Lingual lymph nodes in patients with squamous cell carcinoma of the tongue and the floor of the mouth

Lymph nodes in oral squamous cell carcinoma: a comprehensive anatomical perspective

Oral squamous cell carcinoma (OSCC) often exhibits a propensity for metastasis to lymph nodes (LNs), significantly influencing prognosis. Neck dissection (ND) is an important part in the treatment of OSCC. Variations in the preference for and pathways of lymph node metastasis (LNM) in different regions of the oral cavity have been observed. Currently, there is a lack of sufficient emphasis on the anatomical perspectives of LNM and ND. This review elucidates the lymphatic system of the maxillofacial regions from an anatomical standpoint, details the distribution of the sentinel LNs across different subsites, and summarizes the various classifications of the cervical LNs. Additionally, we elaborate on the methods used to study the lymphatic system, particularly imaging techniques. Furthermore, we investigate the pathways of cervical LNM and evaluate the efficacy of ND from an anatomical viewpoint. The overall objective of this review is to provide essential anatomical knowledge for managing LNs in OSCC, in the hope of providing patients with effective treatment modalities to enhance their quality of life.

Stair-stepped mandibulotomy: Clinical indication, surgery program design, and operation points

For radical treatment of malignancies in the posterior region of the oral cavity and oropharynx, surgical exposure of the tumor by mandibulotomy is often required. Midline or paramedian vertical mandibulotomies are commonly performed in clinical practice, but these can damage the suprahyoid musculature and genioglossus, and weaken the swallowing and speech function of patients. Stair-stepped mandibulotomy is a new procedure, developed on the principles of functional surgery, that preserves the structure and function of the mandible whilst providing a clear field and avoiding damage to critical muscle attachments. Stair-stepped mandibulotomy is suitable for patients whose primary tumor is located in the middle and posterior part of the tongue or oropharynx, especially if the lesion involves extrinsic tongue muscles. In this case report, we draw on 2 cases of typical patients in our center to elaborate the surgery program design, operation points, advantages and disadvantages of stair-stepped mandibulotomy.

Mylohyoid Muscle: Current Understanding for Clinical Management Part II: Clinical Anatomy, Radiology, and Surgical/Clinical Relevance

The mylohyoid is one of the suprahyoid muscles along with the geniohyoid, digastric, and stylohyoid muscles that lies between the anterior belly of the digastric muscle inferiorly and the geniohyoid superiorly. In Part II, the radiology and clinical/surgical importance of the mylohyoid muscle will be discussed.

Efficacy of texture analysis of ultrasonographic images in the differentiation of metastatic and non-metastatic cervical lymph nodes in patients with squamous cell carcinoma of the tongue

OBJECTIVE

We investigated the efficacy of using texture analysis of ultrasonographic images of the cervical lymph nodes of patients with squamous cell carcinoma of the tongue to differentiate between metastatic and non-metastatic lymph nodes.

STUDY DESIGN

We analyzed 32 metastatic and 28 non-metastatic lymph nodes diagnosed by histopathologic examination on presurgical US images. Using the LIFEx texture analysis program, we extracted 36 texture features from the images and calculated the statistical significance of differences in texture features between metastatic and non-metastatic lymph nodes using the t test. To assess the diagnostic ability of the significantly different texture features to discriminate between metastatic and non-metastatic nodes, we performed receiver operating characteristic curve analysis and calculated the area under the curve. We set the cutoff points that maximized the sensitivity and specificity for each curve according to the Youden J statistic.

RESULTS

We found that 20 texture features significantly differed between metastatic and non-metastatic lymph nodes. Among them, only the gray-level run length matrix feature of run length non-uniformity and the gray-level zone length matrix features of gray-level non-uniformity and zone length non-uniformity showed an excellent ability to discriminate between metastatic and non-metastatic lymph nodes as indicated by the area under the curve and the sum of sensitivity and specificity.

CONCLUSIONS

Analysis of the texture features of run length non-uniformity, gray-level non-uniformity, and zone length non-uniformity values allows for differentiation between metastatic and non-metastatic lymph nodes, with the use of gray-level non-uniformity appearing to be the best means of predicting metastatic lymph nodes.

Comparison of transoral and combined approach for surgical treatment of moderately advanced tongue and floor of the mouth cancer

Introduction. Surgical approach for oral cancer treatment is one of the key factors that determines oncologic effectiveness, risk of postoperative complications, need for reconstructive methods etc. Currently, there exists lack of strict criteria for using one or another approaches based on the sound scientific evidence for a primary tumor of given depth of invasion.

Aim. The aim of the study is a retrospective comparative analysis of oncologic efficiency of transoral and combined approaches for surgical treatment of tongue and floor of the mouth moderately advanced carcinoma.

Materials and methods. 75 patients aged between 30 and 80 years with tongue and floor of the mouth squamous cell carcinoma with depth of invasion from 10 to 20 mm were included into the study. In 29 cases the tumor was resected transorally (Group 1), in 45 – via combined approach (Group 2). Group 2 patients had more advanced tumors both locally and regionally. 13 patients of Group 1 and 27 patients of Group 2 underwent adjuvant radiotherapy. The following parameters were used for comparative analysis: the rate of local and regional recurrence, locoregional control, the rate of distant metastasis and Kaplan–Meyer overall survival.

Results. Mean follow up was 33.77 ± 27.72 months (range 14–115 months). The rate of local and regional recurrence was higher in Group 2 (20 % vs 10.3 % and 22.2 % vs 17.2 % respectively). Locoregional control was better in Group 1 (72.4 % vs 62.2 %). The difference for neither of the above-mentioned parameters did not reach statistical significance. Median survival was statistically significantly better in Group 1: 66 ± 17.42 months vs 23 ± 3.85 months (p = 0.030). Poorer treatment results in Group 2 can be explained by a higher proportion of patients with more advanced tumors in this group.

Conclusion. The results of the present study do not allow to conclude that combined approach has oncologic advantage over less aggressive transoral approach for tumors with depth of invasion from 10 to 20 mm. It is questionable to recommend the combined approach as a universal one for lesions with such a stage of local invasiveness.

Surgical anatomy of the lingual lymph nodes: systematic literature analysis and proposition for topographic classification

PURPOSE

Metastatic involvement of the lingual lymph nodes (LLNs) in oral cavity squamous cell cancer (SCC) has recently been proven to significantly reduce locoregional control and survival. Despite recent refinements in the detection of these lesions, the understanding of the LLN topographic anatomy among clinicians is limited. A proposition of a topographic division on LLN based on a comprehensive literature search and synthesis may be helpful in this condition.

METHODS

A literature search and election based on contemporary PRISMA guidelines was performed for sources on LLN anatomy with special attention on their subdivision.

RESULTS

Four topographic LLN subgroups were defined: median-between genioglossal and geniohyoid muscles; intermediate parahyoid-medial to the hyoglossal muscle, at the greater cornu of the hyoid bone; lateral sublingual (paraglandular) LLNs-at the sublingual salivary gland; lateral submandibular (paraglandular) LLNs -lateral to the hyoglossal muscle, at the deep surface of the submandibular salivary gland.

CONCLUSION

The development and implementation of a unified anatomical topographic classification of LLN subgroups may be among the important conditions for improving the detection and treatment of LLN lesions.

Application of near-infrared fluorescence imaging in lingual lymph node screening and drainage pattern observation for tongue cancer

Objective: Lingual lymph node (LLN) metastasis is regarded as an indicator of unfavorable prognosis and a crucial sign of the high degree of primary tumor aggressiveness. However, detecting LLN metastasis is an important but frequently overlooked aspect of diagnosis and surgical treatment planning. The study aims to identify LLNs by intraoperative near-infrared (NIR) fluorescence imaging with indocyanine green absorbed into human serum albumin (ICG: HSA) and describe the presence of lymphatic drainage channels from the floor of the mouth in patients with tongue carcinoma.

Materials and Methods: 21 patients diagnosed with cT1-T4 squamous cell carcinoma (SCC) of the tongue margin and scheduled to undergo tumor resection and unilateral neck dissection were enrolled. After exposing the neck, the patients were injected with 0.3 ml of ICG: HSA (500 μM) in three quadrants around the tumor, excluding the mucous membrane of the basal region cavity. Employing a near-infrared fluorescence imaging system, the fluorescence of levels I, II, III, and IV was measured during neck dissection.

Results: LLNs were detected in four patients and were identified as metastatic LLNs in all 21 patients. The near-infrared fluorescence imaging system showed the existence of lymphatic drainage channels in the floor of the mouth. In patients receiving peritumoral injection of ICG: HSA, the mean fluorescence intensity (MFI)of metastatic lymph nodes (LNs) (178.4 ± 64.39, mean ± SD) was higher than that in non-metastatic LNs (132.0 ± 76.5, mean ± SD) (p < 0.05).

Conclusion: NIR fluorescence imaging with ICG: HSA could be used for intraoperative identification of LLNs and assist in the determination of metastatic lymph nodes for tongue carcinoma patients. Additionally, this finding demonstrates the feasibility of near-infrared fluorescence imaging in defining lymphatic drainage channels in the head and neck.

Sentinel lymph node biopsy with a handheld cordless magnetic probe following preoperative MR lymphography using superparamagnetic iron oxide for clinically N0 early oral cancer: A feasibility study

PURPOSE

Radioisotope (RI) tracers are generally used for preoperative mapping of sentinel lymph node (SLN) and intraoperative detection with a portable γ probe. However, the use of RI has several limitations. Therefore, a method without RI is required for the widespread application of SLN biopsy. The purpose of this study was to evaluate the feasibility of SLN biopsy with a handheld cordless magnetic probe following magnetic resonance lymphography (MRL) using superparamagnetic iron oxide (SPIO) and for clinically N0 early oral cancer.

MATERIALS AND METHODS

MRL using SPIO and SLNB with the handheld cordless magnetic probe were performed for 27 patients with clinically N0 early oral cancer.

RESULTS

In all 27 patients (100%), SLNs were detected by MRL, and the total and mean number of SLNs were 73 and 2.7, respectively. All SLNs identified by MRL were detectable using the magnetic probe in all patients.

CONCLUSIONS

SLNB with handheld cordless magnetic probe following preoperative SLN mapping by MRL using SPIO is feasible, without RI use, for neck management in cases of clinically N0 early oral cancer.

Prognostic Significance of the Metastatic Lingual Lymph Node in Oral Tongue and Floor of Mouth Squamous Cell Carcinoma

PURPOSE

The lingual lymph node (LLN) located on the internal surface of mylohyoid muscle is not currently included in oral cavity cancer surgery or conventional neck dissection. We investigated the risk factors for LLN metastasis and evaluated its oncologic significance in patients with oral tongue and floor of mouth squamous cell carcinoma.

PATIENTS AND METHODS

Adult patients (≥20 years) undergoing upfront surgery and LLN dissection for oral tongue and floor of mouth squamous cell carcinoma between 2009 and 2018 were retrospectively analyzed. Patients who had relapsed after previous treatment or had neoadjuvant chemotherapy or had not undergone surgery were excluded. Association between clinicopathological risk factors (age, gender, tumor differentiation, stage, lymphatic invasion, perineural invasion, vascular invasion, metastatic lymph node ratio, and extranodal extension) and LLN metastasis was evaluated using logistic regression analysis. Disease-free survival in accordance with LLN metastasis was evaluated by the Kaplan-Meier method.

RESULTS

A total of 51 patients were included, and LLN metastasis was found in 9 patients (17.6%). LLN metastasis was significantly associated with advanced nodal stage, poor tumor differentiation, and vascular invasion. Cox proportional-hazards regression models showed that LLN metastasis was associated with an 8.0-fold higher risk of mortality than the absence of LLN metastasis. Patients with LLN metastasis had significantly worse 5-year disease-free survival rate than those without metastasis (22.2% vs 85.7%; P < .001).

CONCLUSIONS

This study suggests that LLN metastasis is a poor prognostic factor in patients with oral tongue and floor of mouth squamous cell carcinoma. The sublingual space should be carefully evaluated preoperatively and intraoperatively.

Prognostic impact of lingual lymph node metastasis in patients with squamous cell carcinoma of the tongue: a retrospective study

Squamous cell carcinoma (SCC) of the tongue rarely metastasizes to the lingual lymph nodes (LLNs), which are inconstant nodes and often situated outside the areas of basic tongue tumor surgery. The current study evaluated the clinicopathological features and prognostic impact of LLN metastasis (LLNM), compared to that of cervical lymph node metastasis, in patients with tongue SCC. A total of 608 patients underwent radical surgery for tongue SCC at our department between January 2001 and December 2016. During neck dissection, we scrutinized and resected lateral LLNs, when present. Of the 128 patients with lymph node metastasis, 107 had cervical lymph node metastasis and 21 had both cervical lymph node metastasis and LLNM. Univariate analysis demonstrated that LLNM was significantly associated with the adverse features of cervical lymph node metastasis. The 5-year disease-specific survival (5y-DSS) was significantly lower in patients with LLNMs than in those without LLNMs (49.0% vs. 88.4%, P < 0.01). Moreover, Cox proportional hazards model analyses revealed that cervical lymph node metastasis at level IV or V and LLNM were independent prognostic factors for 5y-DSS. LLNM has a strong negative impact on survival in patients with tongue SCC. An advanced status of cervical lymph node metastasis may predict LLNM.

MR lymphography with superparamagnetic iron oxide for sentinel lymph node mapping of N0 early oral cancer: A pilot study

OBJECTIVES

The purpose of this pilot study was to evaluate the usefulness of magnetic resonance lymphography (MRL) with superparamagnetic iron oxide (SPIO) in sentinel lymph node (SLN) mapping of clinically N0 early oral cancer, and to conduct a comparative study of this MRL with CT lymphography (CTL).

METHODS

CTL and MRL were performed for SLN mapping before surgery for 20 patients with clinically N0 early oral cancer. The detection rate, number, and location of SLNs in CTL and MRL were evaluated. Furthermore, optimal scanning/imaging timing in MRL was examined.

RESULTS

SLNs were detected by CTL in 18 (90%) patients, and the total and mean number of SLN were 35 and 1.8, respectively. All SLNs could be detected 2 min and 3.5-5 min after contrast medium injection. In all patients, SLNs were detected by MRL at 10 min after SPIO injection, and the total and mean number of SLN was 53 and 2.7, respectively. MRL at 30 min after the injection showed additional 18 secondary lymph nodes.

CONCLUSION

MRL with SPIO is safe and useful imaging for the detection of SLNs in clinically N0 early oral cancer, and the optimal imaging timing is 10 min after SPIO injection.

Lingual Lymph Node Metastases as a Prognostic Factor in Oral Squamous Cell Carcinoma-A Retrospective Multicenter Study

Backgrounds and Objectives: The epidemiology and prognostic role of lingual lymph node (LLN) metastasis in patients with oral squamous cell carcinoma (OSCC) remain unclear. Here, we aimed to analyze the clinicopathological features, risk factors, and prognostic role of LLN metastasis in patients with OSCC. Materials and Methods: In total, 945 patients with OSCC were retrospectively analyzed. Clinicopathological features were compared between patients with and without LLN metastasis. The risk factors of LLN metastasis and its effects on survival outcomes were evaluated using multi-variate analysis. Results: LLN metastasis was noted in 67 patients (7.1%). Habitual alcohol consumption and clinical neck node metastasis were independent risk factors for LLN metastasis. LLN metastasis was an independent prognostic factor for disease-free and overall survival, although LLN dissection did not improve survival outcomes. Conclusion: LLN metastasis is an independent adverse prognostic factor. Further prospective studies are needed to fully assess the extent of LLN dissection required in OSCC patients.

Metastasis to the lateral lingual lymph node located behind the submandibular gland: A case of squamous cell carcinoma of the tongue

Inconsistency in the definition of LLNs may be a hurdle in ensuring the accuracy of the evidence. Refinements in the classification of LLNs, based on the fascial anatomy and lymphatic vessels, are warranted.

Regional metastasis to anatomies beyond traditional neck dissection boundaries: a multi-institutional analysis focused on unconventional metastases in oral cancer patients

Background

Regional metastasis sometimes occurs in anatomies that are not included in traditional neck dissections. The purpose of this study was to evaluate the treatment outcomes of squamous cell carcinoma of oral cavity (SCCOC) patients with unconventional metastatic lymph nodes (UMLNs) in sublingual, buccinator, and parotid anatomies.

Methods

This retrospective multi-institutional analysis of squamous cell carcinoma of oral cavity patients with unconventional metastatic lymph nodes was performed from January 2008 to December 2015. All the included patients received surgical treatment for unconventional metastatic lymph nodes. The end point of the study was to determine the factors influencing these patients’ survival and the corresponding solutions to improve survival. Pathological grade, contralateral metastasis, extranodal extension, and other factors were collected and analyzed by logistic regression and the Cox model.

Results

A total of 89 patients were identified. Among these patients, 25 (28.1%) received primary treatment, 28 (31.5%) received staged (therapeutic) neck dissections, and 36 (40.4%) had recurrent or residual diseases. Altogether, 45 patients (51%) had buccinator node metastases, 31 (35%) had sublingual metastases, 12 (14%) had parotid metastases, and 1 had both buccinator and parotid metastases. Regarding regional metastases, 31 patients (34.8%) had isolated unconventional metastatic lymph nodes. Adjuvant therapies were administered to 72 (80.9%) patients, 25 (28.1%) of whom were treated with radio-chemotherapies. The overall survival rate was 38.2%. Multivariate analysis found that the subsites of unconventional metastatic lymph nodes (P = 0.029), extranodal extension in both unconventional metastatic lymph nodes (P = 0.025) and cervical lymph nodes (P = 0.015), sites of primary or recurrent squamous cell carcinoma of oral cavity (P = 0.035), and types of neck dissections (P = 0.025) were significantly associated with overall survival.

Conclusions

Unconventional metastatic lymph nodes are uncommon, yet awareness of potential unconventional metastatic lymph nodes should be heightened. Early surgical interventions are warranted in patients with sublingual or buccinator metastases, while caution should be given to those with parotid metastases. Aggressive en bloc (in-continuity) resections may be mandatory in advanced oral cancer cases for close anatomic locations with possible buccal or sublingual metastases.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12957-020-02057-6.

Sonographicdetectionof a metastatic lingual lymph node in a patient with tongue cancer

A 41-year-old male was diagnosed with tongue cancer. Preoperative imaging revealed no metastatic lymph nodes. Intraoperative sonography detected a minute hypoechoic lesion in the sublingual space. A pea-sized mass was found during dissection of that space and histopathology revealed a metastatic lymph node. The lingual lymph node should routinely be evaluated sonographically prior to surgical resection of tongue cancer.

Lingual lymph nodes: Anatomy, clinical considerations, and oncological significance

Lingual lymph nodes are an inconstant group of in-transit nodes, which are located on the route of lymph drainage from the tongue mucosa to the regional nodes in neck levels I and II. There is growing academic data on the metastatic spread of oral cancer, particularly regarding the spreading of oral tongue squamous cell carcinoma to lingual nodes. These nodes are not currently included in diagnostic and treatment protocols for oral tongue cancer. Combined information on surgical anatomy, clinical observations, means of detection, and prognostic value is presented. Anatomically obtained incidence of lingual nodes ranges from 8.6% to 30.2%. Incidence of lingual lymph node metastasis ranges from 1.3% to 17.1%. It is clear that lymph nodes that bear intervening tissues from the floor of the mouth should be removed to improve loco-regional control. Extended resection volume, which is required for the surgical treatment of lingual node metastasis, cannot be implied to every tongue cancer patient. As these lesions significantly influence prognosis, special efforts of their detection must be made. Reasonably, every tongue cancer patient must be investigated for the existence of lingual lymph node metastasis. Lymphographic tracing methods, which are currently implied for sentinel lymph node biopsies, may improve the detection of lingual lymph nodes.

[Influence of mandibulotomy approaches on oral function following radical resection of tongue carcinoma]

OBJECTIVE

This study aimed to compare the influences of postoperative oral function in patients with median or paramedian mandibulotomy during the radical resection of tongue carcinoma and to provide evidence for the choice of osteotomy location for mandibulotomy.

METHODS

The clinical data of 126 patients who underwent combined radical neck dissection with mandibulectomy and glossectomy followed by simultaneous reconstruction were analyzed retrospectively. The patients were divided into two groups according to the position of mandibulotomy: median mandibulotomy group (median group, n=60) and paramedian mandibulotomy group (paramedian group, n=66). The fourth edition of the University of Washington Quality of Life Questionnaire (UW-QOL) was used to compare the differences in oral functions, such as swallowing, mastication, and speech, between the two groups during regular follow-up. SPSS 24.0 software package was used for statistical analysis, and P<0.05 was considered statistically significant.

RESULTS

Six months after the operation, no significant differences in swallowing, mastication, and speech functions were found between the median and paramedian groups. However, the swallowing and speech functions in the paramedian group were better than those in the median group 1 year after the operation (P<0.05), whereas no statistical difference in mastication function was observed between the two groups.

CONCLUSIONS

Evaluation of the postoperative oral function results showed that paramedian mandibulotomy was a better surgical approach than median mandibulotomy. Paramedian mandibulotomy is worth prioritizing in the radical resection of tongue carcinoma.

Sentinel lymph node mapping of clinically N0 early oral cancer: a diagnostic pitfall on CT lymphography

OBJECTIVE

The purpose of this study was to reevaluate preoperative computed tomography lymphography (CTL) and enhanced CT images during follow-up to clarify whether SLNs enhanced by CTL were identified accurately before primary surgery with sentinel lymph node biopsy (SLNB) for clinically N0 early oral cancer.

METHODS

Thirty two early oral cancer patients without cervical lymph node metastasis were enrolled in this study. To clarify whether SLNs enhanced by CTL were identified accurately before primary surgery with SLNB, we reevaluated preoperative CTL and enhanced CT images during follow-up in all patients.

RESULTS

SLNs were detected by CTL in 31 of 32 patients (96.9%). During follow-up after primary surgery with SLNB, 4 of 27 patients without SLN metastasis had occult neck metastasis. Of the 4 patients, only 1 patient with cancer of floor of the mouth had overlooking of SLN, and the overlooking rate of SLN was 3.1%. The overlooked small SLN (2.9 × 3.3 × 3.1 mm) was located at contralateral level IB. The CT numbers before, 2, 5, 10 min after iopamidol injection, were 33 HU, 37 HU, 62 HU, 52 HU, respectively. The CT numbers of overlooked SLN 5 and 10 min after the injection was higher than CT images scanned before the iopamidol injection.

CONCLUSIONS

The enhancement of SLNs in CTL images after iopamidol injection should be compared sufficiently with CT images before iopamidol injection to avoid overlooking of SLNs in N0 early oral cancer.

Lingual Lymph Node Metastasis in cT1-2N0 Tongue Squamous Cell Carcinoma: Is It an Indicator for Elective Neck Dissection

Objective: Accurate predictors for occult metastasis in cT1-2N0 tongue squamous cell carcinoma (SCC) remains scarce, the main goal in current study was to evaluate whether there is significant association between lingual lymph node (LLN) metastasis and occult lymph node metastasis as well as whether there is prognostic value of LLN metastasis in early stage tongue SCC.

Methods: Patients with surgically treated primary cT1-2N0 tongue SCC were prospectively enrolled from January 2010 to December 2018. LLNs were dissected independently for pathologic analysis. The main study endpoints were locoregional control survival (LRC) and disease-specific survival (DSS). The Chi-square test and multivariate regression analysis were used to assess the predictors for occult metastasis. The Kaplan-Meier approach and Cox model were used to analyze the potential prognostic factors.

Results: A total of 317 patients were enrolled for analysis. Eighty-eight patients had occult metastasis with a prevalence of 27.8%. LLNs presented in 89 patients, in which 43 patients had LLN metastasis. In the 43 patients with positive LLNs, 20 patients had occult metastasis, in 274 patients with negative LLNs or no LLNs, 68 patients had occult metastasis, the difference was significant (p = 0.012). Further multivariate regression analysis confirmed the independence of LLN metastasis in predicting the occult metastasis. In patients without LLNs, the 5-year LRC rate was 79%, in patients with negative LLNs, the 5-year LRC rate was 78%, in patients with positive LLNs, the 5-year LRC rate was 62%, the difference was significant (p = 0.024). In patients without LLNs, the 5-year DSS rate was 84%, in patients with negative LLNs, the 5-year DSS rate was 74%, in patients with positive LLNs, the 5-year DSS rate was 51%, the difference was significant (p < 0.001), further Cox model confirmed the independence of LLN metastasis in affecting the LRC and DSS.

Conclusions: LLN metastasis is significantly associated with occult neck lymph node metastasis, and decrease the LRC and DSS in early stage tongue SCC.

CT lymphography for sentinel lymph node mapping of clinically N0 early oral cancer

BACKGROUND

The objectives of this retrospective study were to evaluate the usefulness of computed tomography lymphography (CTL) and to clarify the optimal timing of CTL in sentinel lymph node (SLN) mapping of clinically N0 early oral cancer.

METHODS

Twenty patients with clinically N0 early oral cancer underwent CTL with a 128 multi-detector row CT scanner to detect SLN the day before resection of primary tumor and SLN biopsy with indocyanine green (ICG) fluorescence guidance. CT scanning was performed in the first 10 patients at 2, 5, and 10 min after submucosal injection of iopamidol and in the remaining 10 patients at 2, 3.5, 5, and 10 min after the injection of contrast medium. We evaluated the SLN detection rate at each scan timing and the number and location of SLNs. We evaluated whether CTL-enhanced SLNs could be identified intraoperatively as ICG fluorescent lymph nodes.

RESULTS

SLNs were detected by CTL in 19 of the 20 patients (95.0%), and the mean number of SLNs was 2 (range, 1-4). All SLNs were located on the ipsilateral side; 35 of 37 SLNs were located at level I and II, and 2 SLNs were lingual lymph nodes. All SLNs could be detected 2 min and 3.5-5 min after contrast medium injection, and CTL-enhanced SLNs could be identified intraoperatively as fluorescent lymph nodes.

CONCLUSIONS

CTL could facilitate the detection of SLNs in early oral cancer, and the optimal timing of CT scanning was at 2 and 5 min after injection of contrast medium.

The role of the T-N tract in advanced stage tongue cancer

BACKGROUND

We investigated the role of the soft tissue tract between the primary tumor and the neck lymph nodes, the "T-N tract," in patients with tongue squamous cell carcinoma at an advanced stage.

METHODS

We performed a compartmental tongue surgery in 233 patients. Cumulative incidence of relapses and overall survival curves were compared by T-N tract involvement. Multivariate Cox proportional hazards models were used to assess the independent role of T-N tract.

RESULTS

At 4 years of follow-up, patients with disease in the T-N tract experienced a significantly more distant recurrence (40%) than did patients without T-N tract involvement (22%; P = .02). Multivariate Cox models indicate a significant almost triple risk of distant metastases (hazard ratio [HR], 2.70; 95% CI, 1.01-7.19; P = .05) and double risk of death (HR, 2.09; 95%CI, 1.13-3.85; P = .02) in patients with "T-N tract involvement."

CONCLUSIONS

Our data show that the T-N tract plays an important role in prognosis and survival in patients with tongue cancer.

Value of lingual lymph node metastasis in patients with squamous cell carcinoma of the tongue

OBJECTIVES

To investigate the role of lingual lymph node (LLN) metastasis on locoregional control (LRC) in patients with locally advanced tongue squamous cell carcinoma (SCC).

METHODS

A total of 231 patients were prospectively enrolled. Analyses focused on the association between the LLN metastasis and clinical pathologic variables as well as the significance of LLN metastasis in predicting prognosis.

RESULTS

LLNs were noted in 58 patients, 33 of whom were positive for LLN metastasis. LLN metastasis was significantly related to adverse pathologic characteristics. In patients with LLN metastasis, the 5-year LRC rate was 45%. In patients without LLN metastasis, the 5-year LRC rate was 65% and the difference was significant (P = 0.013). Further, Cox model analysis confirmed the independence of LLN metastasis from prognosis prediction.

CONCLUSION

LLN metastasis in locally advanced tongue SCC is relatively uncommon; however, LLNs should be routinely dissected because they could significantly decrease locoregional control.

LEVEL OF EVIDENCE

2b. Laryngoscope, 129:2527-2530, 2019.