LAUSR

Management of the neck in patients with oral cavity squamous cell carcinoma has been evolving in the past few decades. Most recently, a randomized controlled trial reported that in a clinically N0 neck, patients who underwent an elective neck dissection had improved 3‐year overall survival (80% vs 67.5%). Approximately one‐quarter of patients undergoing elective neck dissection had nodal involvement (26.5%) and had a complication rate of 6.6%. Based on this study, all patients with oral cavity cancer with a depth of invasion greater than 3mm should undergo elective neck dissection, but three‐quarters of patients would have benign lymph nodes in the pathology specimen. In this context, sentinel lymph node biopsy (SLNB) becomes an attractive option to help determine which patients should undergo elective selective neck dissection (SND) and help others avoid unnecessary surgery. The study by Loree et al. reviews their experiences with 108 patients with clinically N0 oral cavity cancers. Interestingly, the underlying rate of nodal disease was similar to the RCT mentioned above. The sensitivity of SLNB was 75%. Notably, there was no difference in overall survival comparing patients with an accurate biopsy compared to those with false negative or unsuccessful SLNB. The possible benefits of SLNB can be summarized as follows: (1) identifies patients with the nodal disease to better decide who needs SND, (2) maps lymphatic drainage from the lesion to ensure proper dissection of at‐risk compartments, and (3) allows finer sectioning and pathologic analysis. These should be weighed against the possible disadvantages, which include: (1) false negative and unsuccessful results, (2) surgical complications, and (3) requires 2 separate procedures if SND is performed.