advantages and disadvantages. SLNB can assess the individual drainage pattern and, with step serial sectioning and immunohistochemistry (IHC), can enable the accurate detection of micrometastases and isolated tumor cells (ITCs). Staging of the neck is improved relative to END with routine histopathological examination. The improvements in staging are particularly notable for the contralateral neck and the pretreated neck. However, for floor of mouth (FOM) tumors, occult metastases are frequently missed by SLNB due to the proximity of activity from the primary site to the lymphatics (the shine through phenomenon). For FOM cancers, it is advised to perform either elective neck dissection or superselective neck dissection of the preglandular triangle of level I. New tracers and techniques under development may improve the diagnostic accuracy of SLNB for early-stage OSCC, particularly for FOM tumors. Treatment of the neck (either neck dissection or radiotherapy), although limited to levels I–IV, remains mandatory for any positive category of metastasis (macrometastasis, micrometastasis, or ITCs). Recently, the updated EANM practical guidelines for SLN localization in OSCC and the surgical consensus guidelines on SLNB in patients with OSCC were published. In this review, the current evidence and results of SLNB in early OSCC are presented.