Reliability of Sentinel Node Biopsy in Head and Neck Cutaneous Squamous Cell Carcinoma

Abstract

Objectives:

Sentinel lymph node biopsy (SLNB) is the standard of care for melanoma staging, but its role in cutaneous squamous cell carcinoma (cSCC) has not been established. This study seeks to: 1) analyze the feasibility and reliability SLNB for head and neck (H&N) cSCC and 2) identify risk factors associated with a positive SLN.

Methods:

A comprehensive systematic review of MEDLINE, PubMed, Cochrane, and ASCO databases was conducted to identify H&N cSCC SLNB studies with associated recurrence rates. Dual-blinded data extraction was conducted. Primary outcomes were successful SLN harvest and false omission rate, with secondary outcomes of risk factors for a positive SLN.

Results:

221 articles were screened; 74 patients from 11 publications met inclusion criteria (3 case series; 8 prospective cohorts). Studies ranged from 1 to 15 patients (median 5), with a median follow-up of 21 months. Median age was 73.5 years. Average tumor size was 3.08 cm. At least 1 SLN was identified in 100% of patients (median 2.5). 10 (13.5%) had a positive SLN; no additional metastatic nodes were identified in 9 patients receiving completion lymphadenectomy. Tumor size was not associated with SLN status (P = 0.09; 95% CI: -.27, 3.02). Additional high risk features (thickness, perineural invasion, location, and differentiation) were inconsistently recorded. 3 of 64 (4.7%) failed regionally in the setting of a negative SLNB.

Conclusions:

H&N cSCC SLNB is feasible and reliable for staging, with a false omission rate of 4.7%, mirroring that of melanoma. Prospective studies documenting high risk features are required.