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Poutoglidis A, Georgalas C, Fyrmpas G, Karamitsou P. What is the rate of occult nodal metastasis in squamous cell carcinomas of the sinonasal tract? A systematic review. Eur Arch Otorhinolaryngol 2024; 281:3325-3331. [PMID: 38367074 DOI: 10.1007/s00405-024-08481-8] [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: 10/06/2023] [Accepted: 01/15/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE The role of elective neck dissection (END) in the management of clinical N0 (cN0) squamous cell carcinomas (SCC) of the sinonasal tract is unclear. In this systematic review, we evaluate the risk of occult nodal metastasis in sinonasal SCCs with cN0M0 tumors to support clinical decision making. METHODS A literature search was conducted in the following three electronic databases: Medline/PubMed, ScienceDirect, and Google Scholar. Articles were assessed for eligibility in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Two independent authors extracted the data. The Methodological Items for Non-Randomized Studies (MINORS) tool was used for the assessment of biases of each included study. RESULTS Our systematic review included six studies that met the inclusion criteria, all retrospective in design. The rate of histologically proven metastasis of sinonasal SCC to the clinically negative neck is 12.5%. Almost half of the positive cases are pathologically staged as N2 (6.5%). CONCLUSION Our systematic review provides the rate of sinonasal SCC occult metastasis to the neck so that the surgeons can discuss with patients the risks and possible merits of adding an elective neck management in the surgical plan.
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Affiliation(s)
- Alexandros Poutoglidis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Christos Georgalas
- Medical School, University of Nicosia, 2408, Nicosia, Cyprus
- Endoscopic Skull Base Centre Athens, Hygeia Hospital, 15123, Athens, Greece
| | - Georgios Fyrmpas
- Department of Otorhinolaryngology, School of Medicine, Democritus University of Thrace, 69100, Alexandroupolis, Greece
| | - Paraskevi Karamitsou
- Department of Otorhinolaryngology-Head and Neck Surgery, 'G. Papanikolaou' General Hospital, Leoforos Papanikolaou, 57010, Thessaloniki, Greece.
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2
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Couto EV, Lau F, Gazmenga FP, Texeira D, Bertuzzo CS, Chone CT. A pilot study of quantitative real-time polymerase chain reaction metastases detection on sentinel lymph nodes of oral cancer and literature review. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e2024S126. [PMID: 38865545 PMCID: PMC11164285 DOI: 10.1590/1806-9282.2024s126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 06/14/2024]
Affiliation(s)
- Eduardo Vieira Couto
- Universidade Estadual de Campinas, Department of Otolaryngology Head and Neck Surgery – São Paulo (SP), Brazil
| | - Fabio Lau
- Universidade Estadual de Campinas, Department of Otolaryngology Head and Neck Surgery – São Paulo (SP), Brazil
| | - Fabio Portella Gazmenga
- Universidade Estadual de Campinas, Department of Otolaryngology Head and Neck Surgery – São Paulo (SP), Brazil
| | - Daniel Texeira
- Universidade Estadual de Campinas, Department of Otolaryngology Head and Neck Surgery – São Paulo (SP), Brazil
| | - Carmen Sílvia Bertuzzo
- Universidade Estadual de Campinas, Medical Sciences College, Department of Medical Genetics – São Paulo (SP), Brazil
| | - Carlos Takahiro Chone
- Universidade Estadual de Campinas, Department of Otolaryngology Head and Neck Surgery – São Paulo (SP), Brazil
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3
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Li F, Huang Q, Hsueh C, Huang H, Zhu Y, Gong H, Tao L, Zhou L, Zhang M. A Survival Nomogram Containing Lymph Node Ratio for Hypopharyngeal Carcinoma Patients After Neck Dissection. Otolaryngol Head Neck Surg 2023; 168:1097-1106. [PMID: 36939525 DOI: 10.1002/ohn.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/27/2022] [Accepted: 10/09/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The purpose of our study is to establish a survival nomogram based on lymph node ratio (LNR) in hypopharyngeal carcinoma. STUDY DESIGN Retrospective cohort study. SETTING Hypopharyngeal squamous cell carcinoma (HPSCC) is prone to regional metastasis. Emerging evidence has shown that LNR is a promising prognostic factor in HPSCC. METHODS From January 2004 to January 2018, 411 HPSCC patients who underwent neck dissection at our institution were retrospectively studied. The enrolled patients were divided into training and validation cohorts at a ratio of 7:3. A survival nomogram was finally built based on factors screened from multivariate analysis using the bidirectional stepwise method. RESULTS LNR was superior to other nodal classifications for survival prediction and was used to establish the R classification. A nomogram was developed using R classification (p < .001), pT classification (p < .001), tumor invasive depth (p < .001), and internal jugular vein adhesion (p = .001). The C-indexes were 0.712 and 0.703 in the training and validation dataset. The 36- and 60-month AUCs were 0.767 and 0.766 in the training dataset and 0.713 and 0.757 in the validation dataset, respectively. The calibration curves showed relatively good agreement between the predicted and actual probability. CONCLUSION Based on the LNR, we developed a survival nomogram for HPSCC after neck dissection, which will be a practical tool to discriminate patients with different survival risks.
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Affiliation(s)
- Feiran Li
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Qiang Huang
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Chiyao Hsueh
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Huiying Huang
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Yi Zhu
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Hongli Gong
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Lei Tao
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Liang Zhou
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Ming Zhang
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
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4
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Li F, Hsueh C, Gong H, Zhu Y, Tao L, Zhou L, Wang S, Zhang M. The management of metastatic neck nodes following induction chemotherapy in N2/3 classification hypopharyngeal carcinoma. Head Neck 2022; 44:2009-2017. [PMID: 35915865 DOI: 10.1002/hed.27106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/27/2022] [Accepted: 05/12/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND For patients with less chemosensitive neck nodes, poor prognosis after chemoradiotherapy (CRT) could be predicted and neck dissection is needed. METHODS Ninety-two N2/3 hypopharyngeal carcinoma patients were retrospectively studied. According to response after induction chemotherapy (ICT), patients were treated with neck dissection followed by concurrent CRT (CCRT) (group 1), surgery plus postoperative CRT (group 2), or CCRT for primary and regional sites (group 3). RESULTS Overall survival and disease-free survival rates of group 1 were significantly higher than group 2 (p = 0.038, p = 0.031) and group 3 (both p = 0.018). Regional control rate of group 1 was significantly higher than group 3 (p = 0.041). There were no significant differences between groups 1 and 2 regarding local and regional control (p = 0.746, p = 0.302). CONCLUSIONS Neck dissection followed by CCRT is the best choice for patients with responsive primary but nonresponsive nodes.
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Affiliation(s)
- Feiran Li
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Chiyao Hsueh
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Hongli Gong
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Yi Zhu
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Lei Tao
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Liang Zhou
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Shengzi Wang
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Ming Zhang
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
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5
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Zhang Y, Su X, Qiao Y, Huang S, Kou Y. Occult lymph node metastasis in the contralateral neck of oropharyngeal squamous cell carcinoma: a meta-analysis and literature review. Eur Arch Otorhinolaryngol 2022; 279:2157-2166. [PMID: 35041065 DOI: 10.1007/s00405-021-07230-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to determine whether contralateral cervical lymph node dissection is needed in patients with oropharyngeal squamous cell carcinoma (OPSCC) with contralateral cervical cN0. METHODS We searched the PubMed, Web of Science, Embase, Chinese Biomedical Literature Database (CBM) and Cochrane Library databases up to August 14, 2021 for studies examining the contralateral neck occult metastasis rate of patients with ipsilateral clinical neck-negative (cN0) OPSCC and the contralateral neck occult metastasis rate of patients with ipsilateral clinical neck-positive (cN1, cN2a, cN2b) OPSCC. This rate is used to determine whether patients with contralateral cN0 OPSCC need contralateral cervical lymph node dissection. RESULTS A total of 14 articles, including 532 cases, were included in the analysis. When studying the rate of ipsilateral cervical occult metastasis in patients with ipsilateral cN0, 163 cases were included in 11 studies. The results showed that the rate of contralateral cervical occult lymph node metastasis in patients with ipsilateral cN0 was 0.6816% (95% CI 0.0000-4.4880 (P = 0.3005)). In the study of ipsilateral cN+ (cN1, cN2a, cN2b), a total of 369 cases of 10 articles were included in the analysis. The results showed that the rate of contralateral cervical occult lymph node metastasis in patients with ipsilateral cN+ was 11.4920% [95% CI 7.8944-15.5223 (P = 0.0000)]. CONCLUSION For cancer treatment, the ultimate goal is to achieve the best control of cancer and the lowest complications. It seems unnecessary to intervene in the contralateral neck of patients with OPSCC with ipsilateral cN0. For OPSCC with ipsilateral cN+ , this index is a factor that cannot be ignored when making clinical decisions.
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Affiliation(s)
- Ying Zhang
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, No. 117. Nanjing Bei Jie, Heping District, Shenyang, 110002, Liaoning Province, China.,School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Diseases, Shenyang, Liaoning Province, China
| | - Xingzhou Su
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, No. 117. Nanjing Bei Jie, Heping District, Shenyang, 110002, Liaoning Province, China.,School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Diseases, Shenyang, Liaoning Province, China
| | - Yumeng Qiao
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, No. 117. Nanjing Bei Jie, Heping District, Shenyang, 110002, Liaoning Province, China.,School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Diseases, Shenyang, Liaoning Province, China
| | - Shaohui Huang
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, No. 117. Nanjing Bei Jie, Heping District, Shenyang, 110002, Liaoning Province, China. .,School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Diseases, Shenyang, Liaoning Province, China.
| | - Yurong Kou
- Department of Oral Biology, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, No. 117 Nanjing North Street, Heping District, Shenyang, 110002, Liaoning Province, China.,School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Diseases, Shenyang, Liaoning Province, China
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6
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Roy P, Mallick I, Arun I, Zameer L, Dey D, Singh A, Chatterjee S, Jain P, Manikantan K, Sharan R, Pattatheyil A. Nodal yield and topography of nodal metastases from oral cavity squamous cell carcinoma - An audit of 1004 cases undergoing primary surgical resection. Oral Oncol 2020; 113:105115. [PMID: 33341004 DOI: 10.1016/j.oraloncology.2020.105115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Nodal metastasis is an important prognostic factor in oral squamous cell carcinoma (OSCC). Detailed topographic study of metastasis can guide surgical and adjuvant radiation treatment protocols. METHODS Retrospective analysis of distribution of nodal spread was done by auditing pathology records of 1004 patients who underwent primary surgical management at our center. RESULTS The median nodal yield was 41 (range of 9-166) nodes, per patient. Metastasis was present in 42.9% patients, of which 52.3% demonstrated extranodal extension. Reclassification by AJCC8 criteria resulted in up-staging in 35.6% patients (pN1, pN2a, pN2b, pN2c, pN3a and pN3b in 13.1%, 3.7%, 6.9%, 0.9%, 0%, 18.1% respectively). Ipsilateral levels Ib and IIa were involved in a quarter of patients each, while IIb, IV and V were involved in < 4%, 3% and 1% of patients, respectively. Contralateral nodal metastasis was present in 5.4%. Skip metastases to level IV were 2.2% and 1.2% for tongue and gingivobuccal primaries. Tongue primaries had a lower likelihood of involving level Ib, but higher of level IIa and III, compared to gingivobuccal primaries, and a lower likelihood of extranodal extension. Primary site did not influence nodal metastasis to levels IIb, IV or V, but other factors like lymphovascular invasion, pT stage and margin status had an influence. CONCLUSION This large series with high nodal yield, shows low level of metastasis to level IIb, IV and V, which can help modify future guidelines for extent of surgery and avoid targeted adjuvant radiation to specific levels.
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Affiliation(s)
- Paromita Roy
- Oncopathology, Tata Medical Center, Kolkata, India.
| | | | - Indu Arun
- Oncopathology, Tata Medical Center, Kolkata, India
| | | | - Debdeep Dey
- Oncopathology, Tata Medical Center, Kolkata, India
| | - Angad Singh
- Oncopathology, Tata Medical Center, Kolkata, India
| | | | - Prateek Jain
- Head and Neck Surgery, Tata Medical Center, Kolkata, India
| | | | - Rajeev Sharan
- Head and Neck Surgery, Tata Medical Center, Kolkata, India
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7
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Nishio N, van den Berg NS, Martin BA, van Keulen S, Fakurnejad S, Rosenthal EL, Wilson KE. Photoacoustic Molecular Imaging for the Identification of Lymph Node Metastasis in Head and Neck Cancer Using an Anti-EGFR Antibody-Dye Conjugate. J Nucl Med 2020; 62:648-655. [PMID: 33008927 PMCID: PMC8844260 DOI: 10.2967/jnumed.120.245241] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/27/2020] [Indexed: 12/14/2022] Open
Abstract
The presence of lymph node (LN) metastases is an essential prognostic indicator in patients with head and neck squamous cell carcinoma (HNSCC). This study assessed photoacoustic molecular imaging (PAMI) of the antiepidermal growth factor receptor antibody (panitumumab) conjugated to a near-infrared fluorescent dye, IRDye800CW (panitumumab-IRDye800CW; pan800), for the identification of occult metastatic LNs in patients with HNSCC (n = 7). Methods: After in vitro photoacoustic imaging characterization of pan800, PAMI was performed on excised neck specimens from patients infused with pan800 before surgery. Freshly obtained neck specimens were imaged with 3-dimensional, multiwavelength spectroscopic PAMI (wavelengths of 680, 686, 740, 800, 860, 924, and 958 nm). Harvested LNs were then imaged with a closed-field near-infrared fluorescence imager and histologically examined by the pathologist to determine their metastatic status. Results: In total, 53 LNs with a maximum diameter of 10 mm were analyzed with photoacoustic and fluorescence imaging, of which 4 were determined to be metastatic on the final histopathologic report. Photoacoustic signals in the LNs corresponding to accumulated pan800 were spectrally unmixed using a linear least-square-error classification algorithm. The average thresholded photoacoustic signal intensity corresponding to pan800 was 5-fold higher for metastatic LNs than for benign LNs (2.50 ± 1.09 arbitrary units [a.u.] vs. 0.53 ± 0.32 a.u., P < 0.001). Fluorescence imaging showed that metastatic LNs had a 2-fold increase in fluorescence signal compared with benign LNs ex vivo (P < 0.01, 0.068 ± 0.027 a.u. vs. 0.035 ± 0.018 a.u.). Moreover, the ratio of the average of the highest 10% of the photoacoustic signal intensity over the total average, representative of the degree of heterogeneity in the pan800 signal in LNs, showed a significant difference between metastatic LNs and benign LNs (11.6 ± 13.4 vs. 1.8 ± 0.7, P < 0.01) and an area under the receiver-operating-characteristic curve of 0.96 (95% CI, 0.91-1.00). Conclusion: The data indicate that PAMI of IRDye800-labeled tumor-specific antibody may have the potential to identify occult LN metastasis perioperatively in HNSCC patients.
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Affiliation(s)
- Naoki Nishio
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.,Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Nynke S van den Berg
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Brock A Martin
- Department of Pathology, Stanford University School of Medicine, Stanford, California; and
| | - Stan van Keulen
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Shayan Fakurnejad
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Eben L Rosenthal
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Katheryne E Wilson
- Department of Radiology, Stanford University School of Medicine, Stanford, California
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8
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Mandlik D, Vatsyayan A, Raina P, Patel P, Patel P, Sharma N, Patel M, Bhatt S, Mankiwala S, Patel D, Patel K. Efficacy of Single Transverse Neck Incision for Modified Radical Neck Dissection. J Maxillofac Oral Surg 2020; 19:342-346. [PMID: 32801525 DOI: 10.1007/s12663-019-01261-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 07/22/2019] [Indexed: 11/25/2022] Open
Abstract
Background To assess the viability of the single transverse neck incision (STNI) for modified radical neck dissection and to analyze the yield of lymph nodes using this approach. Materials and Methods We conducted a prospective observational study in the Department of Head and Neck Surgical Oncology at our Tertiary Cancer Care Centre from November 2013 to May 2017. Results A total of 257 patients underwent surgical treatment for malignant tumors of the head and neck which included 265 modified radical neck dissections (eight bilateral and 249 unilateral). Average of total dissected nodal yield was 37.07. Average yield of positive neck nodes was 2.78. Conclusion Single transverse neck incision is an acceptable technique for modified radical neck dissection as it provides adequate surgical exposure for achieving optimal nodal clearance with little technical difficulty.
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Affiliation(s)
- Dushyant Mandlik
- Department of Head and Neck Oncology, HCG Cancer Centre, Ahmedabad, Gujarat 380060 India
| | - Ashutosh Vatsyayan
- Department of Head and Neck Oncology, HCG Cancer Centre, Ahmedabad, Gujarat 380060 India
| | - Priyanka Raina
- Department of Head and Neck Oncology, HCG Cancer Centre, Ahmedabad, Gujarat 380060 India
| | - Purvi Patel
- Department of Head and Neck Oncology, HCG Cancer Centre, Ahmedabad, Gujarat 380060 India
| | - Parin Patel
- Department of Head and Neck Oncology, HCG Cancer Centre, Ahmedabad, Gujarat 380060 India
| | - Nitin Sharma
- Department of Head and Neck Oncology, HCG Cancer Centre, Ahmedabad, Gujarat 380060 India
| | - Mitesh Patel
- Department of Head and Neck Oncology, HCG Cancer Centre, Ahmedabad, Gujarat 380060 India
| | - Sushen Bhatt
- Department of Head and Neck Oncology, HCG Cancer Centre, Ahmedabad, Gujarat 380060 India
| | - Shrinal Mankiwala
- Department of Head and Neck Oncology, HCG Cancer Centre, Ahmedabad, Gujarat 380060 India
| | - Daxesh Patel
- Department of Head and Neck Oncology, HCG Cancer Centre, Ahmedabad, Gujarat 380060 India
| | - Kaustubh Patel
- Department of Head and Neck Oncology, HCG Cancer Centre, Ahmedabad, Gujarat 380060 India
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9
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Nishio N, van den Berg NS, van Keulen S, Martin BA, Fakurnejad S, Teraphongphom N, Chirita SU, Oberhelman NJ, Lu G, Horton CE, Kaplan MJ, Divi V, Colevas AD, Rosenthal EL. Optical molecular imaging can differentiate metastatic from benign lymph nodes in head and neck cancer. Nat Commun 2019; 10:5044. [PMID: 31695030 PMCID: PMC6834597 DOI: 10.1038/s41467-019-13076-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 10/15/2019] [Indexed: 12/26/2022] Open
Abstract
Identification of lymph node (LN) metastasis is essential for staging of solid tumors, and as a result, surgeons focus on harvesting significant numbers of LNs during ablative procedures for pathological evaluation. Isolating those LNs most likely to harbor metastatic disease can allow for a more rigorous evaluation of fewer LNs. Here we evaluate the impact of a systemically injected, near-infrared fluorescently-labeled, tumor-targeting contrast agent, panitumumab-IRDye800CW, to facilitate the identification of metastatic LNs in the ex vivo setting for head and neck cancer patients. Molecular imaging demonstrates a significantly higher mean fluorescence signal in metastatic LNs compared to benign LNs in head and neck cancer patients undergoing an elective neck dissection. Molecular imaging to preselect at-risk LNs may thus allow a more rigorous examination of LNs and subsequently lead to improved prognostication than regular neck dissection.
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Affiliation(s)
- Naoki Nishio
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 900 Blake Wilbur Drive, Stanford, CA, 94305, USA.,Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Nynke S van den Berg
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 900 Blake Wilbur Drive, Stanford, CA, 94305, USA
| | - Stan van Keulen
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 900 Blake Wilbur Drive, Stanford, CA, 94305, USA.,Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Brock A Martin
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Shayan Fakurnejad
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 900 Blake Wilbur Drive, Stanford, CA, 94305, USA
| | - Nutte Teraphongphom
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 900 Blake Wilbur Drive, Stanford, CA, 94305, USA
| | - Stefania U Chirita
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 900 Blake Wilbur Drive, Stanford, CA, 94305, USA
| | - Nicholas J Oberhelman
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 900 Blake Wilbur Drive, Stanford, CA, 94305, USA
| | - Guolan Lu
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 900 Blake Wilbur Drive, Stanford, CA, 94305, USA
| | - Crista E Horton
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 900 Blake Wilbur Drive, Stanford, CA, 94305, USA
| | - Michael J Kaplan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 900 Blake Wilbur Drive, Stanford, CA, 94305, USA
| | - Vasu Divi
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 900 Blake Wilbur Drive, Stanford, CA, 94305, USA
| | - A Dimitrios Colevas
- Department of Medicine, Division of Medical Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA
| | - Eben L Rosenthal
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 900 Blake Wilbur Drive, Stanford, CA, 94305, USA.
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10
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Duan Q, Xu M, Zhang X, Jia M, Yuan R, Gan M. Clinical significance of cytokeratin in the cervical lymph nodes of patients with mandibular gingival squamous cell carcinoma. Oncol Lett 2018; 16:3135-3139. [PMID: 30127905 PMCID: PMC6096087 DOI: 10.3892/ol.2018.9005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 06/12/2018] [Indexed: 12/13/2022] Open
Abstract
The present study aims to analyze the expression of broad spectrum cytokeratin in the cervical lymph nodes of patients with mandibular gingival squamous cell carcinoma and explore the metastasis of mandibular gingival squamous cell carcinoma in cervical lymph nodes. This study included 42 patients with mandibular gingival squamous cell carcinoma, which was staged according to the clinical staging criteria by International Union Against Cancer 2002 (UICC) and the Level staging method of cervical lymph node by American Academy of Otolaryngology-Head and Neck Surgery 1991. Monoclonal mouse anti-human cytokeratin (AE1/AE3) antibody was used in immunohistochemical examination and hematoxylin and eosin (H&E) staining. All positive sections by H&E staining were also positive by immunohistochemistry (IHC). The positive rate of routine H&E staining and serial-section H&E staining was 8.03 and 9.57%, respectively, the positive rate of IHC was 12.82%. The positive rate of IHC was significantly different with that of routine H&E staining (χ2=7.17, P<0.01), yet not significantly different with that of serial-section H&E staining (χ2=3.10, P>0.05). Lymph node metastasis was mainly in Level I, II and III, both serial-section H&E staining and IHC showed lymph node metastasis in Level IV for advanced patients. IHC showed 19 lymph node micrometastasis in 12 patients, while neither serial-section nor routine H&E staining showed micrometastasis. Lymph node dissection of hyoid bone (mainly in Level I, II and III) could be used for early patients, and the dissection could be expanded to Level IV for advanced patients.
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Affiliation(s)
- Qingyun Duan
- Oral and Maxillofacial Surgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Mei Xu
- Department of Ophtalmology, Hangzhou Jianggan District People's Hospital, Hangzhou, Zhejiang 310016, P.R. China
| | - Xiong Zhang
- Oral and Maxillofacial Surgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Muyun Jia
- Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University Medical College, Qingdao, Shandong 266003, P.R. China
| | - Rongtao Yuan
- Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University Medical College, Qingdao, Shandong 266003, P.R. China
| | - Min Gan
- Oral and Maxillofacial Surgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, Zhejiang 310006, P.R. China
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11
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Ho AS, Kim S, Tighiouart M, Gudino C, Mita A, Scher KS, Laury A, Prasad R, Shiao SL, Van Eyk JE, Zumsteg ZS. Metastatic Lymph Node Burden and Survival in Oral Cavity Cancer. J Clin Oncol 2017; 35:3601-3609. [PMID: 28880746 PMCID: PMC5791830 DOI: 10.1200/jco.2016.71.1176] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Current staging systems for oral cavity cancers incorporate lymph node (LN) size and laterality, but place less weight on the total number of positive metastatic nodes. We investigated the independent impact of numerical metastatic LN burden on survival. Methods Adult patients with oral cavity squamous cell carcinoma undergoing upfront surgical resection for curative intent were identified in the National Cancer Data Base between 2004 and 2013. A neck dissection of a minimum of 10 LNs was required. Multivariable models were constructed to assess the association between the number of metastatic LNs and survival, adjusting for factors such as nodal size, laterality, extranodal extension, margin status, and adjuvant treatment. Results Overall, 14,554 patients met inclusion criteria (7,906 N0 patients; 6,648 node-positive patients). Mortality risk escalated continuously with increasing number of metastatic nodes without plateau, with the effect most pronounced with up to four LNs (HR, 1.34; 95% CI, 1.29 to 1.39; P < .001). Extranodal extension (HR, 1.41; 95% CI, 1.20 to 1.65; P < .001) and lower neck involvement (HR, 1.16; 95% CI, 1.06 to 1.27; P < .001) also predicted increased mortality. Increasing number of nodes examined was associated with improved survival, plateauing at 35 LNs (HR, 0.98; 95% CI, 0.98 to 0.99; P < .001). In multivariable models accounting for the number of metastatic nodes, contralateral LN involvement (N2c status) and LN size were not associated with mortality. A novel nodal staging system derived by recursive partitioning analysis exhibited greater concordance than the American Joint Committee on Cancer (8th edition) system. Conclusion The number of metastatic nodes is a critical predictor of oral cavity cancer mortality, eclipsing other features such as LN size and contralaterality in prognostic value. More robust incorporation of numerical metastatic LN burden may augment staging and better inform adjuvant treatment decisions.
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Affiliation(s)
- Allen S. Ho
- All authors: Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sungjin Kim
- All authors: Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Cynthia Gudino
- All authors: Cedars-Sinai Medical Center, Los Angeles, CA
| | - Alain Mita
- All authors: Cedars-Sinai Medical Center, Los Angeles, CA
| | - Kevin S. Scher
- All authors: Cedars-Sinai Medical Center, Los Angeles, CA
| | - Anna Laury
- All authors: Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ravi Prasad
- All authors: Cedars-Sinai Medical Center, Los Angeles, CA
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12
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Capelli FDA, Paes VR, Machado MM, Menezes CL, Silva PRAD, Siqueira SAC, Alves VAF, Matos LL, Cernea CR. Quantitative analysis of lymph nodes in neck dissection specimens. Morphologic study. Acta Cir Bras 2017; 31:428-33. [PMID: 27487276 DOI: 10.1590/s0102-865020160070000001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/23/2016] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To quantify the amount of lymph nodes harvested in modified radical neck dissection. METHODS Cross-sectional anatomical study conducted in 28 non-preserved cadavers. RESULTS The mean number of lymph nodes found in each nodal level of the 56 modified radical neck dissections performed were: level IA - 1.5 (95% CI: 1.1 - 1.8), level IB - 2.5 (95% CI: 2.1 - 2.9), level IIA - 7.2 (95% CI: 6.0 - 8.5), IIB level - 6.5 (95% CI: 5.5 - 7.4), level III - 6.6 (95% CI: 5.7 - 7.4), level IV - 8.6 (95% CI: 7.1 - 10.1), level V - 11 (95% CI: 9.2 - 12.7), totalizing 43.8 lymph nodes (95% CI: 40.3 - 47.4). CONCLUSION The results defined a parameter in relation to the minimum recommended nodal yield in a modified radical neck dissection, as well as the number of lymph nodes in each level of this dissection, performed in clinical practice.
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Affiliation(s)
- Fábio de Aquino Capelli
- MD, Department of Head and Neck Surgery, School of Medicine, Universidade de São Paulo (USP), Sao Paulo-SP, Brazil. Analysis of data, manuscript writing, design and supervise all phases of the study
| | - Vitor Ribeiro Paes
- MD, Department of Pathology, School of Medicine, USP, Sao Paulo-SP, Brazil. Analysis of data, histopathological examinations, design and supervise all phases of the study
| | | | | | | | | | - Venâncio Avancini Ferreira Alves
- PhD, Chairman, Full Professor, Department of Pathology, School of Medicine, USP, Sao Paulo-SP, Brazil. Design and supervise all phases of the study
| | - Leandro Luongo Matos
- PhD, Assistant Professor, Department of Head and Neck Surgery, School of Medicine, USP (LIM 28) and Instituto do Câncer do Estado de São Paulo (ICESP), Brazil. Analysis of data, manuscript writing, critical revision, design and supervise all phases of the study
| | - Claudio Roberto Cernea
- PhD, Associate Professor, Head Division, Department of Head and Neck Surgery, School of Medicine, USP, Sao Paulo-SP, Brazil. Critical revision, design and supervise all phases of the study
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13
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Toppi JT, Bruscino-Raiola F. Modified radical neck dissection vs. selective neck dissection: an analysis of lymph node yield and post-surgical outcomes. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015. [DOI: 10.1007/s00238-014-1054-1] [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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14
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Abstract
The cervical lymph nodes can be affected by a variety of infectious, inflammatory, benign, and malignant pathologic conditions. Clinical history and physical examination with the complementary use of imaging is essential to accurately make a diagnosis or appropriate differential. Knowledge of cervical lymph node anatomy, drainage pathways, morphologic variations, and common nodal pathology is key to correct interpretation of cervical lymph nodes on imaging. Computed tomography (CT), MR, ultrasound, and PET/CT are complementary imaging modalities that can be used in the evaluation of cervical lymph node pathology.
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Affiliation(s)
- Laura B Eisenmenger
- Department of Radiology, University of Utah, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140, USA; Department of Biomedical Informatics, University of Utah, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140, USA
| | - Richard H Wiggins
- Department of Radiology, University of Utah, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140, USA; Department of Biomedical Informatics, University of Utah, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140, USA; Division of Otolaryngology-Head and Neck Surgery, University of Utah, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140, USA.
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15
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Acar T, Savas R, Kocacelebi K, Guneyli S. Supraclavicular lymphadenopathy: should it be perceived as the virchow's node of head and neck tumors? Oncol Res Treat 2014; 37:726-30. [PMID: 25531718 DOI: 10.1159/000369429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 10/21/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND In this study, we aimed to determine the correlation between supraclavicular lymph node involvement (SLNI) and metastatic potential, frequency, and metastases predilection sites in patients diagnosed with various head and neck tumors (HNT) and staged via positron emission tomography/computed tomography (PET/CT) imaging. We also investigated the impact of different variables on SLNI. PATIENTS AND METHODS 270 patients diagnosed with HNT were enrolled in the study (194 males and 96 females, mean age 54.9 ± 14.7 years (range 18-89 years)). RESULTS Nasopharyngeal carcinoma demonstrated significant SLNI (p < 0.01); however, other subtypes of HNT did not. In all HNT studied, no apparent metastatic predilection tendency for the supraclavicular region was observed, as opposed to the well-described Virchow's node. Age, gender, tumor size, and systemic metastases were not identified as statistically significant variables contributing to SLNI. Multivariate regression analysis revealed an increased cervical (p < 0.01) and thoracic (p = 0.001) lymph node involvement in patients with SLNI. CONCLUSION SLNI with the possibility of metastasis was more frequently observed in nasopharyngeal carcinoma, advancing the nodal status without significantly influencing the T and M stages. A careful evaluation of this very small region is of critical importance for proper nodal staging in nasopharyngeal cancer patients.
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Affiliation(s)
- Turker Acar
- Department of Radiology, Mevlana University School of Medicine, Konya, Turkey
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16
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Ward MJ, Mellows T, Harris S, Webb A, Patel NN, Cox HJ, Piper K, Ottensmeier CH, Thomas GJ, King EV. Staging and treatment of oropharyngeal cancer in the human papillomavirus era. Head Neck 2014; 37:1002-13. [PMID: 24753272 DOI: 10.1002/hed.23697] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 03/28/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Oropharyngeal squamous cell carcinoma (SCC) is staged using the TNM system. Human papillomavirus (HPV)-positive tumors have improved prognosis, despite presenting at advanced stage. Optimal treatment and stratification of HPV-positive patients are not clearly defined. METHODS We retrospectively analyzed 266 patients with oropharyngeal SCC for mortality and feeding tube dependency related to TNM stage, HPV status, and treatment. RESULTS TNM staging was prognostic in HPV-negative patients (stage III/IV hazard ratio [HR], 2.00; p = .05; N(+) HR, 2.19; p = .02). Only T classification was prognostic in HPV-positive tumors (T3/T4 HR 3.31; p = .006). HPV-positive tumors showed improved survival regardless of treatment. Patients receiving chemotherapy had a significantly increased risk of feeding tube dependency (odds ratio [OR], 1.72; p = .03). CONCLUSION These data suggest that the current TNM system has little prognostic value in HPV-positive oropharyngeal SCC. Patients with HPV-positive tumors show improved survival independent of treatment. The addition of chemotherapy increases the risk of feeding tube dependency and could potentially be avoided in T1/T2 HPV-positive tumors without compromising survival.
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Affiliation(s)
- Matthew J Ward
- Cancer Sciences Unit, University of Southampton, United Kingdom
| | - Toby Mellows
- Cancer Sciences Unit, University of Southampton, United Kingdom
| | - Scott Harris
- Department of Medical Statistics, University of Southampton, United Kingdom
| | - Andrew Webb
- Department of Oral and Maxillofacial Surgery, University Hospital Southampton NHS Foundation Trust, United Kingdom
| | - Nimesh N Patel
- Department of Otolaryngology - Head and Neck Surgery, University Hospital Southampton NHS Foundation Trust, United Kingdom
| | - Hugh J Cox
- Department of Otolaryngology - Head and Neck Surgery, Poole NHS Foundation Trust, United Kingdom
| | - Kim Piper
- Department of Cellular Pathology, Bart's and The London School of Medicine and Dentistry, United Kingdom
| | - Christian H Ottensmeier
- Cancer Sciences Unit, University of Southampton, United Kingdom.,NIHR Experimental Cancer Medicine Centre Southampton, United Kingdom
| | - Gareth J Thomas
- Cancer Sciences Unit, University of Southampton, United Kingdom.,NIHR Experimental Cancer Medicine Centre Southampton, United Kingdom
| | - Emma V King
- Cancer Sciences Unit, University of Southampton, United Kingdom.,Department of Otolaryngology - Head and Neck Surgery, Poole NHS Foundation Trust, United Kingdom.,NIHR Experimental Cancer Medicine Centre Southampton, United Kingdom
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Trivedi S, Mattos J, Gooding W, Godfrey TE, Ferris RL. Correlation of tumor marker expression with nodal disease burden in metastatic head and neck cancer. Otolaryngol Head Neck Surg 2013; 149:261-8. [PMID: 23625795 DOI: 10.1177/0194599813486876] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate the correlation between the percentage of metastatic tumor present in lymph nodes resected from patients with squamous cell carcinoma of the head and neck (HNSCC) and level of expression of 3 marker genes: pemphigus vulgaris antigen (PVA), parathyroid hormone-related peptide (PTHrP), and tumor-associated calcium signal transducer 1 (TACSTD1). In addition, we investigated whether the level of expression of these 3 markers was associated with clinical outcomes for patients with HNSCC. STUDY DESIGN Retrospective analysis of previously harvested patient samples. SETTING The University of Pittsburgh. SUBJECTS AND METHODS A total of 448 lymph nodes from 92 patients with HNSCC were evaluated for expression of the gene markers PVA, PTHrP, and TACSTD1 using real-time polymerase chain reaction. Confirmation of metastasis was determined by histologic examination. The expression level of these markers versus tumor percentage was analyzed. RESULTS All 3 markers were studied independently and were associated with tumor percentage in metastatic lymph nodes. PVA had the strongest correlation, followed by PTHrP and then TACSTD1. PVA levels had a trend toward association with clinical outcome, specifically time to death caused by cancer, but this was confounded by tumor stage. CONCLUSION All 3 tumor gene markers were associated with percentage of tumor cells in metastatic lymph nodes. PVA had the strongest correlation. PVA may add prognostic utility beyond pathologic staging, but this requires analysis of a larger cohort. Prospective studies of tumor volume in metastatic nodes should determine a lower limit threshold of molecular marker detection.
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Affiliation(s)
- Sumita Trivedi
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA
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18
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Prognostic Significance of Nodal Metastasis in Advanced Tumours of the Larynx and Hypopharynx. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.otoeng.2012.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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19
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Barroso Ribeiro R, Ribeiro Breda E, Fernandes Monteiro E. Prognostic significance of nodal metastasis in advanced tumors of the larynx and hypopharynx. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 63:292-8. [PMID: 22579383 DOI: 10.1016/j.otorri.2012.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 02/06/2012] [Accepted: 02/13/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To estimate the relevance of post-surgical neck nodal classification (pN) on the global survival of patients with advanced tumors of the larynx and hypopharynx, primarily treated with surgery including neck dissection (ND). To understand the prognostic significance of metastatic lymph nodes' extracapsular spread (ECS) and its impact on survival. MATERIAL AND METHODS A retrospective review of patients primarily submitted for total laryngectomy (TL) with either elective or therapeutic bilateral ND. Overall and disease-free survival was analysed according to post-operative histopathological ND results, concerning the presence or absence of nodal involvement, number of affected nodes and the existence of ECS. RESULTS One hundred and twenty patients met the inclusion criteria of this study. Concerning nodal involvement, the histopathological evaluation demonstrated positive lymph nodes in 46.6% of the cN0 patients. The rate of patients alive after 2 years of follow-up, based on pN analysis, was 88.1% for the pN0 group, 65.4% for the group N+ without ECS, 46.2% for the N+ ECS+ (1 node) and 15.4% for the N+ ECS+ (more than 1 node) group (P<.001). CONCLUSIONS This study demonstrates a high prevalence of occult neck disease in tumours of the larynx and hypopharynx. The involvement of metastatic cervical lymph nodes has a negative impact on survival. Patients with multinodal ECS have a poorer survival, reflected by a higher rate of loco-regional and distant metastases, when compared to ECS in one single lymph node.
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Affiliation(s)
- Ricardo Barroso Ribeiro
- Departamento de Otorrinolaringología, Instituto Oncológico Portugués Francisco Gentil, Oporto, Portugal.
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20
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Van Abel KM, Moore EJ. Focus issue: neck dissection for oropharyngeal squamous cell carcinoma. ISRN SURGERY 2012; 2012:547017. [PMID: 22586518 PMCID: PMC3265121 DOI: 10.5402/2012/547017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 11/21/2011] [Indexed: 11/23/2022]
Abstract
The staging and prognosis of oropharyngeal squamous cell carcinoma is intimately tied to the status of the cervical lymph nodes. Due to the high risk for occult nodal disease, most clinicians recommend treating the neck for these primary tumors. While there are many modalities available, surgical resection of nodal disease offers both a therapeutic and a diagnostic intervention. We review the relevant anatomy, nodal drainage patterns, clinical workup, surgical management and common complications associated with neck dissection for oropharyngeal squamous cell carcinoma.
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Affiliation(s)
- Kathryn M. Van Abel
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Eric J. Moore
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
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21
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DEGANELLO A, GITTI G, MECCARIELLO G, PARRINELLO G, MANNELLI G, GALLO O. Effectiveness and pitfalls of elective neck dissection in N0 laryngeal cancer. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2011; 31:216-21. [PMID: 22058599 PMCID: PMC3203726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 05/08/2011] [Indexed: 11/24/2022]
Abstract
The aim of the study was to evaluate the efficacy and potential pitfalls of selective neck dissection of levels II-IV in controlling occult neck disease in clinically negative neck (cN0) of patients with laryngeal squamous cell carcinoma. Charts of 96 consecutive cN0 laryngeal cancer patients undergoing 122 neck dissections at the University of Florence from January 2000 to December 2004 were reviewed. N0 neck was defined with contrast enhanced computed tomography scan. Occult neck disease rate was 12.5%, involvement per level was: 47.6% at level II, 38.1% at level III, 9.5% at level IV. Six patients developed neck recurrence (6.25%) after selective neck dissection of levels II-IV within the first two years after treatment. In conclusion, selective neck dissection of levels II-IV is effective in N0 laryngeal squamous cell carcinoma; posterior limits of surgical resection are missing therefore if post-operative radiation is required, the field should be extended beyond the dissected levels. The low incidence of occult neck disease indicates the need to refine treatment strategy, restricting elective neck dissection only to supraglottic T2 with epilaryngeal involvement, supraglottic T3-4 and glottic T4 tumours, and considering a "wait and see" protocol implemented with imaging techniques and cytological assessments for other lesions.
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Affiliation(s)
- A. DEGANELLO
- Address or correspondence: Dr. Alberto Deganello, Clinica di Otorinolaringologia Chirurgia Testa e Collo, Dipartimento di Scienze Chiurrgiche, Università di Firenze, viale Morgagni 85, 50134 Firenze, Italy. Fax: +39 055 435649. E-mail:
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22
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The sudden presentation and progression of overt cervical metastases following treatment of head and neck cancers. Eur Arch Otorhinolaryngol 2010; 268:1-4. [PMID: 21113788 PMCID: PMC3015201 DOI: 10.1007/s00405-010-1431-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 11/02/2010] [Indexed: 11/12/2022]
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