{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T22:58:01Z","timestamp":1787612281289,"version":"build-2736575974"},"reference-count":45,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2020,7,3]],"date-time":"2020-07-03T00:00:00Z","timestamp":1593734400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Sentinel lymph node biopsy (SLNB) has been introduced as a diagnostic staging modality for detection of occult metastases in patients with early stage oral cancer. Comparisons regarding accuracy to the routinely used elective neck dissection (END) are lacking in literature. Methods: A retrospective, multicenter cohort study included 390 patients staged by END and 488 by SLNB. Results: The overall sensitivity (84% vs. 81%, p = 0.612) and negative predictive value (NPV) (93%, p = 1.000) were comparable between END and SLNB patients. The END cohort contained more pT2 tumours (51%) compared to the SLNB cohort (23%) (p &lt; 0.001). No differences were found for sensitivity and NPV between SLNB and END divided by pT stage. In floor-of-mouth (FOM) tumours, SLNB had a lower sensitivity (63% vs. 92%, p = 0.006) and NPV (90% vs. 97%, p = 0.057) compared to END. Higher disease-specific survival (DSS) rates were found for pT1 SLNB patients compared to pT1 END patients (96% vs. 90%, p = 0.048). Conclusion: In the absence of randomized clinical trials, this study provides the highest available evidence that, in oral cancer, SLNB is as accurate as END in detecting occult lymph node metastases, except for floor-of-mouth tumours.<\/jats:p>","DOI":"10.3390\/cancers12071783","type":"journal-article","created":{"date-parts":[[2020,7,6]],"date-time":"2020-07-06T09:49:11Z","timestamp":1594028951000},"page":"1783","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":72,"title":["Elective Neck Dissection or Sentinel Lymph Node Biopsy in Early Stage Oral Cavity Cancer Patients: The Dutch Experience"],"prefix":"10.3390","volume":"12","author":[{"given":"Inne J.","family":"den Toom","sequence":"first","affiliation":[{"name":"Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koos","family":"Boeve","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands"},{"name":"Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daphne","family":"Lobeek","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0221-9538","authenticated-orcid":false,"given":"Elisabeth","family":"Bloemena","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery\/Oral Pathology, Amsterdam UMC\/Academic Centre for Dentistry (ACTA), 1081 HV Amsterdam, The Netherlands"},{"name":"Department of Pathology, Amsterdam UMC (location VU Medical Center), 1081 HV Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2028-9713","authenticated-orcid":false,"given":"Maarten L.","family":"Donswijk","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6270-9483","authenticated-orcid":false,"given":"Bart","family":"de Keizer","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Martin C.","family":"Klop","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Ren\u00e9","family":"Leemans","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC (location VU University Medical Center), 1081 HV Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan M.","family":"Willems","sequence":"additional","affiliation":[{"name":"Department of Pathology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands"},{"name":"Department of Pathology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4784-0499","authenticated-orcid":false,"given":"Robert P.","family":"Takes","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max J.H.","family":"Witjes","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7128-5814","authenticated-orcid":false,"given":"Remco","family":"de Bree","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1097\/MLG.0b013e31816e2eb7","article-title":"The effect of occult nodal metastases on survival and regional control in patients with head and neck squamous cell carcinoma","volume":"118","author":"Gourin","year":"2008","journal-title":"Laryngoscope"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1002\/1097-0142(19900701)66:1<109::AID-CNCR2820660120>3.0.CO;2-A","article-title":"The patterns of cervical lymph node metastases from squamous carcinoma of the oral cavity","volume":"66","author":"Shah","year":"1990","journal-title":"Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1001\/archotol.1994.01880310005001","article-title":"Use of decision analysis in planning a management strategy for the stage N0 neck","volume":"120","author":"Weiss","year":"1994","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_4","first-page":"1829","article-title":"Advances in diagnostic modalities to detect occult lymph node metastases in head and neck squamous cell carcinoma","volume":"37","author":"Takes","year":"2014","journal-title":"Head Neck"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1002\/cncr.24161","article-title":"Predictive value of tumor thickness for cervical lymph-node involvement in squamous cell carcinoma of the oral cavity","volume":"115","author":"Huang","year":"2009","journal-title":"Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1002\/hed.20275","article-title":"Importance of tumor thickness and depth of invasion in nodal involvement and prognosis of oral squamous cell carcinoma: A review of the literature","volume":"27","author":"Pentenero","year":"2005","journal-title":"Head Neck"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1056\/NEJMoa1506007","article-title":"Elective versus therapeutic neck dissection in node-negative oral cancer","volume":"373","author":"Vaish","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1016\/j.oraloncology.2015.08.013","article-title":"Elective neck dissection versus observation in the clinically node negative neck in early oral cancer: Do we have the answer yet?","volume":"51","author":"Brekel","year":"2015","journal-title":"Oral Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/j.oraloncology.2015.06.006","article-title":"The history of sentinel node biopsy in head and neck cancer: From visualization of lymphatic vessels to sentinel nodes","volume":"51","author":"Nieweg","year":"2015","journal-title":"Oral Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Liu, M., Wang, S.J., Yang, X., and Peng, H. (2017). Diagnostic efficacy of sentinel lymph node biopsy in early oral squamous cell carcinoma: A meta-analysis of 66 studies. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0170322"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Boeve, K., Schepman, K., Schuuring, E., Roodenburg, J., Halmos, G.B., Boorsma, R., De Visscher, J., Brouwers, A., Van Der Vegt, B., and Witjes, M.J.H. (2018). High sensitivity and negative predictive value of sentinel lymph node biopsy in a retrospective early stage oral cavity cancer cohort in the Northern Netherlands. Clin. Otolaryngol.","DOI":"10.1111\/coa.13107"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1002\/hed.23632","article-title":"Sentinel node biopsy for early-stage oral cavity cancer: The VU University Medical Center experience","volume":"37","author":"Toom","year":"2014","journal-title":"Head Neck"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1016\/j.oraloncology.2014.07.020","article-title":"Sentinel lymph node biopsy in clinically N0 T1\u2013T2 staged oral cancer: The Dutch multicenter trial","volume":"50","author":"Flach","year":"2014","journal-title":"Oral Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/j.bjoms.2017.07.007","article-title":"Sentinel lymph node biopsy for oral squamous cell carcinoma. Where are we now?","volume":"55","author":"Schilling","year":"2017","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1002\/lary.27323","article-title":"Sentinel lymph node biopsy versus elective neck dissection for stage I to II oral cavity cancer","volume":"129","author":"Cramer","year":"2018","journal-title":"Laryngoscope"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.oraloncology.2019.01.016","article-title":"Elective neck dissection in oral squamous cell carcinoma: Past, present and future","volume":"90","author":"Takes","year":"2019","journal-title":"Oral Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1016\/j.ijom.2014.07.016","article-title":"Comparison of related complications: Sentinel node biopsy versus elective neck dissection","volume":"43","author":"Hernando","year":"2014","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1002\/hed.21001","article-title":"Function, postoperative morbidity, and quality of life after cervical sentinel node biopsy and after selective neck dissection","volume":"31","author":"Schiefke","year":"2009","journal-title":"Head Neck"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1002\/hed.21622","article-title":"Comparison of morbidity between sentinel node biopsy and elective neck dissection for treatment of the n0 neck in patients with oral squamous cell carcinoma","volume":"33","author":"Murer","year":"2010","journal-title":"Head Neck"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/j.jcms.2016.01.017","article-title":"Sentinel node biopsy versus elective neck dissection. Which is more cost-effective? A prospective observational study","volume":"44","author":"Hernando","year":"2016","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/j.oraloncology.2013.05.001","article-title":"Management of the N0 neck in early stage oral squamous cell cancer: A modeling study of the cost-effectiveness","volume":"49","author":"Govers","year":"2013","journal-title":"Oral Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.oraloncology.2015.11.011","article-title":"Cost\u2013utility of sentinel lymph node biopsy in cT1\u2013T2N0 oral cancer","volume":"53","author":"Flach","year":"2016","journal-title":"Oral Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2459","DOI":"10.1245\/s10434-010-1111-3","article-title":"Sentinel node biopsy in head and neck squamous cell cancer: 5-year follow-up of a European Multicenter Trial","volume":"17","author":"Alkureishi","year":"2010","journal-title":"Ann. Surg. Oncol."},{"key":"ref_24","first-page":"E1033","article-title":"Staging of early lymph node metastases with the sentinel lymph node technique and predictive factors in T1\/T2 oral cavity cancer: A retrospective single-center study","volume":"38","author":"Pedersen","year":"2015","journal-title":"Head Neck"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1002\/hed.24440","article-title":"Technique for reliable sentinel node biopsy in squamous cell carcinomas of the floor of mouth","volume":"38","author":"Stoeckli","year":"2016","journal-title":"Head Neck"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1002\/cncr.27872","article-title":"Long-term regional control and survival in patients with \u201clow-risk,\u201d early stage oral tongue cancer managed by partial glossectomy and neck dissection without postoperative radiation","volume":"119","author":"Ganly","year":"2012","journal-title":"Cancer"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.oraloncology.2018.01.020","article-title":"Neck recurrence in clinically node-negative oral cancer: 27-year experience at a single institution","volume":"78","author":"Mizrachi","year":"2018","journal-title":"Oral Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2154","DOI":"10.1016\/j.joms.2019.03.015","article-title":"Elective neck dissection versus wait-and-watch policy for oral cavity squamous cell carcinoma in early stage: A systematic review and meta-analysis based on survival data","volume":"77","author":"Cao","year":"2019","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1159\/000077232","article-title":"Immunohistochemical studies in the identification of lymph node micrometastases in patients with squamous cell carcinoma of the head and neck","volume":"66","author":"Rinaldo","year":"2004","journal-title":"ORL"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1148\/radiology.180.2.2068312","article-title":"Occult metastatic neck disease: Detection with US and US-guided fine-needle aspiration cytology","volume":"180","author":"Brekel","year":"1991","journal-title":"Radiology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2655","DOI":"10.1002\/hed.25739","article-title":"Surgical consensus guidelines on sentinel node biopsy (SNB) in patients with oral cancer","volume":"41","author":"Schilling","year":"2019","journal-title":"Head Neck"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1007\/s00259-012-2129-5","article-title":"Concomitant radio- and fluorescence-guided sentinel lymph node biopsy in squamous cell carcinoma of the oral cavity using ICG-99mTc-nanocolloid","volume":"39","author":"Berg","year":"2012","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1245\/s10434-015-4883-7","article-title":"Feasibility of real-time near-infrared fluorescence tracer imaging in sentinel node biopsy for oral cavity cancer patients","volume":"23","author":"Christensen","year":"2016","journal-title":"Ann. Surg. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3708","DOI":"10.1245\/s10434-015-4382-x","article-title":"[(99m)Tc]Tilmanocept accurately detects sentinel lymph nodes and predicts node pathology status in patients with oral squamous cell carcinoma of the head and neck: Results of a phase III multi-institutional trial","volume":"22","author":"Agrawal","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1007\/s00405-016-4280-2","article-title":"Additional non-sentinel lymph node metastases in early oral cancer patients with positive sentinel lymph nodes","volume":"274","author":"Toom","year":"2016","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"93","DOI":"10.3322\/caac.21388","article-title":"The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more \u201cpersonalized\u201d approach to cancer staging","volume":"67","author":"Amin","year":"2017","journal-title":"CA A Cancer J. Clin."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Brierley, J.D., Gospodarowicz, M., and Wittekind, C. (2017). UICC TNM Classification of Malignant Tumours, Wiley. [8th ed.].","DOI":"10.1002\/9780471420194.tnmc26.pub3"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1001\/jamaoto.2014.1548","article-title":"Primary Tumor Staging for Oral Cancer and a Proposed Modification Incorporating Depth of Invasion","volume":"140","author":"Ebrahimi","year":"2014","journal-title":"JAMA Otolaryngol. Neck Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"122","DOI":"10.3322\/caac.21389","article-title":"Head and neck cancers-major changes in the American Joint Committee on cancer eighth edition cancer staging manual","volume":"67","author":"Lydiatt","year":"2017","journal-title":"CA A Cancer J. Clin."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1111\/his.13886","article-title":"Addition of tumour infiltration depth and extranodal extension improves the prognostic value of the pathological TNM classification for early-stage oral squamous cell carcinoma","volume":"75","author":"Boeve","year":"2019","journal-title":"Histopathology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2100","DOI":"10.1002\/hed.25665","article-title":"Depth of invasion in patients with early stage oral cancer staged by sentinel node biopsy","volume":"41","author":"Toom","year":"2019","journal-title":"Head Neck"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"3190","DOI":"10.1245\/s10434-009-0726-8","article-title":"Joint practice guidelines for radionuclide lymphoscintigraphy for sentinel node localization in oral\/oropharyngeal squamous cell carcinoma","volume":"16","author":"Alkureishi","year":"2009","journal-title":"Ann. Surg. Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1007\/s00259-018-4235-5","article-title":"The EANM practical guidelines for sentinel lymph node localisation in oral cavity squamous cell carcinoma","volume":"46","author":"Giammarile","year":"2018","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2668","DOI":"10.1002\/(SICI)1097-0142(19991215)86:12<2668::AID-CNCR11>3.0.CO;2-R","article-title":"International Union Against Cancer. Classification of isolated tumor cells and micrometastasis","volume":"86","author":"Hermanek","year":"1999","journal-title":"Cancer"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.oraloncology.2011.11.007","article-title":"Tumour infiltration depth \u22654 mm is an indication for an elective neck dissection in pT1cN0 oral squamous cell carcinoma","volume":"48","author":"Melchers","year":"2012","journal-title":"Oral Oncol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/12\/7\/1783\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:47:09Z","timestamp":1760176029000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/12\/7\/1783"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,3]]},"references-count":45,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2020,7]]}},"alternative-id":["cancers12071783"],"URL":"https:\/\/doi.org\/10.3390\/cancers12071783","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.739256598.793581441","asserted-by":"object"}]},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,3]]}}}