FLEX November 2023

Received: 31 January 2022 Revised: 11 April 2022 Accepted: 1 June 2022 DOI: 10.1002/hed.27121

CLINICAL REVIEW

Sentinel lymph node biopsy in high-risk cutaneous squamous cell carcinoma of the head and neck: Systematic review and meta-analysis

Andrea Costantino MD 1,2

| Luca Canali MD 1,2 | Bianca Maria Festa MD 1,2 |

Giuseppe Spriano MD 1,2 | Giuseppe Mercante MD 1,2 | Armando De Virgilio MD, PhD 1,2

1 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy 2 Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy Correspondence Bianca Maria Festa, Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele – Milan, Italy. Email: biancamaria.festa@gmail.com

Abstract The aim of our study was to better define the role of sentinel lymph node biopsy (SLNB) in high-risk cutaneous squamous cell carcinoma of the head and neck (cSCCHN). A systematic review and meta-analysis was performed according to the PRISMA statement. Seven-hundred and five patients were included from 20 studies. The pooled SLN identification rate was 98.8% (95% CI: 97.0 – 99.8). The median number of SLN excised was 3.6 ( n = 371, 95%CI: 2.0 – 4.4). The pooled SLNB positive rate and cumulative regional recurrence rate (RRR) in negative SLNB were 5.6% (95%CI: 2.6 – 9.6) and 2.9% (95%CI: 0.5 – 7.2), respectively. The high SLN identification rate demonstrates SLNB feasibil ity in cSCCHN. The low SLNB positive rate and the relatively high RRR raise some doubts concerning its clinical utility. Further studies are mandatory to define predictors of lymph node metastases able to better select patients that may benefit from a SLNB.

KEYWORDS head and neck skin cancer, nonmelanoma, occult metastases, recurrence, regional control

1 | INTRODUCTION

spreading, with an overall rate of regional metastases ranging from 1.2% to 34.3%. 7 – 11 Of importance, nodal metastatic cSCC is associated to considerably less favor able outcomes, with overall survival rates of 50% – 70%. 12 For this reason, several tumor-related and patient-related factors have been described as predictors of lymph node metastases and survival, 13 – 16 and cSCC is usually classi fied in low risk and high risk. 17 – 19 Even if a therapeutic neck dissection is recommended for clinically proven node metastases, the elective treat ment of node negative tumors remains controversial. 20 Elective neck dissection (END) is rarely performed in head and neck cSCC (cSCCHN), with heterogeneous occult metastases rate reported by previous studies. 21 – 23

Nonmelanoma skin cancer is the most common cancer worldwide, with cutaneous squamous cell carcinoma (cSCC) representing approximately 20% of cases. 1 – 3 The majority of these lesions (75% – 80%) occurs on sun exposed areas of the head and neck, 4 and the incidence varies widely by geographic location. 5 Patients suffering from resectable localized cSCC have an excellent progno sis, with an overall survival rate of approximately 95%. 6 However, cSCC is prone to regional lymph nodes

Giuseppe Mercante and Armando De Virgilio contributed equally to this study.

Head & Neck. 2022;44:2288 – 2300.

2288

© 2022 Wiley Periodicals LLC.

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