What is the role of sentinel lymph node biopsy in early-stage oral cavity carcinoma?

BACKGROUND Lymphatic spread in oral cavity squamous cell carcinoma (OSCC) remains a critical factor for staging, treatment, and prognosis. Involvement of the regional lymphatics portends approximately 50% decrease in survival. OSCC–cervical metastases remain common. Due to the inaccuracy of the physical exam and imaging to reliably detect occult disease, elective neck dissections (ENDs) have become the standard of care for the majority of clinically node-negative (cN0) patients. However, many patients (55%–76%) with T1/2 cN0 OSCC disease will not have pathologically positive cervical metastases, and are being subjected to overtreatment with unnecessary morbidity by an END. Sentinel lymph node biopsy (SLNB) has emerged as a powerful tool for advancing minimally invasive surgical management of many cancers. SLNB has been proven to be highly sensitive, cost-effective, and beneficial to patient quality of life. The data supporting the use of SLNB in early-stage OSCC, a brief description of the SLNB method, and recent technical advances are the focus of this article.