Sentinel lymph node biopsy in early oral cancer - interpreting high significance in low-event cohorts

Sep 30, 2026

Uploaded by Margaret

Editorial commentary congratulates Struckmeier and colleagues on retrospective findings about sentinel lymph node biopsy in early-stage oral squamous cell carcinoma, including contralateral drainage rates and their association with locoregional control trends. The text contrasts the study’s low reported sentinel-node positivity with prior trials and meta-analyses, critiques the absence of recommended immunohistochemical steps, and discusses adjuvant therapy indications, recurrence patterns, and methodological exclusions. It highlights that the number of nodes removed, not only metastatic status, predicts recurrence-free survival and explores potential explanations.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages3

Reading Time8 min

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Editorial Commentary

Contralateral drainage and locoregional control

Sentinel-node positivity rate and pathology methods

Treatment, recurrence reporting, and follow-up

Nodes removed as a predictor of recurrence-free survival

Editorial Commentary Sentinel lymph node biopsy in early oral cancer: interpreting high significance in low-event cohorts Grégoire B. Morand1,2^, Martin W. Huellner2,3 1Department of Otolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland; 2University of Zurich, Zurich, Switzerland; 3Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland Correspondence to: Grégoire B. Morand, MD, MSc. Department of Otolaryngology-Head and Neck Surgery, University Hospital Zurich, Frauenklinikstrase 24, 8091 Zurich, Switzerland; University of Zurich, Zurich, Switzerland. Email: [gregoire.morand@usz.ch](gregoire.morand@usz.ch). Comment on: Struckmeier AK, König D, Klutmann S, et al. Sentinel lymph node biopsy in early-stage oral squamous cell carcinoma: clinical outcomesand optimal lymph node removal thresholds. Oral Oncol 2025;168:107598 . Keywords: Single photon emission computed tomography/computed tomography (SPECT/CT); sentinel lymph node (SLN); indocyanine green; radionuclide imaging; neoplasms Submitted Oct 10, 2025. Accepted for publication Nov 20, 2025. Published online Dec 24, 2025. doi: 10.21037/tcr-2025-aw-2206 View this article at: [https://dx.doi.org/10.21037/tcr-2025-aw-2206](https://dx.doi.org/10.21037/tcr-2025-aw-2206) We would like to congratulate Struckmeier et al. on their recent publication in Oral Oncology, which provides valuable insights into the role and impact of sentinel lymph node biopsy (SLNB) in early-stage oral squamous cell carcinoma (OSCC) (1) . We also wish to acknowledge the important observations made by Misra and Das and to further expand on their discussion (2) . In their retrospective cohort of 48 early-stage OSCC patients, Struckmeier et al. reported that sentinel lymph nodes ( SLNs) in the contralateral neck occurred in approximately 17% of cases and were associated with a trend toward poorer locoregional control. These findings align with prior SLNB studies, including the SENT trial and the work by Stoeckli (3,4), which documented unexpected drainage rates of 14% and 13%, respectively—specifically drainage to the contralateral neck in welllateralized tumors or to retropharyngeal lymph nodes (5) . Notably, Struckmeier et al. reported the overall rate of contralateral drainage and observed that “of the five tumors that crossed the midline, only one tumor exhibited bilateral lymphatic drainage pathways”, although no additional details were provided (1) . The rate of positive SLNBs in the study by Struckmeier et al. was notably lower than that reported in the literature: 8.3%(with approximately 80% of cases being pT1) compared to 23% in the SENT trial. A recently published meta-analysis further indicated that “26% ofT1N0 and 35% ofT2N0 patients were sentinel-node positive”(6). According to their methodology, Struckmeier et al. performed serial sectioning (“bread-loafing”) of the SLNs with hematoxylin and eosin (H&E) staining. When HE microscopy is negative, most established SLNB protocols recommend additional immunohistochemical staining with the antipan cytokeratin antibody AE1/3 to detect micrometastases or isolated tumor cells (3,7)—a step not mentioned in the Struckmeier study. The reported positivity rate of 8.3% corresponds to four patients, two of whom were ultimately classified as pN1 and two as pN2b (1) . Although not explicitly reported, it is assumed that a completion neck dissection was done in those cases. All patients achieved R0 resection. Seven patients (14.5%) received postoperative radiotherapy, while one patient (2%) underwent adjuvant radiochemotherapy (8,9) . The indication for the latter remains unclear, as all patients were R0 and none were staged as pN2a or pN3b, indicative of possible extranodal extension (8,9) . The median followup for the cohort was not reported; overall, four patients developed recurrence, three of which occurred in the neck. ^ ORCID: 0000-0002-6150-6772. © AME Publishing Compan

FAQs

What contralateral drainage rate was reported in the early-stage OSCC cohort?

Contralateral neck sentinel lymph nodes occurred in about 17% of cases, with a trend toward poorer locoregional control.

How does the reported sentinel-node positivity compare with prior studies?

The study reported about 8.3% positivity, which is lower than the 23% reported in the SENT trial and lower than rates summarized in a meta-analysis for T1N0 and T2N0 patients.

Why is the pathological workup considered incomplete in the commentary?

When H&E microscopy is negative, established protocols typically add immunohistochemistry with antipan cytokeratin AE1/3 to detect micrometastases or isolated tumor cells, which was not mentioned in the Struckmeier study.

Sep 30, 2026

Uploaded by Margaret