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Bark R, Kolev A, Elliot A, Piersiala K, Näsman A, Grybäck P, Georén SK, Wendt M, Cardell LO, Margolin G, Marklund L. Sentinel node-assisted neck dissection in advanced oral squamous cell carcinoma-A new protocol for staging and treatment. Cancer Med 2023. [PMID: 37084007 DOI: 10.1002/cam4.5966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is used to improve the staging of and guide treatment in patients with early-stage T1-T2 N0 oral squamous cell carcinoma (OSCC). The role of sentinel nodes (SNs) and the use of SN-technique in advanced OSCC (T3-T4 and/or N+) remain to be evaluated. This study investigates the nodal drainage and the rate of positive SNs (SNs+) in all stages of OSCC. MATERIALS AND METHODS In total, 85 patients with T1-T4 OSCC diagnosed 2019-2021 were included. We used a prolonged interval between peritumoral injection of radionuclide and SPECT-CT to include all SNs. RESULTS Patients with advanced OSCC presented a higher proportion of contralateral lymphatic drainage and a higher rate of SN+ compared to patients with early-stage disease. T3-T4 and N+ tumors presented a tendency for a higher rate of contralateral lymphatic drainage compared to T1-T2 and N0 tumors (p = 0.1). The prevalence of positive nodes (SNs+) was higher among patients with advanced disease, T3-T4 versus T1-T2 (p = 0.0398). CONCLUSION SN-assisted ND enables identification and removal of all SNs + and has the potential for more accurate staging and could possibly give prognostic advantages regarding regional recurrence for all OSCC patients, especially among those with advanced disease. The precise localization of the SNs + also suggests that a more individualized ND approach might be possible in the future even for patients with advanced OSCC.
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Affiliation(s)
- Rusana Bark
- Department of Clinical Sciences Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
- Medical Unit Head Neck Lung and Skin cancer, Department of Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Aeneas Kolev
- Department of Clinical Sciences Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
- Medical Unit Head Neck Lung and Skin cancer, Department of Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Alexandra Elliot
- Department of Clinical Sciences Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
- Medical Unit Head Neck Lung and Skin cancer, Department of Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Krzysztof Piersiala
- Department of Clinical Sciences Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Näsman
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Per Grybäck
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Susanna Kumlien Georén
- Department of Clinical Sciences Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
| | - Malin Wendt
- Department of Clinical Sciences Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Olaf Cardell
- Department of Clinical Sciences Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Gregori Margolin
- Department of Clinical Sciences Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
- Medical Unit Head Neck Lung and Skin cancer, Department of Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Linda Marklund
- Department of Clinical Sciences Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
- Medical Unit Head Neck Lung and Skin cancer, Department of Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Surgical Sciences, Section of Otolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
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Matsuzuka T, Tsukahara K, Yoshimoto S, Chikamatsu K, Shiotani A, Oze I, Murakami Y, Shinozaki T, Enoki Y, Ohba S, Kawakita D, Hanai N, Koide Y, Sawabe M, Nakata Y, Fukuda Y, Nishikawa D, Takano G, Kimura T, Oguri K, Hirakawa H, Hasegawa Y. Predictive factors for dissection-free sentinel node micrometastases in early oral squamous cell carcinoma. Sci Rep 2023; 13:6188. [PMID: 37061623 PMCID: PMC10105758 DOI: 10.1038/s41598-023-33218-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 04/10/2023] [Indexed: 04/17/2023] Open
Abstract
This sentinel node (SN) biopsy trial aimed to assess its effectiveness in identifying predictive factors of micrometastases and to determine whether elective neck dissection is necessary in oral squamous cell carcinoma. This retrospective study included 55 patients from three previous trials, with positive SNs. The relationship between the sizes of the metastatic focus and metastasis in non-sentinel node (NSN) was investigated. Four of the 55 largest metastatic focus were isolated tumor cells, and the remaining 51 were ranged from 0.2 to 15 mm, with a median of 2.6 mm. The difference of prevalence between 46 negative- and 9 positive-NSN was statistically significant with regard to age, long diameter of primary site and number of cases with regional recurrence. In comparing the size of largest metastatic focus dividing the number of positive SN, with metastaic focus range of < 3.0 mm in one-positive SN group, there were 18 (33%) negative-NSN and no positive-NSN. Regarding prognosis, 3-year overall survival rate of this group (n = 18) and other (n = 37) were 94% and 73% (p = 0.04), and 3-year recurrence free survival rate of this group and other were 94% and 51% (p = 0.03), respectively. Absolutely a further prospective clinical trial would be needed, micrometastases may be defined as solitary SN metastasis with < 3.0 mm of metastatic focus, and approximately 33% of neck dissections could be avoided using these criteria.
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Affiliation(s)
- Takashi Matsuzuka
- Department of Head and Neck Surgery - Otorhinolaryngology, Asahi University Hospital, 3-23 Hashimotocou, Gifu, 500-8523, Japan.
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuaki Chikamatsu
- Department of Otolaryngology Head and Neck Surgery, Gunma University School of Medicine, Maebashi, Japan
| | - Akihiro Shiotani
- Department of Otolaryngology Head and Neck Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Isao Oze
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Yoshiko Murakami
- Department of Diagnostic Pathology, Nagoya Medical Center, Nagoya, Japan
| | - Takeshi Shinozaki
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yuichiro Enoki
- Department of Head and Neck Oncology / Ear, Nose and Throat, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shinichi Ohba
- Department of Otorhinolaryngology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Daisuke Kawakita
- Department of Otorhinolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yusuke Koide
- Department of Otolaryngology Head and Neck Surgery, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Michi Sawabe
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yusuke Nakata
- Department of Otorhinolaryngology, Shiga University of Medical Science, Otsu, Japan
| | - Yujiro Fukuda
- Department of Otolaryngology Head and Neck Surgery, Kawasaki Medical School, Kurashiki, Japan
| | - Daisuke Nishikawa
- Department of Otorhinolaryngology, Kindai University Nara Hospital, Nara, Japan
| | - Gaku Takano
- Department of Otorhinolaryngology, Nagoya City University West Medical Center, Nagoya, Japan
| | - Takahiro Kimura
- Department of Otolaryngology - Head and Neck Surgery, Nara Medical University, Kashihara, Japan
| | - Keisuke Oguri
- Department of Otorhinolaryngology, Konan Kosei Hospital, Konan, Japan
| | - Hitoshi Hirakawa
- Department of Otorhinolaryngology, Head and Neck Surgery, University of the Ryukyus Faculty of Medicine, Okinawa, Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery - Otorhinolaryngology, Asahi University Hospital, 3-23 Hashimotocou, Gifu, 500-8523, Japan
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Garau LM, Di Gregorio F, Nonne G, Volterrani D, Manca G. Measures of performance for sentinel lymph node biopsy in oro-oropharyngeal squamous cell carcinoma: a systematic review and meta-analysis. Clin Transl Imaging 2023. [DOI: 10.1007/s40336-023-00552-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Guerlain J, Marhic A, Casiraghi O, Lumbroso J, Garcia G, Breuskin I, Janot F, Temam S, Gorphe P, Moya-Plana A. Occult nodal metastases in T1-T2cN0 oral squamous cell carcinoma: Correlation between sentinel node positivity and completion neck dissection analysis. Oral Oncol 2023; 139:106338. [PMID: 36807087 DOI: 10.1016/j.oraloncology.2023.106338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/31/2023] [Accepted: 02/12/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVES Sentinel node procedure (SN) is a standard procedure that has shown its safety and effectiveness for T1/T2 cN0 oral squamous cell carcinoma (OSCC), with completion neck dissection (CND) for patients with positive SN. The aim of this study was to characterize the nodal involvement in a cohort of SN + OSCC. MATERIALS AND METHODS Patients with T1/T2 cN0 OSCC with positive SN with CND were included in this single-center, prospective cohort study between 2000 and 2013. RESULTS 54/301 patients had at least one positive SN. In 43/54 (80 %) cases, only the SN(s) were invaded; with only one SN involved (SN+=1) in 36/54 (67 %) cases. No predictive factors of nodal involvement in the CND were found considering the followings: SN micro/macrometastases, primary tumor's depth of invasion (DOI), perineural spread, lymphovascular involvement, primary tumor location, T stage and extranodal extension. The SN micrometastatic involvement (n = 22) was significantly associated with only one SN + CND- (p = 0.017). In the group of patients with unique micrometastatic involvement in the SN (n = 20/54), there was a higher isolated nodal recurrence free time (p = 0.017). CONCLUSION 80% of T1/T2 cN0 OSCC with positive SN had no other lymph node metastases in the CND, questioning the potential benefits of this procedure. Predictive factors such as the size of the SN metastasis need to be tested to stratify the risk of positive non-SN lymph nodes leading to a personalized treatment, lowering the therapeutic morbidity while maintaining the oncologic safety.
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Affiliation(s)
- J Guerlain
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France.
| | - A Marhic
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France
| | - O Casiraghi
- Department of Pathology, Gustave Roussy Cancer Campus, Grand Paris, France
| | - J Lumbroso
- Nuclear Medicine Department, Gustave Roussy Cancer Campus, Grand Paris, France
| | - G Garcia
- Department of Medical Imaging, Gustave Roussy Cancer Campus, Grand Paris, France
| | - I Breuskin
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France
| | - F Janot
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France
| | - S Temam
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France
| | - P Gorphe
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France
| | - A Moya-Plana
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France
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de Bree R, de Keizer B, Civantos FJ, Takes RP, Rodrigo JP, Hernandez-Prera JC, Halmos GB, Rinaldo A, Ferlito A. What is the role of sentinel lymph node biopsy in the management of oral cancer in 2020? Eur Arch Otorhinolaryngol 2020; 278:3181-3191. [PMID: 33369691 PMCID: PMC8328894 DOI: 10.1007/s00405-020-06538-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/30/2020] [Indexed: 02/06/2023]
Abstract
Approximately 70–80% of patients with cT1-2N0 oral squamous cell carcinoma (OSCC) ultimately prove to have no cancer in the cervical lymphatics on final pathology after selective neck dissection. As a result, sentinel lymph node biopsy (SLNB) has been adopted during the last decade as a diagnostic staging method to intelligently identify patients who would benefit from formal selective lymphadenectomy or neck irradiation. While not yet universally accepted, SLNB is now incorporated in many national guidelines. SLNB offers a less invasive alternative to elective neck dissection (END), and has some advantages and disadvantages. SLNB can assess the individual drainage pattern and, with step serial sectioning and immunohistochemistry (IHC), can enable the accurate detection of micrometastases and isolated tumor cells (ITCs). Staging of the neck is improved relative to END with routine histopathological examination. The improvements in staging are particularly notable for the contralateral neck and the pretreated neck. However, for floor of mouth (FOM) tumors, occult metastases are frequently missed by SLNB due to the proximity of activity from the primary site to the lymphatics (the shine through phenomenon). For FOM cancers, it is advised to perform either elective neck dissection or superselective neck dissection of the preglandular triangle of level I. New tracers and techniques under development may improve the diagnostic accuracy of SLNB for early-stage OSCC, particularly for FOM tumors. Treatment of the neck (either neck dissection or radiotherapy), although limited to levels I–IV, remains mandatory for any positive category of metastasis (macrometastasis, micrometastasis, or ITCs). Recently, the updated EANM practical guidelines for SLN localization in OSCC and the surgical consensus guidelines on SLNB in patients with OSCC were published. In this review, the current evidence and results of SLNB in early OSCC are presented.
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Affiliation(s)
- Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Francisco J Civantos
- Department of Otolaryngology, Sylvester Cancer Center, University of Miami, Florida, USA
| | - Robert P Takes
- Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, ISPA, IUOPA, Oviedo, Spain
| | | | - Gyorgy B Halmos
- Department of Otolaryngology/Head and Neck Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Alessandra Rinaldo
- Department of Otolaryngology, University of Udine School of Medicine, Udine, Italy
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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Feng H, Zhong L, Yang X, Wan Q, Pei X, Wang J. Development and validation of prognostic index based on autophagy-related genes in patient with head and neck squamous cell carcinoma. Cell Death Discov 2020; 6:59. [PMID: 32695478 PMCID: PMC7360573 DOI: 10.1038/s41420-020-00294-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/10/2020] [Accepted: 05/16/2020] [Indexed: 02/05/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is one of the most common cancers worldwide, accounting for almost 50% of all malignancies in developing nations. Autophagy plays a vital role in cancer initiation, malignant progression, and resistance to treatment. However, autophagy-related gene sets have rarely been analyzed in HNSCC. Hence, it is necessary to assess its clinical and pathological significance in a larger cohort of patients with HNSCC. The purpose of this study was to establish a novel autophagy-related prognostic marker for HNSCC. We screened 232 autophagy-related genes (ARGs) and identified 38 differentially expressed ARGs in The Cancer Genome Atlas (TCGA) cohorts. The prognosis-related ARGs signature, established using the univariate and multivariate Cox proportional regression models, consists of 10 ARGs that could divide patients into high-risk and low-risk groups. Survival analysis indicated that patients in the high-risk group had dramatically shorter overall survival compared with their low-risk counterparts. Cox regression analysis further confirmed the independent prognostic value of the autophagy-related signature, and the area under the receiver operating characteristic curve of the combined prognostic model was 0.722. Finally, the efficacy of autophagy-related signature was also validated by an independent cohort from the Gene Expression Omnibus (GEO) database. Collectively, we successfully constructed a novel autophagy-related signature for the prediction of prognosis in patients with HNSCC.
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Affiliation(s)
- Hao Feng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu, 610041 China
| | - Linna Zhong
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu, 610041 China
| | - Xiangjun Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu, 610041 China
| | - Qianbing Wan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu, 610041 China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041 China
| | - Xibo Pei
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu, 610041 China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041 China
| | - Jian Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu, 610041 China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041 China
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Longton E, Lawson G, Bihin B, Mathieu I, Hanin FX, Deheneffe S, Vander Borght T, Laloux M, Daisne JF. Individualized Prophylactic Neck Irradiation in Patients with cN0 Head and Neck Cancer Based on Sentinel Lymph Node(s) Identification: Definitive Results of a Prospective Phase 1-2 Study. Int J Radiat Oncol Biol Phys 2020; 107:652-661. [PMID: 32294522 DOI: 10.1016/j.ijrobp.2020.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/29/2020] [Accepted: 03/22/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE This prospective, nonrandomized, interventional phase 1-2 study investigated the individualization of elective node irradiation in clinically N0 head and neck squamous cell carcinoma by sentinel lymph node (SLN) mapping with single-photon emission computed tomography/computed tomography (SPECT/CT) and its impact on tumor control and radiation-related toxicity. METHODS AND MATERIALS Forty-four patients with clinically N0 head and neck squamous cell carcinoma treated with definitive (chemo-)radiation therapy were imaged with SPECT/CT after 99mTc nanocolloid injection around the tumor. The neck levels containing up to the 4 hottest SLNs were selected for prophylactic irradiation. A comparative virtual planning was performed with the selection of neck levels based on the current international guidelines. Regional control was monitored as a function of the selected volume. Dosimetric data for the organs at risk were compared between the plans. Normal tissue complication probability (NTCP) rates were derived for xerostomia, dysphagia, and hypothyroidism to predict the clinical benefit and correlated to quality-of-life (QoL) assessments at 6 months. RESULTS Sixteen percent of patients presented unpredicted lymphatic drainage, and 48% drained unilaterally. The nodal clinical target volume based on lymphoscintigraphy was smaller than the nodal clinical target volume based on international guidelines by a factor of 2 (P < .0001). After a median follow-up of 46 months, only 1 patient experienced a regional relapse in a nonirradiated area. Significant median dose reductions to organs at risk were observed, particularly to contralateral salivary glands in patients with unilateral drainage (14.6-28.1 Gy) and to the thyroid gland in all patients (22.4-48.9 Gy). Median NTCP reductions were observed for xerostomia (0.3% to 13.7%), dysphagia (1.7% to 10.8%), and hypothyroidism (14.0% to 36.1%). QoL at 6 months was improved, particularly in patients irradiated unilaterally. CONCLUSIONS Neck SLN mapping with SPECT/CT individualizes and reduces the elective nodal target volumes without compromising the regional control. The NTCP rates were reduced and favorable QoL were observed in all patients, particularly in the case of unilateral irradiation.
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Affiliation(s)
- Eléonore Longton
- Department of Radiation Oncology, Université Catholique de Louvain, CHU -UCL-Namur, site Sainte-Elisabeth, Namur, Belgium.
| | - Georges Lawson
- Department of Head and Neck Surgery, Université Catholique de Louvain, CHU-UCL-Namur, site Godinne, Yvoir, Belgium
| | - Benoit Bihin
- Unit of Biostatistics, University of Namur, Namur Research Institute for Life Sciences (NARILIS), Namur, Belgium
| | - Isabelle Mathieu
- Department of Nuclear Medicine, Université Catholique de Louvain, CHU-UCL-Namur, site Sainte-Elisabeth, Namur, Belgium
| | - Francois-Xavier Hanin
- Department of Nuclear Medicine, Université Catholique de Louvain, CHU-UCL-Namur, site Sainte-Elisabeth, Namur, Belgium
| | - Stéphanie Deheneffe
- Department of Radiation Oncology, Université Catholique de Louvain, CHU -UCL-Namur, site Sainte-Elisabeth, Namur, Belgium
| | - Thierry Vander Borght
- Department of Nuclear Medicine, Université Catholique de Louvain, CHU-UCL-Namur, site Godinne, Yvoir, Belgium; Namur Research Institute for Life Sciences (NARILIS), Belgium and Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Marc Laloux
- Department of Maxillo-Facial Surgery, Université Catholique de Louvain, CHU-UCL-Namur, site Sainte-Elisabeth, Namur, Belgium
| | - Jean-François Daisne
- Department of Radiation Oncology, Université Catholique de Louvain, CHU -UCL-Namur, site Sainte-Elisabeth, Namur, Belgium
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Peigné L, Godey F, Le Gallo M, Le Gall F, Fautrel A, Morcet J, Jégoux F. One-step nucleic acid amplification for detecting lymph node metastasis of head and neck squamous cell carcinoma. Oral Oncol 2020; 102:104553. [PMID: 32004908 DOI: 10.1016/j.oraloncology.2019.104553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/21/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND In head and neck squamous cell carcinoma (HNSCC) 30% of cN0 patients have occult metastasis. LN invasion is a major prognostic factor. Sentinel lymph node (SLN) is an option for cN0 neck management. One-step nucleic acid amplification (OSNA) used to analyze SLN in breast cancer is also a candidate to get more reliable intraoperative HNSCC lymph node (LN) staging. OBJECTIVE To compare OSNA analysis to pathological analysis in cN0 HNSCC. MATERIALS AND METHODS 157 LN from 26 cN0 HNSCC patients were prospectively analyzed (6.3LN/patient). Exclusion criteria were previous surgery or radiotherapy. Each node was cut into 4 equal pieces alternatively sent to pathological analysis and OSNA technique. IHC CK19 was performed on the primary tumor biopsy and RT-qPCR of CK19, PVA and EPCAM on the LN lysate of discordant cases. RESULTS OSNA was able to provide intraoperative result in all patients. OSNA detected 21 metastases. There were 139 concordant LN (88.5%). There were 18 initial discordant LN (11.5%), 13 (8.3%) were OSNA positive/pathological analysis negative, 5 (3.2%) were OSNA negative/pathological analysis positive. After elimination of allocation bias, false negative rate was 1.3%, sensitivity and specificity were 90% and 95.6%, PPV and NPV were 75% and 98.5%. CONCLUSION Our results suggest that OSNA should be considered to improve SNB analysis both for increasing micro metastasis diagnosis and offer extemporaneous results. Study registered under clinicaltrials.gov database number NCT02852343.
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Affiliation(s)
- Lucie Peigné
- Head Neck Surgery Department, University Hospital, Rennes, France
| | - Florence Godey
- Department of Biology, Eugène Marquis Comprehensive Cancer Center, CS 44 229, Av. De Bataille Flandres Dunkerques, 35042 Rennes Cedex, France
| | - Mathieu Le Gallo
- Chemistry, Oncogenesis, Stress, Signaling COSS, INSERM 1242, Rennes 1 University, CLCC Eugene Marquis, Rue de la bataille Flandres Dunkerques, Rennes, France
| | - François Le Gall
- Pathology Department, University Hospital, Rennes, France; Head Neck Surgery Department, University Hospital, Rennes, France
| | - Alain Fautrel
- H2P2, Histopathological Platform, University of Rennes, 35000 Rennes, France
| | - Jeff Morcet
- Clinical Investigation Center, CIC INSERM 1414, University Hospital of Rennes, France
| | - Franck Jégoux
- Head Neck Surgery Department, University Hospital, Rennes, France; Chemistry, Oncogenesis, Stress, Signaling COSS, INSERM 1242, Rennes 1 University, CLCC Eugene Marquis, Rue de la bataille Flandres Dunkerques, Rennes, France.
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9
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Garau LM, Muccioli S, Caponi L, Maccauro M, Manca G. Sentinel lymph node biopsy in oral–oropharyngeal squamous cell carcinoma: standards, new technical procedures, and clinical advances. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00338-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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10
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Sharma D, Koshy G, Grover S, Sharma B. Sentinel Lymph Node Biopsy: A new approach in the management of head and neck cancers. Sultan Qaboos Univ Med J 2017; 17:e3-e10. [PMID: 28417021 PMCID: PMC5380418 DOI: 10.18295/squmj.2016.17.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/21/2016] [Accepted: 10/06/2016] [Indexed: 12/14/2022] Open
Abstract
Cervical lymph node metastasis affects the prognosis and overall survival rate of and therapeutic planning for patients with head and neck squamous cell carcinomas (HNSCCs). However, advanced diagnostic modalities still lack accuracy in detecting occult neck metastasis. A sentinel lymph node biopsy is a minimally invasive auxiliary method for assessing the presence of occult metastatic disease in a patient with a clinically negative neck. This technique increases the specificity of neck dissection and thus reduces morbidity among oral cancer patients. The removal of sentinel nodes and dissection of the levels between the primary tumour and the sentinel node or the irradiation of target nodal basins is favoured as a selective treatment approach; this technique has the potential to become the new standard of care for patients with HNSCCs. This article presents an update on clinical applications and novel developments in this field.
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Affiliation(s)
- Deepti Sharma
- Department of Oral & Maxillofacial Pathology, Christian Dental College & Hospital, Ludhiana, Punjab, India
| | - George Koshy
- Department of Oral & Maxillofacial Pathology, Christian Dental College & Hospital, Ludhiana, Punjab, India
| | - Sonal Grover
- Department of Oral & Maxillofacial Pathology, Christian Dental College & Hospital, Ludhiana, Punjab, India
| | - Bhushan Sharma
- Department of Oral & Maxillofacial Pathology, Christian Dental College & Hospital, Ludhiana, Punjab, India
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11
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Den Toom IJ, Bloemena E, van Weert S, Karagozoglu KH, Hoekstra OS, de Bree R. Additional non-sentinel lymph node metastases in early oral cancer patients with positive sentinel lymph nodes. Eur Arch Otorhinolaryngol 2016; 274:961-968. [PMID: 27561671 PMCID: PMC5281672 DOI: 10.1007/s00405-016-4280-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/19/2016] [Indexed: 12/17/2022]
Abstract
To determine risk factors for additional non-sentinel lymph node metastases in neck dissection specimens of patients with early stage oral cancer and a positive sentinel lymph node biopsy (SLNB). A retrospective analysis of 36 previously untreated SLNB positive patients in our institution and investigation of currently available literature of positive SLNB patients in early stage oral cancer was done. Degree of metastatic involvement [classified as isolated tumor cells (ITC), micro- and macrometastasis] of the sentinel lymph node (SLN), the status of other SLNs, and additional non-SLN metastases in neck dissection specimens were analyzed. Of 27 studies, comprising 511 patients with positive SLNs, the pooled prevalence of non-SLN metastasis in patients with positive SLNs was 31 %. Non-SLN metastases were detected (available from 9 studies) in 13, 20, and 40 % of patients with ITC, micro-, and macrometastasis in the SLN, respectively. The probability of non-SLN metastasis seems to be higher in the case of more than one positive SLN (29 vs. 24 %), the absence of negative SLNs (40 vs. 19 %), and a positive SLN ratio of more than 50 % (38 vs. 19 %). Additional non-SLN metastases were found in 31 % of neck dissections following positive SLNB. The presence of multiple positive SLNs, the absence of negative SLNs, and a positive SLN ratio of more than 50 % may be predictive factors for non-SLN metastases. Classification of SLNs into ITC, micro-, and macrometastasis in the future SLNB studies is important to answer the question if treatment of the neck is always needed after positive SLNB.
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Affiliation(s)
- Inne J Den Toom
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Elisabeth Bloemena
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry (ACTA) Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Pathology, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Stijn van Weert
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - K Hakki Karagozoglu
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry (ACTA) Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Otto S Hoekstra
- Department of Radiology and Nuclear Medicine, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Remco de Bree
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
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12
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Green B, Blythe JNS, Brennan PA. Sentinel lymph node biopsy for head and neck mucosal cancers - an update on the current evidence. Oral Dis 2016; 22:498-502. [PMID: 26948863 DOI: 10.1111/odi.12470] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/02/2016] [Indexed: 02/05/2023]
Abstract
Regional metastases are a prominent feature of mucosal-associated head and neck squamous cell carcinomas and are an important prognostic factor. Sentinel lymph node biopsy (SLNB) is one modality that has potential to add to the accuracy of neck staging, although it is currently not used as widely in the head and neck as it is in other areas such as breast cancer. We review the efficacy of SLNB in head and neck mucosal squamous cell carcinomas and provide an overview of current practice and include details of technical advances.
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Affiliation(s)
- B Green
- Department of Gastroenterology, Torbay Hospital, Torquay, UK
| | - JNStJ Blythe
- Department of Oral & Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - P A Brennan
- Department of Oral & Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
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13
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Green B, Bisase B, Godden D, Mitchell DA, Brennan PA. Current surgical management of metastases in the neck from mucosal squamous cell carcinoma of the head and neck. Br J Oral Maxillofac Surg 2016; 54:135-40. [DOI: 10.1016/j.bjoms.2015.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 06/30/2015] [Indexed: 01/17/2023]
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14
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Mehta V, Nathan CA. What is the role of sentinel lymph node biopsy in early-stage oral cavity carcinoma? Laryngoscope 2015; 126:9-10. [PMID: 26257245 DOI: 10.1002/lary.25541] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Vikas Mehta
- Department of Otolaryngology/Head and Neck Surgery, Louisiana State University Health-Shreveport, Shreveport, Louisiana, U.S.A
| | - Cherie-Ann Nathan
- Department of Otolaryngology/Head and Neck Surgery, Louisiana State University Health-Shreveport, Shreveport, Louisiana, U.S.A
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15
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Coskun HH, Medina JE, Robbins KT, Silver CE, Strojan P, Teymoortash A, Pellitteri PK, Rodrigo JP, Stoeckli SJ, Shaha AR, Suçrez C, Hartl DM, de Bree R, Takes RP, Hamoir M, Pitman KT, Rinaldo A, Ferlito A. Current philosophy in the surgical management of neck metastases for head and neck squamous cell carcinoma. Head Neck 2015; 37:915-26. [PMID: 24623715 PMCID: PMC4991629 DOI: 10.1002/hed.23689] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 01/03/2014] [Accepted: 03/08/2014] [Indexed: 12/11/2022] Open
Abstract
Neck dissection is an important treatment for metastases from upper aerodigestive carcinoma; an event that markedly reduces survival. Since its inception, the philosophy of the procedure has undergone significant change from one of radicalism to the current conservative approach. Furthermore, nonsurgical modalities have been introduced, and, in many situations, have supplanted neck surgery. The refinements of imaging the neck based on the concept of neck level involvement has encouraged new philosophies to evolve that seem to benefit patient outcomes particularly as this relates to diminished morbidity. The purpose of this review was to highlight the new paradigms for surgical removal of neck metastases using an evidence-based approach.
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Affiliation(s)
- H. Hakan Coskun
- Department of Otolaryngology–Head and Neck Surgery, Uludag University School of Medicine, Bursa, Turkey
| | - Jesus E. Medina
- Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - K. Thomas Robbins
- Division of Otolaryngology–Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Carl E. Silver
- Departments of Surgery and Otolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Afshin Teymoortash
- Department of Otolaryngology–Head and Neck Surgery, University of Marburg, Marburg, Germany
| | - Phillip K. Pellitteri
- Department of Otolaryngology–Head and Neck Surgery, Guthrie Health System, Sayre, Pennsylvania
| | - Juan P. Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto Universitario de Oncologıa del Principado de Asturias, Oviedo, Spain
| | - Sandro J. Stoeckli
- Department of Otorhinolaryngology–Head and Neck Surgery, Kantonsspital, St. Gallen, Switzerland
| | - Ashok R. Shaha
- Head and Neck Service, Memorial Sloan–Kettering Cancer Center, New York, New York
| | - Carlos Suçrez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto Universitario de Oncologıa del Principado de Asturias, Oviedo, Spain
| | - Dana M. Hartl
- Department of Otolaryngology–Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France
- Laboratoire de Phonétique et de Phonologie, Sorbonne Nouvelle, Paris, France
| | - Remco de Bree
- Department of Otolaryngology–Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Robert P. Takes
- Department of Otolaryngology–Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marc Hamoir
- Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital and Cancer Center, Brussels, Belgium
| | - Karen T. Pitman
- Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, Arizona
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16
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Sentinel lymph node biopsy in oral and oropharyngeal squamous cell carcinoma: current status and unresolved challenges. Eur J Nucl Med Mol Imaging 2015; 42:1469-80. [PMID: 25916741 DOI: 10.1007/s00259-015-3049-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/15/2015] [Indexed: 12/14/2022]
Abstract
Because imaging with ultrasound, computed tomography, magnetic resonance imaging or positron emission tomography is unreliable for preoperative lymph node staging of early-stage oral and oropharyngeal squamous cell carcinoma (OSCC), elective neck dissection has been typically performed. The targeted sampling of sentinel lymph nodes (SLN) identified by lymphoscintigraphy and detected by gamma probe has become an effective alternative for the selection of patients for regional nodal resection. With careful consideration to technique, high SLN detection rates have been reported. Advanced techniques including intraoperative handheld gamma camera imaging and freehand single photon emission computed tomography (SPECT) are expected to increase surgical confidence in these procedures. This review gives an update on SLN biopsy in patients with OSCC including clinical standards and controversial aspects.
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17
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Head and neck cancer: towards a new paradigm with sentinel node localization. Clin Transl Imaging 2014. [DOI: 10.1007/s40336-014-0096-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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18
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Daisne JF, Installé J, Bihin B, Laloux M, Vander Borght T, Mathieu I, Lawson G. SPECT/CT lymphoscintigraphy of sentinel node(s) for superselective prophylactic irradiation of the neck in cN0 head and neck cancer patients: a prospective phase I feasibility study. Radiat Oncol 2014; 9:121. [PMID: 24885222 PMCID: PMC4040475 DOI: 10.1186/1748-717x-9-121] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 05/18/2014] [Indexed: 02/06/2023] Open
Abstract
Background Clinically node negative HNSCC patients have a risk ranging between 18 and 45% of occult metastases, making prophylactic irradiation mandatory. Selective irradiation of nodal target volume based on international guidelines is practice. Anyway, about half the tumours lying in an anatomical subsite known to potentially drain bilaterally effectively do so, leading to unnecessary large volume irradiation. Moreover, 15% of the tumours show drainage outside of predicted basin, increasing the risk for potential geographical misses. Three-dimensional SPECT/CT lymphoscintigraphy (LS) of sentinel node(s) may help to individualize nodal target volume selection. This prospective phase I study explores its feasibility and the dosimetric impact. Methods Ten cN0 HNSCC patients eligible for definitive radiotherapy were imaged with SPECT/CT after 99mTc nanocolloid injection around the tumour. The neck levels containing up to four hottest nodes were identified and selected for prophylactic irradiation (CTVn-LS) by volumetric modulated arc therapy. A comparative virtual planning was performed with volumes selected according to international guidelines (CTVn-IG). Results Migration was observed in all patients (one with gamma probe only). 2.9 sentinel nodes were detected per patient on average. In some patients, accurate localization was difficult when not using thermoplastic mask for SPECT/CT. CTVn-LS was totally encompassed by CTVn-IG in all patients but one (unpredicted drainage in retropharyngeal level). On average, CTVn-LS and related planning target volumes were two times smaller than IG ones. This led to significant dose decrease in identified organs at risk as well as remaining volume at risk. Conclusions SPECT/CT LS is a promising tool to individualize prophylactic node CTV in cN0 HNSCC patients eligible for definitive radiotherapy. Oncological safety must be confirmed by ongoing phase II study.
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Affiliation(s)
- Jean-François Daisne
- Radiation Oncology, Clinique & Maternité Ste-Elisabeth, Place Louise Godin, Namur 15 - 5000, Belgium.
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19
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Den Toom IJ, Heuveling DA, Flach GB, van Weert S, Karagozoglu KH, van Schie A, Bloemena E, Leemans CR, de Bree R. Sentinel node biopsy for early-stage oral cavity cancer: the VU University Medical Center experience. Head Neck 2014; 37:573-8. [PMID: 24677355 DOI: 10.1002/hed.23632] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 02/17/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Sentinel node biopsy (SNB) in head and neck cancer is recently introduced as the staging technique of oral squamous cell carcinoma. We report the results of SNB in patients diagnosed with a T1-T2 oral squamous cell carcinoma and clinically negative (N0) neck in a single center. METHODS A retrospective analysis of 90 previously untreated patients who underwent SNB between 2007 and 2012 was performed. The SNB procedure consisted of preoperatively performed lymphoscintigraphy, intraoperative detection using blue dye, and gamma probe guidance and histopathologic examination including step-serial sectioning (SSS) and immunohistochemical (IHC) staining. A positive SNB was followed by neck dissection, whereas regular follow-up with ultrasound-guided fine-needle aspiration cytology (FNAC) was done in case of a negative SNB. RESULTS The lymphoscintigraphic identification rate was 98% (88 of 90 patients) and the surgical detection rate was 99% (87 of 88 patients). The upstaging rate was 30%. Sensitivity of SNB was 93% and the negative predictive value was 97%. The median follow-up was 18 months (range, 2-62 months). Overall survival (OS) and disease-free survival (DFS) for SNB negative were 100% and 84% and for SNB positive patients 73% and 88%, respectively. CONCLUSION SNB is a reliable diagnostic staging technique for the clinically negative neck in patients with early-stage (T1-T2, cN0) oral squamous cell carcinoma.
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Affiliation(s)
- Inne J Den Toom
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
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20
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Alvarez J, Bidaguren A, McGurk M, Diaz-Basterra G, Brunsó J, Andikoetxea B, Martín J, Barbier L, Arteagoitia I, Santamaría J. Sentinel node biopsy in relation to survival in floor of the mouth carcinoma. Int J Oral Maxillofac Surg 2014; 43:269-73. [DOI: 10.1016/j.ijom.2013.10.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 09/17/2013] [Accepted: 10/24/2013] [Indexed: 02/06/2023]
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21
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Sebbesen L, Bilde A, Therkildsen M, Mortensen J, Specht L, von Buchwald C. Three-year follow-up of sentinel node-negative patients with early oral cavity squamous cell carcinoma. Head Neck 2013; 36:1109-12. [DOI: 10.1002/hed.23414] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 03/21/2013] [Accepted: 06/10/2013] [Indexed: 02/06/2023] Open
Affiliation(s)
- Lars Sebbesen
- Department of Otorhinolaryngology; Head and Neck Surgery, and Audiology, Rigshospitalet and Faculty of Health and Medical Science, University of Copenhagen; Denmark
| | - Anders Bilde
- Department of Otorhinolaryngology; Head and Neck Surgery, and Audiology, Rigshospitalet and Faculty of Health and Medical Science, University of Copenhagen; Denmark
| | - Marianne Therkildsen
- Department of Pathology; Rigshospitalet and Faculty of Health and Medical Science, University of Copenhagen; Denmark
| | - Jann Mortensen
- Department of Clinical Physiology and Nuclear Medicine; Rigshospitalet and Faculty of Health and Medical Science, University of Copenhagen; Denmark
| | - Lena Specht
- Department of Oncology; Rigshospitalet and Faculty of Health and Medical Science, University of Copenhagen; Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology; Head and Neck Surgery, and Audiology, Rigshospitalet and Faculty of Health and Medical Science, University of Copenhagen; Denmark
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22
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Leusink FKJ, van Es RJJ, de Bree R, Baatenburg de Jong RJ, van Hooff SR, Holstege FCP, Slootweg PJ, Brakenhoff RH, Takes RP. Novel diagnostic modalities for assessment of the clinically node-negative neck in oral squamous-cell carcinoma. Lancet Oncol 2013. [PMID: 23182196 DOI: 10.1016/s1470-2045(12)70395-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Oral squamous-cell carcinomas arise in mucosal linings of the oral cavity and frequently metastasise to regional lymph nodes in the neck. The presence of nodal metastases is a determinant of prognosis and clinical management. The neck is staged by palpation and imaging, but accuracy of these techniques to detect small metastases is low. In general, 30-40% of patients will have occult nodal disease and will develop clinically detectable lymph-node metastases when the neck is left untreated. The choice at present is either elective treatment or careful observation followed by treatment of the neck in patients who develop manifest metastases. These unsatisfying therapeutic options have been the subject of debate for decades. Recent developments in staging of the neck, including expression profiling and sentinel lymph-node biopsy, will allow more personalised management of the neck.
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Affiliation(s)
- Frank K J Leusink
- Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, Utrecht, Netherlands.
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23
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de Bree R. How to analyze the diagnostic value of sentinel node biopsy in head and neck cancer. Eur Arch Otorhinolaryngol 2013; 270:789-91. [DOI: 10.1007/s00405-012-2321-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2012] [Indexed: 02/05/2023]
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