No Association Found Between Sentinel Lymph Node Biopsy Timing and Success

Walker TD, Cusick A, Shahwan KT, Carr DR. Timing of sentinel lymph node biopsy in cutaneous squamous cell carcinoma. J Am Acad Dermatol. 2023 Jan;88(1):249-251. doi: 10.1016/j.jaad.2022.05.016. Epub 2022 May 16. PMID: 35588922.

This was a literature review which analyzed 20 articles including 561 SLNBs. Statistical analysis concluded that there is significant association between SLNB timing and success rates.

Clinical Pearls

• This study answered the question if there is an association between sentinel lymph node biopsy timing and success rate

• This was a literature review which analyzed 20 articles including 561 SLNBs. Statistical analysis concluded that there is significant association between SLNB timing and success rate.

• Limitations include a small sample size and literature review design.

Discussion:

Sentinel lymph node biopsy (SNLB) is a very common procedure performed for nodal staging in various malignancies. The utility of SLNB in treating cutaneous squamous cell carcinoma (cSCC) is an emerging topic in dermatology surgery. SLNB is traditionally performed prior to excision of lesions to preserve lymphatic flow, however, in some cases high-risk features of tumors are noticed only after excision and SLNB is performed following excision. This study aimed to determine if the timing of SLNB (prior to vs following) affects success rates of the procedure.

A PubMed search was performed for articles published through November 1, 2021 relating to this topic, with the inclusion criteria including only articles in English, articles presenting primary data on 5 or more cases of high-risk cSCC undergoing SLNB in the absence of known metastatic disease, and including data on SNLB failure rates before and after excision. SLNB success was defined as detection and removal of at least 1 sentinel lymph node.

The results of the study included 20 articles with a total of 561 SLNBs performed on patients. Of these, 553 (98.6%) were successful and 54 (9.6%) were positive. The majority of SLNBs were performed prior to or concurrently with excision (444; 79.1%) while 117 (20.9%) were performed after. Only 8 SLNBs were unsuccessful, all of which were performed prior to or during excision. Following analysis of these results, no statistical significant was detected between SLNB timing and success. Limitations of this study include the small sample size and literature review design.