Sentinel node biopsy (SLNB) is not new and is well established in the management of early breast cancer and melanoma. New trials such as the European Sentinel Node (SENT) trial and others sought to address the question of the clinical node negative (N0) neck.  There is still controversy surrounding the appropriate management of the N0 neck. If the risk of occult metastasis is 15-20% then 75-80% patients will have had an unnecessary procedure. The authors used data sent to the SENT trial and estimated the treatment costs of patients going through the traditional surgical pathway or a sentinel node biopsy pathway. They conclude the SLNB pathway is cheaper and there is a good flow chart outlining the pathways for the traditional and SLNB pathways for stage i and ii oral squamous cell carcinoma (SCC). I was interested in this paper as there is a chance of reducing patient morbidity and focusing on neck dissection for patients that require it. The monetary calculations may also be difficult to ignore in the current climate. 

The relative cost of sentinel lymph node biopsy in early oral cancer.
O’Connor R, Pezier T, Schilling C, McGurk M.
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Sunil K Bhatia

Royal Shrewsbury Hospital, Shrewsbury, UK.

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