Sentinel lymph node biopsy versus elective neck dissection in evaluation of cN0 neck in patients with oral and oropharyngeal squamous cell carcinoma. Systematic review and meta-analysis study

BackgroundThe sentinel node biopsy concept has been gaining popularity in the head and neck cancer literature and several pilot studies have been published.PurposeThis study aimed to systematically evaluate the diagnostic accuracy of sentinel lymph node biopsy in cN0 patients with squamous cell carcinoma of the oral cavity and oropharynx.MethodsA systematic literature review was performed using MEDLINE from 1980 to 2014 by combining oral cavity and oropharyngeal SCC keywords with sentinel node biopsy keywords. We included diagnostic accuracy studies which used neck dissection as a reference test for the sentinel node biopsy. Study characteristics and measures of accuracy were extracted. Diagnostic accuracy was calculated from 2 × 2 tables.ResultsA total of 35 studies (1121 patients) were included. The pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio, diagnostic odds ratio, positive predictive value, negative predictive value and accuracy were 93%, 100%, 35.89%, .12%, 282.7%, 100%, 97% and 97.8%, respectively.ConclusionsHigh sensitivity, negative predictive value and accuracy of SLNB support its role as a valid diagnostic technique to correctly stage cN0 patients with OCSCC and OPSCC.