Immunohistochemical staining with cytokeratin combining semi-serial sections for detection of cervical lymph node metastases of oral squamous cell carcinoma

Impact of multisection and immunohistochemistry in lymph node staging of Gastric Carcinoma - Case series

Gastric carcinoma (GC) locoregional recurrence may occur even in cases where the tumor has been completely resected, possibly due to lymph node (LN) micrometastases. It is estimated that in 10% to 30% of cases, LN micrometastases are not detected by a conventional method for histological assessment of LN metastases with hematoxylin-eosin (HE). A cross-sectional study assessed 51 patients with GC by histological evaluation of the LN micrometastases through LN multi sectioning associated with immunohistochemistry analysis with monoclonal antibodies AE1 and AE3. Total gastrectomy was performed in 51% of patients. The total number of resected LN nodes was 1698, with a mean number of resected LN of 33.3 ± 13.2 per surgical specimen, of which 187 had metastasis. After the application of LN multisection and immunohistochemistry, LN micrometastases were found in 45.1% of the cases. LN staging changed in 29.4%, and tumor staging changed in 23.5% of the cases. In patients initially staged as pN0, LN staging and tumor staging changed, both in 19.2% of the cases. In patients initially staged as pN1 or more, LN staging changed in 40.0% of them, and tumor staging changed in 28.0% of the cases. The accuracy of HE for the histological staging of LN tumoral involvement was 76%, which was considered insufficient for CG patients staging. Investigation of LN micrometastasis through LN multisection and immunohistochemistry should be performed, particularly in cases where the presence of blood and lymphatic vessel invasion has been identified after conventional histological analysis, as well as in patients with advanced GC.

Accuracy of 18 F-FDG PET/CT in Detection of Neck Metastases of Oral Squamous Cell Carcinoma in Patients Without Large Palpable Lymph Nodes

OBJECTIVE

To measure the efficacy of positron emission tomography/computed tomography (PET/CT) in the diagnosis of neck metastases of oral squamous cell carcinoma (OSCC) in patients without enlarged lymph nodes and to determine the threshold of maximum standardized uptake values (SUV_max) in diagnosis.

STUDY DESIGN

In total, 78 OSCC patients without large palpable lymph nodes were included. PET/CT findings were compared with histopathologic neck status.

RESULTS

Neck dissection was performed in 78 patients with 98 neck sides, and 31 neck sides harbored metastases. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT were 83.9%, 73.1%, 76.5%, 59.1%, and 90.7%, respectively. The area under the curve in receiver operating characteristic analysis was 0.76, which indicated that SUV_max of lymph nodes was useful in diagnosis of pathologic neck status. The threshold SUV_max was 2.21, which was the best diagnosis threshold of neck metastasis.

CONCLUSIONS

PET/CT is valuable in diagnosis of neck status. The probability of neck metastasis increased with increasing SUV_max values, but the threshold SUV_max should not be the sole criterion for determining the presence of neck metastases. Fluorodeoxyglucose PET/CT is recommended for evaluation of neck status in OSCC patients without large palpable lymph nodes.

Hesperetin on Cell Surface Glycoconjugates Abnormalities and Immunohistochemical Staining with Cytokeratin in 7,12 Dimethylbenz(a)anthracene Induced Hamster Buccal Pouch Carcinogenesis

Hesperetin, a naturally occurring citrus flavanone of the bioactive substance, possesses different pharmacological and biochemical activities including anti-cancer and anti-oxidants effect. The aim of the study to investigate that hesperetin on abnormalities of glycoconjugates (protein bound hexose, hexosamine, total sialic acid and fucose), histology (PAS staining) and immunoexpression of cytokeratin during 7,12-dimethylbenz(a)anthracene (DMBA) induced hamster buccal pouch (HBP) carcinogenesis. Oral tumors were developed in the buccal pouches of male golden Syrian hamsters by topical application of 0.5% DMBA thrice a week for 10 weeks and developed morphological alterations depicted as hyperplasia, dysplasia and well-differentiated squamous cell carcinoma formation with noticeable abnormalities of glycoconjugates and cytokeratin. The protective effect of hesperetin against DMBA was evaluated by assessing immunohistochemical expression, histological sections of buccal tissues and the levels of glycoconjugates in the buccal mucosa and plasma were analyzed. Hesperetin administrated orally at a dose of 20 mg/kg b.w. to hamsters treated with DMBA, significantly reduced the status of glycoconjugates and cytokeratin to the near normal range. Overall findings accomplished that hesperetin protects cell surface glycoconjugates abnormalities in DMBA induced HBP carcinogenesis.

Detection of cervical lymph node micrometastasis and isolated tumor cells in oral squamous cell carcinoma using immunohistochemistry and serial sectioning

INTRODUCTION

Oral squamous cell carcinoma (OSCC) comprises one of the largest subsets of cancers with a tendency for regional metastasis. Nodal status is a key prognostic indicator in patients with OSCC, particularly with N0 neck. Occult metastasis in the form of micrometastasis (MM) and isolated tumor cells (ITCs), often goes undetected by routine hematoxylin and eosin (H&E) examination using 1-2 sections for analysis. This limitation could be overcome by combining serial sectioning (SS) with immunohistochemistry (IHC) for the detection of MM and ITC. Pan-cytokeratin (pan-CK) (AE1/AE3) is particularly a useful marker to detect these deposits as their presence has resulted in varied interpretations and different applications of the tumor-node-metastasis system.

OBJECTIVES

The objective of the study was to identify a suitable method for detecting MM and ITC in lymph nodes (LNs) of OSCC by combining SS and IHC and to compare it with conventional H&E staining.

MATERIALS AND METHODS

This laboratory-based, prospective study was conducted on 133 LNs harnessed from ten patients treated with radical neck dissection for primary OSCC. The LNs were subjected to SS at 100 μm intervals. The sections were stained with routine H&E staining, pan-CK and analyzed for MM and ITC according to criteria laid by Hermanek et al.

STATISTICAL ANALYSIS

The obtained data were subjected to statistical analysis using Chi-square test.

RESULTS

The application of combination of SS and IHC using pan-CK (AE1/AE3) in our study revealed the presence of MM and ITC in 2.25% of the LNs diagnosed as negative on routine H&E examination. The detection of these occult metastatic deposits resulted in upstaging of 33.33% of the patients.

CONCLUSION

In the view of crucial role of occult LN metastasis in prognosis and survival of OSCC patients with N0 neck, diagnostic tools such as IHC staining, particularly with pan-CK (AE1/AE3), combined with SS should be preferred over conventional methods as they result in upstaging, thus sparing the low-risk patients the morbidity of unnecessary treatment.

A meta-analysis on selective versus comprehensive neck dissection in oral squamous cell carcinoma patients with clinically node-positive neck

OBJECTIVE

Properly management of cervical lymph node metastases is a critical treatment for patients with oral squamous cell carcinoma (OSCC). However there is no consensus on the optimal treatment for oral cancer patients with clinically node-positive (cN+) neck. This study aims to access the feasibility of selective neck dissection in oral cancer patients with cN+neck.

METHOD

We searched PubMed and EMBASE up to April 2015 to identify the studies which compared selective neck dissection (SND) with comprehensive neck dissection (CND) in OSCC patients with cN+neck. Data were extracted by two authors. The meta-analysis was conducted with regional recurrence and disease specific death as primary endpoints.

RESULT

Five studies with a total of 443 patients met our inclusion criteria. No significant difference was found regarding regional recurrence, disease specific death or overall death between the SND and CND group.

CONCLUSION

These findings suggest that cN+OSCC patients treated with SND in conjunction with adjuvant therapy got comparable clinical outcome to CND.

Supraomohyoid neck dissection in the management of oral squamous cell carcinoma: special consideration for skip metastases at level IV or V

PURPOSE

The aim of this study was to evaluate the therapeutic safety and prognosis of supraomohyoid neck dissections for oral squamous cell carcinoma, with a special focus on the risk of skip metastases in level IV or V.

MATERIALS AND METHODS

A retrospective study was conducted of 637 patients with oral squamous cell carcinoma who were admitted to the department of oral and maxillofacial surgery from September 1995 through July 2010. After completing a diagnostic evaluation, all patients underwent surgery (wide primary excision with supraomohyoid neck dissection, extended supraomohyoid neck dissection, or modified radical or radical neck dissection) and were followed periodically.

RESULTS

Levels I, II, and III were the most common sites of occult metastasis. Skip metastases alone at level IV or V and any neck recurrence at level IV or V were not found. Three-year neck recurrence-free survival and disease-specific survival were not significantly different among the patients who underwent supraomohyoid neck dissection, extended supraomohyoid neck dissection, or modified radical or radical neck dissection owing to cN0 to cN(+) disease.

CONCLUSIONS

The rate of skip metastasis at level IV or V is very rare and is very difficult to diagnose accurately. The results of this retrospective study show that supraomohyoid neck dissection for oral squamous cell carcinoma is an appropriate treatment.