Sentinel lymph node biopsy for early oral cancer - accuracy and considerations in patient selection.

Sentinel lymph node biopsy (SLNB) for staging oral squamous cell carcinoma (OSCC) patients presenting with early (T1 and T2 N0) disease in preference to elective neck dissection (END) remains controversial worldwide. A retrospective analysis of 145 patients who underwent sentinel lymph node biopsy for a previously untreated early oral cancer between 2010 and 2020 was performed. The primary outcome measures were predictors of occult metastases, accuracy of SLNB and disease specific plus overall survival. The negative predictive value, the false negative rate, and sensitivity for SLNB were 97%, 7.8%, and 92%, respectively. Depth of invasion (DOI) was a significant predictor of N status, overall survival, and disease specific survival. There was a significant difference in the incidence of the neck node metastasis in patients with DOI <5mm compared to those with DOI >5mm. For tumours >5mm there was a moderate to good correlation between radiological depth on contrast enhanced computed tomography (CECT) and histopathological DOI. Preoperative estimation of DOI may be a useful tool in the counselling of patients in the selection of either SLNB or END for N staging purposes in early OSCC.

The light at the end of the tunnel? Can light-based tests increase the accuracy of our diagnoses of pre-cancerous/cancerous lesions?

Study selection Two electronic databases (Medline/PubMed and Embase) were searched up to 30 August 2020. Selected papers fitted the following criteria: human studies published in the English language that assessed adult patients over the age of 18 with a presumptive diagnosis of an oral potentially malignant disorder, oral cancer or oropharyngeal cancer. The studies compared either visual inspection or light-based tests with diagnostic biopsy of the lesions. The outcome measures identified were: sensitivity, specificity, summary receiver operating characteristic curve (SROC), positive predictive value (PPV) and negative predictive value (NPV).Data extraction and synthesis The extraction of data followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline process. Two independent reviewers selected articles via PubMed search, and a further two independent reviewers selected articles via an Embase search. The quantitative data obtained from each study was used to create a database that recorded information on sensitivity, specificity, accuracy, PPV and NPV. Additionally, the value of true positive (VP), false positive (FP), true negative (VN) and false negative (FN) were extracted from each study. In cases where these were not reported, an estimate was calculated. The quality of diagnostic precision studies (QUADAS-2) tool was used to rate the quality of studies as high, unclear, or low.Results A total of 40 papers were ultimately included within the meta-analysis with 5,562 samples of autofluorescence, 1,353 samples of chemiluminescence and 1,892 samples of clinical examination. The majority of the studies evaluating chemiluminescence used the ViziLite technique while most of the studies evaluating autofluorescence used the VELscope. The QUADAS-2 pointed to most of the studies included in this review being of good quality. Clinical examination had the highest specificity (0.78-95% CI [0.65-0.87]) for declaring mucosa to be normal in the absence of dysplasia and malignancy, but had the lowest sensitivity (0.63-95% CI [0.45-0.78]) of actually diagnosing sinister lesions. Autofluorescence more accurately identified premalignant and malignant changes (sensitivity = 0.86 95% CI [0.77-0.91]) compared with chemiluminescence (sensitivity = 0.67 95% CI [0.38-0.87]) and visual examination (sensitivity = 0.63 95% CI [0.45-0.78]). Autofluorescence was also faster and simpler to use compared with chemiluminescence.Conclusions This review and meta-analysis concludes that autofluorescence has greater accuracy in identifying premalignant and early neoplastic changes compared with clinical examination and chemiluminescence. Biopsy remains the gold standard for definitive diagnosis of oropharyngeal and oral premalignant and malignant conditions.

A case of facial lymphoma mimicking dental infection.

UNLABELLED: Infective and neoplastic swellings of the face are common. Often, the differential diagnosis is obvious, but sometimes it can be difficult to ascertain. We report the case of a cheek swelling thought to be infective in origin, but this unusual lesion turned out to be a diffuse large B-cell lymphoma. This was found to be a solitary cutaneous lesion, with associated submandibular lymphadenopathy. The initial plan was for treatment with chemo-radiotherapy, however, the lesion has, surprisingly, begun to resolve spontaneously following biopsy. CLINICAL RELEVANCE: The most frequent cause of facial swellings presenting to dentists is infective, usually from dental sources, but other causes of facial swelling do need to be considered.

Lateral dermoid cyst.

This is an unusual case of a lateral dermoid cyst that caused some diagnostic confusion.

Benign schwannoma of the left cervical phrenic nerve.

A patient presented with a benign schwannoma of the cervical phrenic nerve on the left side of the neck. Analysis of the aspirate suggested the diagnosis and it was confirmed on imaging. The patient had the lesion excised with preservation of the phrenic nerve.