After 2007, an SLNB alone trial was applied in eligible patients, designed to do the subsequent neck dissection only in cases with positive sentinel lymph node(s) in the pathologic examination. As described in the previous study, SLNB was introduced in our institution after 2002, starting with the validation phase to test the procedure’s feasibility and safety. In our institution, the treatment of choice for the patients with cN0 tongue cancer has been surgical resection of the primary tumor with END since the establishment of the head and neck cancer center in January 1995. If necessary, ultrasonography-guided fine-needle aspiration cytology was also performed. Physical evaluation, computed tomography, magnetic resonance imaging, and positron emission tomography were evaluated as a preoperative workup for clinical nodal staging. To distinguish the recurrence and failure of positive node detection, cases with short follow up within 6 months were also eliminated. Patients with advanced T stage (T3 or T4) or those who had undergone other tongue cancer treatments before surgery were excluded. We enrolled patients who had tongue cancer with cN0 early tongue squamous cell carcinoma treated surgically in Samsung Medical Center between January 1995 and December 2018 in the study. Retrospective cohort enrollments and medical records review were exempt from the patient’s informed consent. The study was approved by Institutional Review Board of Samsung Medical Center (SMC IRB 6). A propensity score analysis was performed to achieve a more balanced comparison, matching the resection margin to reduce the retrospective design’s potential bias. In a retrospective cohort study of a single institution, we compared the regional control rate, recurrence-free survival (RFS), and OS according to whether patients underwent SLNB or END. This study aimed to evaluate the oncologic safety of SLNB in the management of cN0 oral tongue cancer in direct comparison with END. One of the hurdles is the scarcity of research directly comparing oncologic outcomes of SLNB with END to justify routine SLNB application. Despite recognizing the acceptable diagnostic accuracy of SLNB for detecting occult nodal metastasis, there are still hurdles for its widespread application in clinical practice by many head and neck surgeons. False-negative or false-omission rates were 9.8%–14%, although these rates should be maintained under 5%. According to other prospective multicenter trials, the negative predictive value of SLNB is reported to be around 95%, depending on the subsite of the tumor. Recently, sentinel lymph node biopsy (SLNB) is gaining popularity because many studies have reported evidence supporting the proposal that SLNB is a useful staging procedure to detect occult nodal metastasis accurately, theoretically helping threequarters of patients with cN0 oral squamous cell carcinoma to avoid unnecessary surgery. However, debate continues regarding the necessity of surgical procedures for the substantial proportion of patients (over half) who do not have any metastatic disease. Based on this landmark study, END was accepted as the standard treatment for cN0 oral cancer patients. 67.5%), with an occult metastasis rate of 26.5%. The patients who underwent END were reported to have an improved 3-year overall survival (OS) rate over therapeutic neck dissection (80% vs. A recent randomized controlled trial compared elective neck dissection (END) versus therapeutic neck dissection as treatment options for cN0 oral cancer. The proper neck management of cN0 oral cancer patients has long been controversial. It is well known that the occult metastasis rate in clinically node-negative (cN0) patients with oral cancer ranges from 21% to 35% and that occult metastasis is challenging to detect, even with a thorough physical examination and imaging studies. Since the presence of lymph node metastases is one of the most critical factors in the survival and recurrence rate of oral cancer, accurate detection and proper management of nodal disease are essential.
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