Diagnostic Accuracy and Predictive Factors of Sentinel Lymph Node Biopsy in Cutaneous Squamous Cell Carcinoma: A Systematic Review
Omar El Sewify, Marion Sylvain, Cory Tremblay, Helene Retrouvey, Ammara GhummanIntroduction
Sentinel lymph node biopsy (SLNB) is increasingly used to stage cutaneous squamous cell carcinoma (cSCC), particularly in high-risk cases, though its diagnostic accuracy remains debated. This systematic review aims to evaluate SLNB detection rates, diagnostic accuracy, complications and predictors of positivity in patients with non-mucosal cSCC.
Methods
Following PRISMA guidelines, Medline, Embase, Scopus and Cochrane Library were searched to January 2025. Studies reporting SLNB outcomes in histologically confirmed cSCC were included. Pediatric and mucosal/anogenital cases were excluded. Data on demographics, tumour characteristics, SLNB outcomes and complications were extracted. Comparisons between SLNB-positive, negative and false-negative groups were performed (
Results
Forty-four studies (3043 patients, 3050 lesions) were included. Among 2956 patients undergoing SLNB, nodes were identified in 96.9%, with positivity in 10.9%. False negatives occurred in 1.7% of the cases (rate 13.2%). SLNB-positive patients had larger tumours (4.24 vs 2.88 cm,
Conclusion
SLNB demonstrates high detection but notable false negative rates in cSCC. Positive SLNB correlates with aggressive tumour features and worse outcomes. SLNB may assist staging in high-risk patients but should be used selectively, with close surveillance in SLNB-negative cases.