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907 Is it feasible to perform sentinel lymph node biopsy with only blue dye in early oral cancer? a large cancer center experience

In European Journal of Cancer
By: Vishno JR.
Contributor(s): Kumar V | Chaturved A | Misra S | Gupta S | Akhta N | Dontula PK | Rajan S | Agrawal P | Jamal N.
Material type: materialTypeLabelArticlePublisher: Amsterdam: Elsevier 2017Description: .Subject(s): lymph node biopsy | Oral cancerOnline resources: PDF In: European Journal of Cancer Vol.72, Supplement no.1, p.S111Summary: Background: Oral cavity squamous cell carcinoma is one of the most common cancers in south Asia. Sentinel lymph node biopsy has a good accuracy using combination of lymphoscintigraphy and blue dye technique in oral cancer; however, the limited availability of lymphoscintigraphy facilities in many developing countries requires exploration of alternative techniques. The need for the present study was to evaluate the feasibility and role of sentinel lymph node biopsy in identifying the occult lymph node metastasis using methylene blue dye alone. Material and Methods: We conducted a prospective study in 94 patients with early oral cancer (cT1, T2 and cN0) in a high volume tertiary care cancer centre in India from 2013 to 2016. Patients having negative neck nodes on clinical examination and ultrasound were included in study. Intra operatively, one ml of methylene blue dye was injected at the interface of tumor and palpable normal tissue in four quadrants. After10−15 minutes incision in neck was given and any visualized blue nodes were dissected and sent for frozen section, routine histopathology and immunohistochemistry (IHC) for cytokeratin. Elective neck dissection was done in all patients as per institutional protocol. Results: A total of 94 patients (79.8% male and 20.2% female) with mean age of 46.23 years (range 20−77 years) were included in this study. Smokeless tobacco was the commonest risk factor. Tumor subsites were tongue (45.7%), buccal mucosa (38.3%), and lip (16%). Mean follow up was 14.20±6.7 months (range 2−17 months). Identification rate of sentinel lymph node was 93.61% with mean blue node (1.83±1.03). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for frozen section and histopathology were 84.6%, 100%, 100%, 93.9% and 95.5% respectively. IHC detected two micrometastases and one isolated tumor cells. Occult lymph node metastasis was seen in 27.6% cases. The lymph node distribution was as level IA (5.7%), IB (48.6%), IIA (37.1%), and III (8.6%). None of the patient had lymph metastasis to level IV or V. Majority of the patients (57.4%) had pathological T2 disease. We did not encountered anaphylactic or allergic reactions to methylene blue dye in our study. Pathological TNM stage was as T1 (46.8%), T2 (53.18%), N1 (23.4%) and N2 (5.31%). Recurrence was seen in 10.7% patients at mean follow up of 8.3 months (range 3 to 12 months). Conclusion: Thus we conclude that SLNB with blue dye alone in early oral cancer is feasible. It can be used successfully with good sensitivity and negative predictive value in limited resource countries like India. Immunohistochemistry contributes to SLNB increasing sensitivity and negative predictive value to improve diagnostic value. No conflict of interest
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Articles Articles Tata Memorial Hospital
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Published in European Cancer Congress 27 – 30 January 2017

Background: Oral cavity squamous cell carcinoma is one of the most common cancers in south Asia. Sentinel lymph node biopsy has a good
accuracy using combination of lymphoscintigraphy and blue dye technique
in oral cancer; however, the limited availability of lymphoscintigraphy
facilities in many developing countries requires exploration of alternative
techniques. The need for the present study was to evaluate the feasibility
and role of sentinel lymph node biopsy in identifying the occult lymph node
metastasis using methylene blue dye alone.
Material and Methods: We conducted a prospective study in 94 patients with early oral cancer (cT1, T2 and cN0) in a high volume tertiary care
cancer centre in India from 2013 to 2016. Patients having negative neck
nodes on clinical examination and ultrasound were included in study. Intra operatively, one ml of methylene blue dye was injected at the interface of tumor and palpable normal tissue in four quadrants. After10−15 minutes incision in neck was given and any visualized blue nodes
were dissected and sent for frozen section, routine histopathology and
immunohistochemistry (IHC) for cytokeratin. Elective neck dissection was
done in all patients as per institutional protocol.
Results: A total of 94 patients (79.8% male and 20.2% female) with
mean age of 46.23 years (range 20−77 years) were included in this study.
Smokeless tobacco was the commonest risk factor. Tumor subsites were
tongue (45.7%), buccal mucosa (38.3%), and lip (16%). Mean follow up
was 14.20±6.7 months (range 2−17 months). Identification rate of sentinel
lymph node was 93.61% with mean blue node (1.83±1.03). Sensitivity,
specificity, positive predictive value, negative predictive value and accuracy
for frozen section and histopathology were 84.6%, 100%, 100%, 93.9% and
95.5% respectively. IHC detected two micrometastases and one isolated
tumor cells. Occult lymph node metastasis was seen in 27.6% cases. The
lymph node distribution was as level IA (5.7%), IB (48.6%), IIA (37.1%),
and III (8.6%). None of the patient had lymph metastasis to level IV or
V. Majority of the patients (57.4%) had pathological T2 disease. We did
not encountered anaphylactic or allergic reactions to methylene blue dye
in our study. Pathological TNM stage was as T1 (46.8%), T2 (53.18%), N1
(23.4%) and N2 (5.31%). Recurrence was seen in 10.7% patients at mean
follow up of 8.3 months (range 3 to 12 months).
Conclusion: Thus we conclude that SLNB with blue dye alone in early
oral cancer is feasible. It can be used successfully with good sensitivity
and negative predictive value in limited resource countries like India.
Immunohistochemistry contributes to SLNB increasing sensitivity and
negative predictive value to improve diagnostic value.
No conflict of interest

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