Sentinel node biopsy in early oral squamous cell carcinoma - a safe diagnostic and therapeutic procedure

Sentinel node biopsy (SNB) is considered the standard surgical procedure for detecting occult neck node metastasis in oral squamous cell carcinoma (OSCC) in many centers around the world. Due to the fact that this method removes and evaluates the first lymph node(s) reached by the lymphatic flow from the tumor area, this has raised the question of whether SNB could also be considered a therapeutic procedure by targeted lymphadenectomy instead of elective neck dissection (END). Compared to END, its safety and low morbidity have been established. However, the surgical management of the clinical node-negative (cN0) neck in T1/T2 oral carcinoma has been under ongoing debate due to the lack of randomized studies comparing SNB to END in terms of overall survival (OS), disease-free survival (DFS) and neck recurrence rates (NRRs). In the last years, two prospective randomized studies have proven with high-level evidence the noninferiority of SNB compared to END in terms of oncologic outcome while reducing costs and morbidity. In our opinion, SNB should be offered as the new standard therapeutic procedure in early OSCC.