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Table 2: Values of survival in terms of DFS, OS and DSS excluded 150 articles. After screening the titles and abstracts
respect to the different histopathological findings in of the remaining 69 articles, applying the third selection
the articles cited (prospective studies, TxN0, 30 patients at least) we selected
Stuides Histological findings DFS OS DSS 12 articles. [12,16-26] Together with two additional prospective
Broglie et al. Total 85 80 87 articles [27,28] identified from reviews and references, a total of
[24]
2013 Negative SLNB 96 88 96 14 articles were included in this systematic review. Table 1
Positive SLNB 73 74 77 summarizes all the studies included providing the details of
ITC 80 80 80
Micrometastases 69 75 75 the individual studies (full database available from author).
Macrometastases 62 62 73 Table 1 summarizes the pooled sensitivity and negative
Broglie and Total 89 88 91 predictive values of the SNB. Six out of fifteen of these
Stoeckli [26] 2011 Negative SLNB 98 98 95 articles also include survival data [Table 2] in terms of OS,
Positive SLNB 73 71 76 DFS and DSS. All articles studied OSCC T1-2N0 except two
ITC 75 89 75 that included any T and N0.
Micrometastases 71 71 66
Macrometastases 67 67 65
Regarding the radio-isotopic technique employed, 7 authors
SLNB: sentinel lymphatic node biopsy; ITC: isolated tumoral cells; DFS: used colloid sulfur radiolabeled with Technetium99m
disease free survival; OS: overall survival; DSS: disease specific survival (Tc99m-colloidsulfur) and other 5 nanocolloid radiolabeled
with Tecnetium99m (Tc99m-nanocolloid). One of this latter
procedure in the best way.
combined with immunoglobulins. In the two remaining
studies these data were not available. All authors employed
METHODS peritumoral injection. The activity injected was detailed in
12 articles and ranged between 10-80 MBq each dose (mean
We searched the medical literature analysis and retrieval ± 20 MBq). In 9 studies the dose ranged between 10 and
system online (MEDLINE), databases via OVID and Saludteca 20 MBq. The volume of tracer injected per dose was only
(Virtual Library of Extremadura Public Health System) for described in 6 articles and ranged between 0.05 and 0.5 mL
relevant studies published in English from January 2011 to (mean ± 0.23 mL).
January 2016, limited to human subjects. The combination
of search terms used was the following: (1) sentinel node; The imaging technique employed was detailed in 13 studies,
(2) oral; and (3) squamous cell cancer. The abstracts were performing dynamic images after tracer administration
reviewed one by one and applying the inclusion criteria. The and static planar conventional images at 2 h in 6 cases.
inclusion criteria were the following: (1) original studies; (2) Three authors only performed static planar conventional
prospective studies; (3) studies evaluating the role SLNB in images 2 h after tracer administration. One work included
OSCC in N0 patients; and (4) at least 30 subjects included in dynamic, static and SPECT images. Three studies carried
the study. Meta-analysis and review articles were collected out dynamic, static and hybrid SPECT-CT images. In 4 works
in order to establish the introduction and support the data blue dye was injected in the surgical room for improving
in the discussion of the article. The references of these the identification of the sentinel node according to their
latter works were examined and all interesting articles were color and radioactivity. [12,18,27,28]
included for the elaboration of this review.
For the intraoperative SN localization, the equipment
Data extraction employed was as follows: only radioguided probe in 8
For each study, we extracted data on the author’s name, cases, radioguided probe and blue dye colorant in 3 cases,
year, type of study, characteristics of patients, staging of the combined radioguided probe and portable gamma-camera
tumour, type of radiotracer, amount of activity and volume in 1 case and 1 work employed a novel detection system
injected per dose of radiotracer, type of images acquired, with intrasurgical free-hand SPECT (SurgicEye ).
© [20]
method of analysis of images, types of radioguided surgery
equipment employed, surgical technique employed, Regard the surgical technique employed, in eleven works a
histological techniques for evaluating the SN, sensitivity tumorectomy was first performed and immediately a SNB.
(SS), negative predictive value (NPV), patients survival in If the result of SNB showed any lymphatic node affected, a
terms of disease-free survival (DFS), overall survival (OS) ND was carried out in 9 studies. In the remaining 5 studies,
and disease-specific survival (DSS). tumorectomy, SNB and ND was performed in all patients.

All parameters involved in the SNB technique were The number of biopsied nodes was detailed in 9 works,
examined in the articles; they were analyzed in order to with a mean of 3 nodes per patient. The nodes was studied
determine which one would be the most reasonable and in10 studies by mean of histological techniques that include
useful to establish the state of the art of the procedure. hematoxylin-eosin (HE) staining, step serial section (SSS) and
immunohistochemistry (IHC) analysis for cytokeratin AE1/AE3, in
RESULTS order to confirm the absence of metastatic lymph nodal disease.
[12]
In 1 article only HE and IHC techniques were employed. In
The literature search yielded a total of 219 potential articles three works, these data were not available.
[Figure 1]. When we established the second limits (English
articles, of the last 5 years and only human studies) we SS values ranged in all studies between 80% and 100% (mean
Plast Aesthet Res || Volume 3 || May 25, 2016 145