1
|
Krishnan G, Cousins A, Pham N, Milanova V, Nelson M, Krishnan S, van den Berg NS, Shetty A, Rosenthal EL, Wormald P, Thierry B, Foreman A, Krishnan S. Preclinical feasibility of robot-assisted sentinel lymph node biopsy using multi-modality magnetic and fluorescence guidance in the head and neck. Head Neck 2022; 44:2696-2707. [PMID: 36082404 PMCID: PMC9825899 DOI: 10.1002/hed.27177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/08/2022] [Accepted: 08/16/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is a staging procedure dependent on accurate mapping of draining lymphatics via tracers. Robot-assisted SLNB enables access to multiple neck levels with a single incision and intraoperative fluorescence guidance to the SLN. METHODS Lymphatic mapping in swine was done using a magnetic tracer and fluorescent dye, injected into the tongue. MRI preoperatively mapped lymphatic spread of the magnetic tracer. Dissection was performed using a da Vinci Xi robot guided by fluorescence-imaging of the dye. RESULTS Robot-assisted SLNB was successfully performed in all animals (n = 5). A novel MRI protocol differentiated SLNs (n = 6) from lower echelon nodes (n = 11) based on flow progression. Fluorescence imaging provided valuable intraoperative guidance and correlated with magnetic-positive nodes. CONCLUSIONS This study demonstrates preclinical feasibility of a robot-assisted approach to SLNB using magnetic and fluorescent tracers in the head and neck, enabling both preoperative mapping and intraoperative guidance.
Collapse
Affiliation(s)
- Giri Krishnan
- Department of Otolaryngology, Head and Neck SurgeryThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Aidan Cousins
- Future Industries InstituteUniversity of South Australia, Mawson Lakes CampusAdelaideSouth AustraliaAustralia
| | - Nguyen Pham
- Key Centre for Polymers and Colloids, School of Chemistry and University of Sydney Nano InstituteThe University of SydneySydneyNew South WalesAustralia
| | - Valentina Milanova
- Future Industries InstituteUniversity of South Australia, Mawson Lakes CampusAdelaideSouth AustraliaAustralia
| | | | - Shridhar Krishnan
- Department of Oral and Maxillofacial SurgeryThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Nynke S. van den Berg
- Department of Otolaryngology—Division of Head and Neck SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Anil Shetty
- Ferronova Pty LtdAdelaideSouth AustraliaAustralia
| | - Eben L. Rosenthal
- Department of Otolaryngology—Division of Head and Neck SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Peter‐John Wormald
- Department of Otolaryngology, Head and Neck SurgeryThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Benjamin Thierry
- Future Industries InstituteUniversity of South Australia, Mawson Lakes CampusAdelaideSouth AustraliaAustralia
| | - Andrew Foreman
- Department of Otolaryngology, Head and Neck SurgeryThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Suren Krishnan
- Department of Otolaryngology, Head and Neck SurgeryThe University of AdelaideAdelaideSouth AustraliaAustralia
| |
Collapse
|
2
|
Suárez Ajuria M, Gallas Torreira M, García García A, Marichalar Mendía X, Chamorro Petronacci CM, Padín Iruegas E, Pérez Sayáns M. Efficacy of different sentinel lymph node biopsy protocols in oral squamous cell carcinoma: Systematic review and meta-analysis. Head Neck 2022; 44:1702-1714. [PMID: 35362176 PMCID: PMC9314893 DOI: 10.1002/hed.27042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/26/2022] [Accepted: 03/15/2022] [Indexed: 11/25/2022] Open
Abstract
The sentinel node biopsy (SNB) is highly protocolized in other cancers, however, this is not the case for oral squamous cell carcinoma patients, hence our objective was to evaluate the different protocols published. A specific study protocol was designed and subsequently registered on PROSPERO (Ref. CRD42021279217). Twenty‐three articles were included in the meta‐analysis. The grouped sensitivity of the SNB was 82% (95% CI: 0.74–0.88), and the grouped specificity was 100% (95% CI: 0.99–1.00). The use of other radiotracers other than pre‐operative lopamidol showed higher values of sensitivity of 82.80% (95% CI: 76.90%–87.50%; p < 0.001). The use of the blue dye stain showed higher sensitivity values of 85.60% (95% CI: 71.90%–93.20%), compared to sensitivity values of 77.50% when it was not used (95% CI: 69.10%–84.20%) (p < 0.001). Diagnostic rates are variable and they were significantly better when 99mTc was used in all its variations and accompanied by the blue dye staining.
Collapse
Affiliation(s)
- Maria Suárez Ajuria
- Oral Medicine and Surgery Unit, Faculty of dentistry, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Mercedes Gallas Torreira
- Oral Medicine and Surgery Unit, Faculty of dentistry, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Abel García García
- Oral Medicine and Surgery Unit, Faculty of dentistry, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.,Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | | | - Cintia M Chamorro Petronacci
- Oral Medicine and Surgery Unit, Faculty of dentistry, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.,Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Elena Padín Iruegas
- Faculty of Physiotherapy, Department of Functional Biology and Health Sciences, Human Anatomy and Embryology Area, Pontevedra, Spain
| | - Mario Pérez Sayáns
- Oral Medicine and Surgery Unit, Faculty of dentistry, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.,Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| |
Collapse
|
3
|
Methods for sentinel lymph node mapping in oral cancer: a literature review. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Oral cancers, excluding non-melanoma skin cancer, are the most common cancers of the head and neck. Of these, 90% are squamous cell carcinomas (SCC). Surgery, which consists of dissection of the primary tumor and lymphadenectomy, is considered a radical method of treatment. There are several ranges of cervical lymphadenectomy: selective neck dissection (SND), modified radical neck dissection (MRND), and radical neck dissection (RND). The extension of surgery depends on the stage of clinical advancement, which can be determined by TNM classification, among other methods. The greatest controversy is related to SND in patients with cN0 (no evidence of regional lymph node metastasis), which is currently standard procedure. This approach is dictated by the possibility of hidden or subclinical metastases. The use of the sentinel lymph node (SLN) concept in patients with early stage of oral cancer and appropriate methods of its mapping may lead to a reduction in the extent of the lymphadenectomy procedure, thus reducing postoperative mortality and maintaining the patient’s function and quality of life, with correct oncological results. So far, available methods for SLN mapping are based on use of markers: methylene blue dye (MBD), metastable radioactive isotope Technetium (99mTc), or the fluorescent substance indocyanine green (ICG).
Collapse
|
4
|
Paek SH, Yi KH, Kim SJ, Choi JY, Lee KE, Park YJ, Park DJ, Kang KW, Chung JK. Feasibility of sentinel lymph node dissection using Tc-99m phytate in papillary thyroid carcinoma. Ann Surg Treat Res 2017; 93:240-245. [PMID: 29184876 PMCID: PMC5694714 DOI: 10.4174/astr.2017.93.5.240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/11/2017] [Accepted: 04/26/2017] [Indexed: 02/06/2023] Open
Abstract
Purpose Various methods of sentinel lymph node (SLN) biopsy in thyroid cancer have been introduced. Tc-99m phytate as a radiotracer has been successfully utilized for SLN biopsy in breast, cervix, and endometrial cancer. We assessed the feasibility of SLN dissection using Tc-99m phytate in papillary thyroid carcinoma (PTC). Methods Seventeen patients with PTC were prospectively enrolled. Ultrasound-guided peritumoral injection of 55.5 MBq Tc-99m phytate in 0.25-mL normal saline was performed. Preoperative single-photon emission-computed tomography (SPECT) and intraoperative gamma-probe were used for SLN detection during operation. Results Identification rate of SLNs was 70.6% (12 of 17) with SPECT, and 88.2% (15 of 17) with gamma-probe. Combined SPECT and gamma-probe had identification rates of 88.2% (15 of 17). Identification rates of SLNs in central LN compartments were 82.4% (14 of 17) and 41.2% (7 of 17) in lateral LN compartments. Overall sensitivity, specificity, positive predictive value, and negative predictive value of the results of SLN biopsy were 91.6%, 100%, 88.4%, and 100%, respectively. Eight patients (47.1%) had metastasis in SLNs; all patients had SLN metastasis in the central compartment and 2 patients had SLN metastasis in both the central and lateral compartments. Conclusion Combined SPECT and gamma-probe could detect SLNs with an 88.2% identification rate in PTC. SLN biopsy using Tc-99m phytate is technically feasible. Further investigation is warranted for clinical application of Tc-99m phytate in PTC.
Collapse
Affiliation(s)
- Se Hyun Paek
- Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ka Hee Yi
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Su-Jin Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - June Young Choi
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyu Eun Lee
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Young Joo Park
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Do-Joon Park
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Keon Wook Kang
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - June-Key Chung
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
5
|
Gvetadze SR, Xiong P, Lv M, Li J, Hu J, Ilkaev KD, Yang X, Sun J. Contrast-enhanced ultrasound mapping of sentinel lymph nodes in oral tongue cancer-a pilot study. Dentomaxillofac Radiol 2017; 46:20160345. [PMID: 28045344 DOI: 10.1259/dmfr.20160345] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To assess the usefulness of contrast-enhanced ultrasound (CEUS) with peritumoral injection of microbubble contrast agent for detecting the sentinel lymph nodes for oral tongue carcinoma. METHODS The study was carried out on 12 patients with T1-2cN0 oral tongue cancer. A radical resection of the primary disease was planned; a modified radical supraomohyoid neck dissection was reserved for patients with larger lesions (T2, n = 8). The treatment plan and execution were not influenced by sentinel node mapping outcome. The Sonovue™ contrast agent (Bracco Imaging, Milan, Italy) was utilized. After detection, the position and radiologic features of the sentinel nodes were recorded. RESULTS The identification rate of the sentinel nodes was 91.7%; one patient failed to demonstrate any enhanced areas. A total of 15 sentinel nodes were found in the rest of the 11 cases, with a mean of 1.4 nodes for each patient. The sentinel nodes were localized in: Level IA-1 (6.7%) node; Level IB-11 (73.3%) nodes; Level IIA-3 (20.0%) nodes. No contrast-related adverse effects were observed. CONCLUSIONS For oral tongue tumours, CEUS is a feasible and potentially widely available approach of sentinel node mapping. Further clinical research is required to establish the position of CEUS detection of the sentinel nodes in oral cavity cancers.
Collapse
Affiliation(s)
- Shalva R Gvetadze
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China.,2 Department of Reconstructive Maxillofacial Surgery with Microsurgery and External Prosthetics, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia.,3 Department of Consulting and Diagnostics, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - Ping Xiong
- 4 Department of Ultrasound, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mingming Lv
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Jun Li
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Jingzhou Hu
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Konstantin D Ilkaev
- 5 Department of Head and Neck Surgery, NN Blokhin Russian Cancer Research Center, Moscow, Russia
| | - Xin Yang
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Jian Sun
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China
| |
Collapse
|
6
|
Kaya İ, Göde S, Öztürk K, Turhal G, Aliyev A, Akyıldız S, Duygun ÜY, Uluöz Ü, Yavuzer A. The Value of Sentinel Lymph Node Biopsy in Oral Cavity Cancers. Turk Arch Otorhinolaryngol 2015; 53:62-66. [PMID: 29391982 DOI: 10.5152/tao.2015.1178] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/11/2015] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of this study was to establish the effectiveness of sentinel lymph node biopsy in the detection of metastasis in N0 necks of T1-T2 early-stage oral cavity cancers. Materials and Methods Twenty neck dissections were performed in 18 patients diagnosed with T1 and T2 oral cavity cancer, with an indication for elective neck dissection between November 2007 and January 2011. The male to female ratio was 12:8, with a mean age of 54.5 years (range 28-76). Eight of the dissections were performed for lower lip cancer, 7 for tongue cancer, and 5 for floor of the mouth cancer. Sentinel lymph node biopsy was used to detect metastatic lymph nodes. Tc99m radionuclide injection was administered to the periphery of the tumor 24 h before the operation, and a lymphoscintigraphy image was obtained 30 min after the injection. Sentinel lymph nodes were localized and excised on the day of surgery using static lymphoscintigraphy images and a gamma probe. Sentinel lymph nodes were sent for a frozen section examination, and either a selective or a comprehensive neck dissection was performed for each neck according to the results. Results After the final histopathological examination of the specimens, the negative predictive value, the positive predictive value, the accuracy of the sentinel lymph node biopsy, and frozen section accuracy were found to be 100%. Conclusion Sentinel lymph node biopsy was found to be an efficient method in the pathological staging and management of the N0 neck in early T-stage oral cavity cancers.
Collapse
Affiliation(s)
- İsa Kaya
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Sercan Göde
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Kerem Öztürk
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Göksel Turhal
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Araz Aliyev
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Serdar Akyıldız
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir, Turkey
| | | | - Ümit Uluöz
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Atilla Yavuzer
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir, Turkey
| |
Collapse
|
7
|
Sangwan P, Nilakantan A, Patnaik U, Mishra A, Sethi A. Sentinel lymph node localization using 1 % isosulfan blue dye in cases of early oral cavity and oropharyngeal squamous cell carcinoma. Indian J Otolaryngol Head Neck Surg 2014; 67:56-61. [PMID: 25621255 DOI: 10.1007/s12070-014-0752-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 07/18/2014] [Indexed: 11/25/2022] Open
Abstract
To study the use of 1 % isosulfan blue dye in identifying sentinel node, sensitivity and specificity of frozen section and predictive value of sentinel node in predicting other nodal status in the cases of oral cavity and oropharyngeal squamous cell carcinoma. 15 patients of oral cavity and oropharyngeal SCC with clinically N0 neck, who required WLE of the primary lesion as well as neck dissection as per recommended treatment protocol, were selected from OPD. 1 % Isosulfan dye was injected peritumorally intraoperatively after the induction of general anaesthesia. Neck dissection was performed and first node taking up the blue dye was identified, dissected, removed and was sent for frozen section. In two of the 15 cases a sentinel node was identified (sensitivity of the technique-13 %). Both the sentinel nodes were positive for presence of metastasis on final histopathology (specificity-100 %). However, five cases had nodal metastasis on final histopathological examination of the neck dissection specimen (sensitivity of sentinel lymph node biopsy-40 %). Frozen section examination had a sensitivity and specificity of 100 %. All data was analyzed using SPSS 16 software. Use of 1 % Isosulfan Dye for identification of sentinel node is a simple and cheap technique, however, it has low sensitivity as compared to the use of triple diagnostic procedure consisting of lymphoscintigraphy, per op gamma probe localization and using isosulfan dye for sentinel node identification. Sentinel lymph node is representative of nodal status and correlates well with the final histopathological examination of the dissected neck nodes.
Collapse
Affiliation(s)
- Purnima Sangwan
- Department of ENT, Base hospital, Army College of medical Sciences, Delhi Cantt-10, New Delhi, India
| | - Ajith Nilakantan
- Dept of ENT, Army Hospital R&R, Delhi Cantt-10, New Delhi, India
| | | | | | - Ashwani Sethi
- Department of ENT, Base hospital, Army College of medical Sciences, Delhi Cantt-10, New Delhi, India
| |
Collapse
|
8
|
Jozaghi Y, Richardson K, Anand S, Mlynarek A, Hier MP, Forest VI, Sela E, Tamilia M, Caglar D, Payne RJ. Frozen section analysis and sentinel lymph node biopsy in well differentiated thyroid cancer. J Otolaryngol Head Neck Surg 2013; 42:48. [PMID: 24025621 PMCID: PMC3847460 DOI: 10.1186/1916-0216-42-48] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 09/02/2013] [Indexed: 11/20/2022] Open
Abstract
Background The aim of this study is to prospectively review the role of sentinel lymph node (SLN) biopsy in the management of well differentiated thyroid carcinoma (WDTC), and to determine the efficacy of intraoperative frozen section analysis at detecting SLN metastasis and central compartment involvement. Methods The SLN biopsy protocol using 1% methylene blue was performed in 300 patients undergoing thyroidectomy for WDTC. A limited pretracheal central compartment neck dissection (CCND) was performed on all patients. Lymph nodes staining blue were considered as SLN’s. Both frozen and permanent section analyses were performed. Results SLN’s with metastasis were found in 14.3% (43/300) of cases. Of this, 11% (33/300) were positive on intraoperative frozen section analysis. Frozen section results failed in predicting central compartment involvement in 15 cases (5%) whereas central neck compartment involvement was missed in 5 cases (1.7%) when based on permanent section results. On frozen section analysis, the sensitivity, specificity, positive predictive value and negative predictive value (95% CI) of our SLN biopsy technique aiming to remove all disease from the central compartment was 68.8% (53.6-80.9), 100% (98.1-100), 100% (87.0-100) and 94.4% (90.7-96.7) respectively with P < 0.0001. On permanent section analysis, the values were 89.6% (76.6-96.1), 100% (98.1-100), 100% (89.8-100), and 98.1% (95.3-99.3) with P < 0.0001. Conclusion This data series demonstrates that patients with WDTC have positive SLN’s in 14.3% of cases. Moreover, when the SLN’s are negative for metastasis on frozen section, the central compartment was disease-free in 94.4% of cases. Finally, this study shows that 23.3% of positive SLN’s were false negatives on intraoperative frozen section. According to this data, SLN involvement is an accurate predictor of central compartment metastasis, however surgeons should use caution when relying on intraoperative frozen section to determine whether to perform a CCND.
Collapse
Affiliation(s)
- Yelda Jozaghi
- Department of Otolaryngology Head and Neck Surgery, McGill University Thyroid Cancer Center, 3755 Côte Ste-Catherine, Montreal, PQ, Canada.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Shellenberger TD. Sentinel lymph node biopsy in the staging of oral cancer. Oral Maxillofac Surg Clin North Am 2012; 18:547-63. [PMID: 18088852 DOI: 10.1016/j.coms.2006.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Thomas D Shellenberger
- Head and Neck Surgical Oncology, M. D. Anderson Cancer Center Orlando, 1400 South Orange Avenue, MP 760, Orlando, FL 32806, USA; Head and Neck Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA
| |
Collapse
|
10
|
Sentinel lymph node biopsy versus selective neck dissection for detection of metastatic oral squamous cell carcinoma. Clin Exp Metastasis 2012; 29:693-8. [DOI: 10.1007/s10585-012-9492-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 05/20/2012] [Indexed: 10/28/2022]
|
11
|
Tumour infiltration depth ⩾4mm is an indication for an elective neck dissection in pT1cN0 oral squamous cell carcinoma. Oral Oncol 2012; 48:337-42. [DOI: 10.1016/j.oraloncology.2011.11.007] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 10/28/2011] [Accepted: 11/01/2011] [Indexed: 12/30/2022]
|
12
|
Ferris RL, Stefanika P, Xi L, Gooding W, Seethala RR, Godfrey TE. Rapid molecular detection of metastatic head and neck squamous cell carcinoma as an intraoperative adjunct to sentinel lymph node biopsy. Laryngoscope 2012; 122:1020-30. [PMID: 22447185 DOI: 10.1002/lary.22467] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 06/28/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Clinical staging of early head and neck squamous cell carcinoma (SCCHN) is often inaccurate, leading to elective neck dissection to detect the 30% of patients with micrometastatic disease. Sentinel node biopsy accurately stages the regional lymphatics, but intraoperative pathology is only moderately sensitive, and final pathology takes several days to complete. To facilitate immediate neck dissection where necessary, we have identified several promising marker genes of SCCHN metastasis and developed a rapid, accurate, and automated quantitative real-time polymerase chain reaction (PCR) (qRT-PCR) assay for intraoperative use. STUDY DESIGN Prospective tissue collection, retrospective pathologic correlation with qRT-PCR. METHODS From a 40-gene marker screen, we quantified expression of 11 potential tumor genes using a test set of primary tumors (n = 32) and metastatic (n = 19) and benign (n = 10) lymph nodes. Eight patients' paired primary tumor and metastatic nodes were included. A validation set of 442 grossly tumor-negative nodes was evaluated for expression of the most promising markers, comparing metastasis detection by qRT-PCR with pathologic analysis (hematoxylin and eosin and immunohistochemistry). A novel multiplexed, automated, single-tube qRT-PCR assay was used to analyze more than 100 lymph nodes using a two-marker, 35-minute assay to determine its negative predictive value. RESULTS Based on expression of 11 tumor-associated genes from the marker screen, the two most promising markers of SCCHN metastasis in the test set, pemphigus vulgaris antigen (PVA) and tumor-associated calcium signal transducer 1 (TACSTD1), also known as epithelial cell adhesion molecule (EpCAM), were selected. Development of a multiplexed qRT-PCR assay for the detection of metastasis compared favorably with pathologic analysis in the additional 442-node set. A rapid, multiplexed assay using PVA and TACSTD1 demonstrated excellent reproducibility, linearity, and accuracy (≈96% negative predictive value) for identifying positive (n = 40) and negative (n = 62) nodes in a validation subset. CONCLUSIONS Detection of metastatic SCCHN using multiplexed qRT-PCR can be rapid, accurate, and automated and may enable sentinel node biopsy to be used for intraoperative decision-making. PCR amplification of tumor marker genes is an effective method of intraoperative molecular staging of SCCHN and could more appropriately guide application of neck dissection in pN+ SCCHN patients, sparing 60% to 70% of pN0 patients from unnecessary neck dissection. This technique may also be used for identifying residual neck disease posttreatment, using outpatient fine-needle aspiration biopsy specimens.
Collapse
Affiliation(s)
- Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | | | | | | | | | | |
Collapse
|
13
|
Sentinel lymph node biopsy is unsuitable for routine practice in younger female patients with unilateral low-risk papillary thyroid carcinoma. BMC Cancer 2011; 11:386. [PMID: 21888655 PMCID: PMC3224365 DOI: 10.1186/1471-2407-11-386] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 09/02/2011] [Indexed: 12/01/2022] Open
Abstract
Background Sentinel lymph node (SLN) biopsy has been used to assess patients with papillary thyroid carcinoma (PTC). To achieve its full potential the rate of SLN identification must be as close to 100 percent as possible. In the present study we compared the combination of preoperative lymphoscintigraphy scanning by sulfur colloid labeled with 99 m Technetium, gamma-probe guided surgery, and methylene blue with methylene blue, alone, for sentinel node identification in younger women with unilateral low-risk PTC. Methods From January 2004 to January 2007, 90 female patients, ages 23 to 44 (mean = 35), with unilateral low-risk PTC (T1-2N0M0) were prospectively studied. Mean tumor size was 1.3 cm (range, 0.8-3.7 cm). All patients underwent unilateral modified neck dissection. Prior to surgery, patients had, by random assignment, identification and biopsy of SLNs by methylene blue, alone (Group 1), or by sulfur colloid labeled with 99 m Technetium, gamma-probe guided surgery and methylene blue (Group 2). Results In the methylene blue group, SLNs were identified in 39 of 45 patients (86.7%). Of the 39 patients, 28 (71.8%) had positive cervical lymph nodes (pN+), and 21 patients (53.8%) had pSLN+. In 7 of the 28 pN+ patients (25%), metastases were also detected in non-SLN, thus giving a false-negative rate (FNR of 38.9% (7/18), a negative predictive value (NPV) of 61.1% (11/18), and an accuracy of 82.1% (32/39). In the combined technique group, the identification rate (IR) of SLN was 100% (45/45). Of the 45 patients, 27 (60.0%) had pN+, 24 (53.3%) had pSLN+. There was a FNR of 14.3% (3/21), a NPV of 85.7% (18/21), and an accuracy of 93.3% (42/45). The combined techniques group was significantly superior to the methylene blue group in IR (p = 0.035). There were no significant differences between two groups in sensitivity, specificity, NPV, or accuracy. Location of pN+ (55 patients) in 84 patients was: level I and V, no patients; level II, 1 patient (1.2%); level III, 6 patients (7.2%); level III and IV, 8 patients (9.5%); level IV, alone, 8 patients (9.5%); level VI, 32 patients (38.1%). In all 90 patients, IR of SLN was 93.3%, FNR, 25.6%, NPV, 74.4%, and accuracy rate, 88.1 percent. Conclusions Compared to a single technique, there was a significantly higher SLN identification rate for the combined technique in younger female with ipsilateral, low-risk PTC (T1-2N0M0). Thus, a combined SLN biopsy technique seems to more accurately stage lymph nodes, with better identification of SLN located out of the central compartment. Regardless of the procedure used, the high FNR renders the current SLN techniques unsuitable for routine practice. Based on these results, prophylactic node dissection of level VI might be considered because 38.1% of our patients had such node metastases.
Collapse
|
14
|
Amir A, Payne R, Richardson K, Hier M, Mlynarek A, Caglar D. Sentinel lymph node biopsy in thyroid cancer: it can work but there are pitfalls. Otolaryngol Head Neck Surg 2011; 145:723-6. [PMID: 21753032 DOI: 10.1177/0194599811415809] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study is to retrospectively assess the specific perils associated with conducting sentinel lymph node biopsies to determine whether a central compartment neck dissection (CCND) is necessary in well-differentiated thyroid cancer. The goal was to assess the specific reasons for a false negative in 3 specific patients among a large population of thyroidectomy patients. STUDY DESIGN Case series with chart review. SETTING Three McGill University teaching hospitals that are part of the McGill University Thyroid Cancer Center in Montreal, Quebec, Canada. SUBJECTS Patients undergoing thyroidectomy and CCND for nodules suspicious for thyroid cancer (June 2009 to May 2010). METHODS Retrospective analysis of 157 patients who underwent thyroidectomy and analysis of CCND as a function of sentinel lymph node status on frozen section as determined by a pathologist at one of the participating centers. RESULTS Three patients were considered true failures or false negatives of the original protocol. These 3 patients were deemed to have benign lymph node status intraoperatively but were found postoperatively to harbor malignancy and therefore should have undergone CCND. The critical reasons for the imperfect false-negative rate are believed to be secondary to samples falsely deemed benign as well as multinodular disease. CONCLUSION The value of sentinel lymph node biopsy in thyroid cancer, although largely debated, appears to be strong. If caution is taken in using dedicated head and neck pathologists for sentinel lymph node cases, as well as properly addressing multinodular malignancy, clinical decision making can be rendered more objective.
Collapse
Affiliation(s)
- Alexander Amir
- Department of Otolaryngology-Head & Neck Surgery, McGill University Thyroid Cancer Center, Montreal, Canada.
| | | | | | | | | | | |
Collapse
|
15
|
Wensing B, Merkx M, De Wilde P, Marres H, Van den Hoogen F. Assessment of preoperative ultrasonography of the neck and elective neck dissection in patients with oral squamous cell carcinoma. Oral Oncol 2010; 46:87-91. [DOI: 10.1016/j.oraloncology.2009.11.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 11/27/2009] [Accepted: 11/27/2009] [Indexed: 10/20/2022]
|
16
|
Management of clinically negative neck for the patients with head and neck squamous cell carcinomas in the modern era. Oral Oncol 2008; 44:817-22. [DOI: 10.1016/j.oraloncology.2007.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Revised: 08/03/2007] [Accepted: 12/04/2007] [Indexed: 02/08/2023]
|
17
|
Holmes JD. Neck Dissection: Nomenclature, Classification, and Technique. Oral Maxillofac Surg Clin North Am 2008; 20:459-75. [DOI: 10.1016/j.coms.2008.02.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
18
|
Woolgar J, Triantafyllou A. Neck dissections: A practical guide for the reporting histopathologist. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.cdip.2007.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
Richards PS, Peacock TE. The role of ultrasound in the detection of cervical lymph node metastases in clinically N0 squamous cell carcinoma of the head and neck. Cancer Imaging 2007; 7:167-78. [PMID: 18055290 PMCID: PMC2151323 DOI: 10.1102/1470-7330.2007.0024] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nodal involvement is the most important prognostic factor in head and neck squamous cell carcinoma (HNSCC) of mucosal origin. The presence of a single ipsilateral or contralateral metastatic node reduces survival by 50% and bilateral disease by a further 50%. The management of N+ HNSCC is relatively clear-cut. By contrast, the investigation and treatment of patients with clinically N0 disease is controversial. Most institutions electively treat the neck with surgery or radiotherapy because the risk of occult metastases is over 20%, even though it will be unnecessary in the majority of cases. In this situation the main purpose of staging would be to assess those nodes that are not going to be removed. However, the optimal management of the clinically N0 neck remains controversial and there is growing interest in a more conservative approach. Research is now directed toward finding a method of staging sensitive enough to bring the risk of occult metastases below 20%. High spatial resolution, ease of multiplanar scanning, power Doppler and the ability to perform guided fine-needle aspiration for cytology give ultrasound (US) an advantage over other imaging techniques.
Collapse
Affiliation(s)
- P S Richards
- Barts and the London NHS Trust, Department of Diagnostic Imaging, Queen Elizabeth II Wing, St Bartholomew's Hospital, West Smithfield, London, EC1A 7EB, UK.
| | | |
Collapse
|
20
|
Oliver RJ, Clarkson JE, Conway DI, Glenny A, Macluskey M, Pavitt S, Sloan P, Worthington HV. Interventions for the treatment of oral and oropharyngeal cancers: surgical treatment. Cochrane Database Syst Rev 2007:CD006205. [PMID: 17943894 DOI: 10.1002/14651858.cd006205.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Oral and oropharyngeal cancers can be managed by surgery alone or with any combination of radiotherapy, chemotherapy and immunotherapy/biotherapy. Opinions on the surgical treatment, the optimal combinational therapy and the sequence of treatments in combinational therapy varies enormously. OBJECTIVES To determine which surgical treatment modalities for oral and oropharyngeal cancers lead to the best outcomes compared with other surgical, radiotherapy, chemotherapy or immunotherapy/biotherapy combinations. SEARCH STRATEGY Electronic search of the Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE, OLDMEDLINE, EMBASE, AMED and the National Cancer Trials Database. Reference lists from relevant articles were searched and the authors of eligible trials were contacted. Date of the most recent searches: July 2007. SELECTION CRITERIA Randomised controlled trials of surgery alone or in combination with chemotherapy, radiotherapy or immunotherapy/biotherapy for the treatment of primary oral or oropharyngeal cancer or both. DATA COLLECTION AND ANALYSIS A minimum of two review authors conducted data extraction. Risk ratios were calculated for dichotomous outcomes at different time intervals, and hazard ratios were extracted or calculated for disease-free survival, total mortality, and disease-related mortality. Additional information from trial authors was sought. Data on adverse events were collected from the trial reports. MAIN RESULTS Thirty-one trials satisfied the inclusion criteria, only 13 of which were assessed as low risk of bias. Trials were grouped into 12 main comparisons. There were no trials that compared different surgical modalities of the primary tumour itself. However, there were a number of trials comparing different approaches to managing the cervical lymph nodes. The majority of treatment regimens under evaluation were surgery in combination with other modalities. As individual treatment regimens within each comparison varied, meta-analysis was inappropriate in most instances. Only two trials could be pooled, comparing concomitant radio/chemotherapy (with surgery) versus radiotherapy (with surgery). A statistically significant difference was shown for disease-free survival (hazard ratio 0.77, 95% confidence interval (CI): 0.64 to 0.92) and total mortality (hazard ratio 0.78, 95% CI: 0.64 to 0.95) in favour of the concomitant chemotherapy and radiotherapy (with surgery) arm. No other treatment regimens showed consistent statistically significant results across the outcomes measured. AUTHORS' CONCLUSIONS There is some evidence that concomitant radio/chemotherapy (with surgery) is more effective than radiotherapy (with surgery) and may benefit outcomes in patients with more advanced oral and oropharyngeal cancers. As these trials were based on head and neck studies, future studies should evaluate this treatment regimen specifically in oral and oropharyngeal cancers separately and also address tumour staging and its impact on outcomes. In general, future studies are encouraged to evaluate site-specific and stage-specific data for oral and oropharyngeal cancers. Future trials should include health-related quality of life assessment as an outcome measure. There is a need for a consolidated standardised approach to reporting adverse events.
Collapse
Affiliation(s)
- R J Oliver
- Oral and Maxillofacial Surgery, School of Dentistry, University of Manchester, Manchester, UK, M15 6FH.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Pelizzo MR, Rubello D, Boschin IM, Piotto A, Paggetta C, Toniato A, De Salvo GL, Giuliano A, Mariani G, Casara D. Contribution of SLN investigation with 99mTc-nanocolloid in clinical staging of thyroid cancer: technical feasibility. Eur J Nucl Med Mol Imaging 2007; 34:934-8. [PMID: 17235530 DOI: 10.1007/s00259-006-0316-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Accepted: 09/08/2006] [Indexed: 11/28/2022]
Abstract
PURPOSE It is a matter of controversy whether prophylactic lymph node dissection improves prognosis and survival in papillary thyroid carcinoma (PTC) patients without suspicion of lymph node metastases either clinically or on ultrasonography. It is possible that in such patients the use of lymphatic mapping and sentinel lymph node (SLN) biopsy, as are employed for other tumours, will be of assistance. The aim of this study was to evaluate the feasibility of preoperative 99mTc-nanocolloid lymphoscintigraphy and an intra-operative SLN procedure in the management of PTC patients. METHODS Twenty-five consecutive patients were entered in the study between April 2005 and October 2005. All had a preoperative diagnosis of malignancy obtained by fine-needle aspiration cytology (FNAC), without clinical or ultrasonographic evidence of loco-regional lymph node involvement. Patients underwent preoperative lymphoscintigraphy after the injection of 99mTc-nanocolloid [median 6 MBq (range 4-9 MBq) in 0.1-0.2 ml saline injected intratumorally under ultrasound guidance] and an intra-operative SLN procedure using a hand-held gamma probe. Surgery was performed by the same surgeon in all patients. RESULTS Preoperative lymphoscintigraphy identified at least one SLN in all patients. During surgery, using the gamma probe, the surgeon was able to find at least one SLN in all cases. A good correlation was found between preoperative imaging and probe results. Metastasis was found in at least one SLN in 12 (48%) patients. In seven (28%) patients the involved SLN was the most radioactive SLN, while in five (20%) patients a less radioactive SLN was involved by malignancy. Ten of these 12 patients had only micrometastases (<2 mm). Micrometastases were found in the most radioactive SLN in six cases and in less radioactive SLNs in four cases, while in two patients more lymph nodes visualised at lymphoscintigraphy ipsilateral to the primary tumour were sites of metastasis. CONCLUSION The rate of nodal involvement was very high in our series: in 48% of patients at least one metastatic lymph node was found. From a technical point of view the intra-operative SLN procedure in PTC patients was easy to perform, without major intra-operative complications. Our promising preliminary experience needs to be confirmed in larger series of patients series with longer follow-up.
Collapse
Affiliation(s)
- Maria Rosa Pelizzo
- Nuclear Medicine, PET Unit, S. Maria della Misericordia Hospital, Istituto Oncologico Veneto (IOV), Viale Tre Martiri, 140, 45100, Rovigo, and Department of Surgical Science, University of Padova, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Pelizzo MR, Merante Boschin I, Toniato A, Piotto A, Bernante P, Paggetta C, De Salvo GL, Carpi A, Rubello D, Casara D. Sentinel node mapping and biopsy in thyroid cancer: a surgical perspective. Biomed Pharmacother 2006; 60:405-8. [PMID: 16962736 DOI: 10.1016/j.biopha.2006.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The clinical role of sentinel node biopsy (SNB) in thyroid cancer remains an open matter in literature. The main reason of this fact is that nodal disease is considered a non-relevant prognostic factor by some authors in differentiated thyroid cancer (DTC). Aim of this study was to investigate the efficacy of radiocolloid lymphoscintigraphy and of hand held gamma probe procedure for SNB in patients with DTC and its potential clinical role. Forty-one consecutive pts with a small thyroid nodule highly suspected for malignancy at fine-needle aspiration cytology (FNAC) and without clinical and ultrasonographic (US) evidence of lymph node involvement entered the study. All patients underwent lymphoscintigraphy 3 hours before intervention using a 99mTc-nanocolloid solution. One single intratumoral injection of 4-9 MBq in 0.1-02 ml normal saline was obtained under US-guidance followed by a dynamic lymphoscintigraphy. After total thyroidectomy central and lateral compartments of the neck were scanned with a hand held gamma probe. The hottest node and any lymph node with a count rate of more than 10% of the hottest node were removed. SLNs were sent to frozen section analysis and a surgical enlargement of corresponding compartment was performed when at least one SLN was positive at histology. Preoperative lymphoscintigraphy was able to identify one node in six cases, two nodes in five cases, three nodes in 14 cases, four or more nodes in 16 cases. A papillary thyroid carcinoma (PTC) was diagnosed in 39 cases, a mixed papillary-medullary carcinoma in one case and a micro-follicular adenoma in one case. In 21/40 patients (pts) positive lymph nodes were found: in 16/21 patient one node showed micrometastasis only, in 5/21 patients more nodes were metastatic. In particular in 11 cases the first hottest node was involved (true SLN), in 10 cases a second or third hot lymph node was involved. In our preliminary experience lymphoscintigraphy with 99mTc-nanocolloid resulted highly sensitive: in fact at least one lymph node was visualized in all cases and the surgeon was able to detect by means of hand held probe during intervention al least one hot SLN in all cases. In 21/40 pts (more than 50% of cases) metastatic lymph nodes were found despite preoperative clinical and US examination negative for lymph node involvement. In prospective SLN technique might be proposed as a relevant tool in lymphoadenectomy decision in DTC patients with a small tumor.
Collapse
Affiliation(s)
- M R Pelizzo
- Department of Surgical Science, University of Padova, Via Giustiniani, 2, 35100, Padova, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Lurie DM, Seguin B, Schneider PD, Verstraete FJ, Wisner ER. Contrast-assisted ultrasound for sentinel lymph node detection in spontaneously arising canine head and neck tumors. Invest Radiol 2006; 41:415-21. [PMID: 16523025 DOI: 10.1097/01.rli.0000201230.29925.95] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We sought to evaluate a minimally invasive contrast-assisted ultrasound (US) technique for sentinel lymph node (SLN) localization. METHODS Microbubble contrast medium was injected into peritumoral tissues in 10 dogs with spontaneous head or neck tumors. Regional lymph nodes (LNs) were imaged up to 20 minutes after contrast administration using power Doppler US. Comparative lymphoscintigraphy studies were performed in all dogs by peritumoral injection of 99mTc-sulfur colloid administered around the primary lesion. RESULTS US contrast enhancement of SLN revealed sentinel nodes and associated lymphatics in 8 of 10 dogs. In each instance in which contrast-enhanced LN was identified with US, a corresponding SLN was detected by lymphoscintigraphy. Multiple SLNs were present in 2 dogs. Regional lymph nodes were positive for metastasis in 1 dog and reactive in 9 dogs. CONCLUSIONS Contrast-assisted US is effective in localizing SLN. This technique could reduce or eliminate many of the limitations of current SLN detection procedures.
Collapse
Affiliation(s)
- David M Lurie
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, 95616, USA
| | | | | | | | | |
Collapse
|
24
|
Wensing BM, Vogel WV, Marres HAM, Merkx MAW, Postema EJ, Oyen WJG, van den Hoogen FJA. FDG-PET in the clinically negative neck in oral squamous cell carcinoma. Laryngoscope 2006; 116:809-13. [PMID: 16652093 DOI: 10.1097/01.mlg.0000209151.78362.d0] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE With improved diagnostic imaging techniques, it remains difficult to reduce occult metastatic disease in oral squamous cell carcinoma (SCC) to less than 20%. Therefore, supraomohyoid neck dissection (SOHND) still is a valuable staging procedure in these patients. METHODS Patients with clinically and ultrasonographically staged cN0 SCC of the oral cavity underwent FDG-PET before SOHND. Histologic examination of neck dissection specimens was used as a "gold standard." RESULTS Twenty-eight consecutive patients were included, representing 30 necks. Occult metastatic disease was found in 30% of SOHND specimens. Average diameter of metastatic deposits was 4.3 mm. Sensitivity, specificity, and accuracy of FDG-PET was 33%, 76%, and 63%, respectively. CONCLUSIONS In patients with cN0 SCC of the oral cavity, FDG-PET does not contribute to the preoperative workup. FDG-PET does not replace SOHND as a staging procedure.
Collapse
Affiliation(s)
- Bart M Wensing
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboud University Nijmegen Medical Centre, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
25
|
Picon AI, Coit DG, Shaha AR, Brady MS, Boyle JO, Singh BB, Wong RJ, Busam KJ, Shah JP, Kraus DH. Sentinel Lymph Node Biopsy for Cutaneous Head and Neck Melanoma: Mapping the Parotid Gland. Ann Surg Oncol 2006; 23:9001-9009. [PMID: 16715435 PMCID: PMC5545803 DOI: 10.1245/aso.2006.03.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Accepted: 01/09/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) for primary cutaneous head and neck melanoma (CHNM) has been shown to be successful and is the current standard of care for intermediate-thickness melanoma. We evaluated our experience with CHNM associated with SLNB mapping to the region of the parotid gland. METHODS Retrospective review of a prospectively collected melanoma database identified 1014 CHNMs. Two-hundred twenty-three patients underwent SLNB, and 72 (32%) had mapping in the region of the parotid gland between May 1995 and June 2003. RESULTS The mean number of SLNs per patient was 2.5. A sentinel lymph node (SLN) was successfully identified in 94% of patients, and in 12%, the SLN was positive for metastatic disease. Biopsy of intraparotid SLNs was performed in 51.4% and of periparotid SLNs in 26.4%, and a superficial parotidectomy was performed in 22.2%. Ten patients were found to have lymph nodes in the parotid region with metastatic disease (eight identified by SLNB), and two (20%) patients developed intraparotid lymph node recurrence in the setting of a negative SLNB. Same-basin recurrence in SLN-negative patients was 3.3% with a median follow-up of 26 months. Facial nerve dysfunction was identified in seven (10%) patients. Facial nerve function returned to preoperative status in all patients. CONCLUSIONS SLNB for patients with primary CHNM mapping to the parotid gland can be performed with a high degree of accuracy and a low morbidity consisting of temporary facial nerve paresis.
Collapse
Affiliation(s)
- Antonio I Picon
- Gastric and Mixed Tumors Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, 10021
| | - Daniel G Coit
- Gastric and Mixed Tumors Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, 10021
| | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, P.O. Box 285, New York, New York, 10021
| | - Mary S Brady
- Gastric and Mixed Tumors Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, 10021
| | - Jay O Boyle
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, P.O. Box 285, New York, New York, 10021
| | - Bhuvanesh B Singh
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, P.O. Box 285, New York, New York, 10021
| | - Richard J Wong
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, P.O. Box 285, New York, New York, 10021
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, 10021
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, P.O. Box 285, New York, New York, 10021
| | - Dennis H Kraus
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, P.O. Box 285, New York, New York, 10021.
| |
Collapse
|
26
|
López Mollá C, Morales Suárez-Varela M, Carrasco Llatas M, Sopena Monforte R, López Martînez R, Dalmau Galofre J. El ganglio centinela en tumores de laringe: técnica y resultados obtenidos. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2006; 57:307-12. [PMID: 17036992 DOI: 10.1016/s0001-6519(06)78717-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the applicability of sentinel node biopsy in NO carcinomas of the larynx. MATERIALS AND METHODS We carried out a prospective study in 19 patients with carcinoma of the larynx NO. We peritumorally infiltrate with 1 mCi 99mTc-labeled nanocolloidal albumin via rigid endoscopy in general anaesthesia. Sentinel node detection is performed with a gamma sonda during lymph node detection. The histological results of the sentinel node are compared with the excised neck dissection specimen. RESULTS Identification of sentinel node was successful in 17 patients (89.47%). In 11 patients the sentinel node was tumor negative reflecting the correct neck lymph node status (pNO). Three patients had metastases in the sentinel node. We observed three false- negative. The sensitivity of the technique was 50% (3/6) and the negative predictive value 78.6%. CONCLUSIONS We think that more studies are needed to use the technique in the laryngeal cancer and that a correct selection of the patients is essential.
Collapse
Affiliation(s)
- C López Mollá
- Servicio de Otorrinolaringología, Hospital Universitario Dr. Peset, Avenida Gaspar Aguilar, 90 46017 Valencia.
| | | | | | | | | | | |
Collapse
|
27
|
Ferlito A, Rinaldo A, Silver CE, Gourin CG, Shah JP, Clayman GL, Kowalski LP, Shaha AR, Robbins KT, Suárez C, Leemans CR, Ambrosch P, Medina JE, Weber RS, Genden EM, Pellitteri PK, Werner JA, Myers EN. Elective and therapeutic selective neck dissection. Oral Oncol 2006; 42:14-25. [PMID: 15979381 DOI: 10.1016/j.oraloncology.2005.03.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Accepted: 03/20/2005] [Indexed: 11/22/2022]
Abstract
Selective neck dissection is a modification of the more comprehensive modified radical or radical neck dissection that is designed to remove only those nodal levels considered to be at risk for harboring nodal metastases. The role of selective neck dissection continues to evolve: while initially designed as a staging and diagnostic procedure for patients without clinical evidence of nodal disease, a growing body of literature suggests that selective neck dissection has a therapeutic role in patients with clinical and histologic evidence of nodal metastases. The rationale behind selective neck dissection, its application in the clinically negative but histologically node-positive neck and the extended application of selective neck dissection in patients with clinical evidence of nodal disease are discussed.
Collapse
Affiliation(s)
- Alfio Ferlito
- Department of Surgical Sciences, ENT Clinic, University of Udine, Policlinico Universitario, Piazzale S. Maria della Misericordia, 33100 Udine, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Devaney KO, Rinaldo A, Rodrigo JP, Ferlito A. Sentinel node biopsy and head and neck tumors—Where do we stand today? Head Neck 2006; 28:1122-31. [PMID: 16823863 DOI: 10.1002/hed.20443] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Sentinel lymph node sampling may be studied profitably in series of patients with 1 tumor type, such as breast carcinoma, in 1 anatomic locale. The present work analyzes the efficacy of sentinel node sampling in a pathologically diverse group of lesions from an anatomically diverse region such as the head and neck; however, there are risks conflating the findings in different tumors with radically different behaviors, in the process producing muddled data. This report reviews the head and neck experience with sentinel sampling and concludes that certain tumor types that have a known propensity for aggressive behavior are the best candidates for trials employing sentinel node sampling; candidates include many cutaneous melanomas of the head and neck, oropharyngeal squamous carcinomas, and selected thyroid carcinomas. Despite the growing popularity of sentinel node sampling in a variety of regions of the body, however, at this juncture this technique remains an investigational procedure, pending demonstration of a tangible improvement in patient outcome through its use. It is recommended that studies of the efficacy of this technique strive, whenever possible, to segregate results of different tumor types in different head and neck locales from one another so as to produce more focused findings for discrete types of malignancies, and not group together tumor types that may in reality exhibit different biological behaviors.
Collapse
|
29
|
Bénateau H, Babin E, Soubeyrand E, Nicolas J, Blaizot X, Comoz F, Béquignon A, Bouvard G, Compère JF, Chesnay E. Détection du ganglion sentinelle dans les carcinomes épidermoïdes de la cavité buccale et de l’oropharynx. Étude préliminaire. ACTA ACUST UNITED AC 2005; 106:281-6. [PMID: 16292222 DOI: 10.1016/s0035-1768(05)86042-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The sentinel lymph node is defined as the first relay of the lymphatic drainage of the tumor. Isotopic detection of the sentinel lymph node and absence of its metastatic invasion should theoretically be predictive of total drainage of the tumor. The goal of this study was to evaluate sentinel lymph node detectability by lymphoscintigraphy in N0 and/or N1 squamous-cell carcinoma of oral cavity and oropharynx and to determine its negative predictive value. MATERIAL AND METHOD Lymphoscintigraphy was used for sentinel lymph node detection. The procedure required peritumoral injection of technicium-labeled colloids to enable anatomical and cutaneous location of the sentinel lymph node. A one-way Tyco-Mallinckrodt probe was used for intraoperative detection of the sentinel lymph node. This prospective study included 21 patients with N0 or N1 squamous-cell carcinoma of the oral cavity and the oropharynx. The surgical attitude based on T and N was not modified in this prospective study without direct individual benefit for the patient. Neck dissection was achieved without difficulty. RESULTS The sentinel lymph node was identified in 20 out of 21 subjects. The sentinel lymph node was not identified in one patient with recurrence T2N0M0 squamous-cell carcinoma of the oropharynx radiated 3 years earlier. The percentage of false-negatives was 12.5% (1 false-negative out of 8 positive patients), giving a sensibility of the detection method of 87.5% (IC (95%)=[47.35-99.68]). This false-negative patient had a T3N0M0 squamous-cell carcinoma of the oropharynx with a sentinel lymph node removed in territory III. Neck dissection revealed 1 N + R- in the sub-mandibular territory associated with 27 N-R-. The probability of not finding a metastatic node at neck dissection when the sentinel lymph node is not metastatic (negative predictive value) was 92.3% (12/13) (IC (95)=[63.97-99.81]). The specificity of the method was 100%, as was the positive predictive value, because no sentinel node was diagnosed positive wrongly on frozen sections among patients without true histological node metastasis. DISCUSSION For routine care of patients with squamous-cell carcinoma of the oral cavity and the oropharynx detection of the sentinel lymph node is proposed primarily for patients with T1T2N0 staging. Larger tumors can modify the architecture and flow within the lymphatic ducts, and consequently even the concept of a sentinel lymph node. Systematic neck dissection is required or T3T4, even when N0. Our series of T1T2N0 tumors is too small to enable statistically significant conclusions. A low level of false-negative in a larger series would be necessary to propose this technique instead of convention neck dissection for T1T2 tumors of the oral cavity and oropharynx.
Collapse
Affiliation(s)
- H Bénateau
- Service de Chirurgie Maxillo-Faciale et Stomatologie, CHU de Caen.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Klausen TL, Chakera AH, Friis E, Rank F, Hesse B, Holm S. Radiation doses to staff involved in sentinel node operations for breast cancer. Clin Physiol Funct Imaging 2005; 25:196-202. [PMID: 15972020 DOI: 10.1111/j.1475-097x.2005.00611.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of radioactive compounds for sentinel node biopsy is now a generally accepted part of the surgical treatment of breast cancer and melanoma, with the risk of radiation exposure to the operating team. The aim of this investigation was to study the levels of this exposure in relation to the permissible radiation dose limits. METHODS The radiation exposure to the hands and bodies of the operating surgeons (the 'risk persons') was measured by thermoluminescent dosimeters in 79 operations and to the pathologists handling the specimens in 17 cases. Radioactivity and dose rate measurement from tumours and breast specimens were also performed. RESULTS During an operation the mean skin dose (+/-SD) to the thermoluminescent dosimeters placed at the hand and the abdominal wall were 0.04 +/- 0.04 mSv (79 operations) and 0.01 +/- 0.02 mSv (67 operations) respectively. For the pathologist, the mean hand dose per operation was below the detection limit (17 operations). Correlation between the measured dose rate and the radioactive content of the tumours was 0.998. CONCLUSIONS The radiation exposure to the staff involved in sentinel node (SN) biopsy for breast cancer using radioactive labelled tracers will be considerably below the permissible limits, even with high numbers of SN biopsy procedures. Pregnant staff members should participate in <100 SN operations.
Collapse
Affiliation(s)
- T L Klausen
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark.
| | | | | | | | | | | |
Collapse
|
31
|
Harwood M, Wu H, Tanabe K, Bercovitch L. Metastatic basal cell carcinoma diagnosed by sentinel lymph node biopsy. J Am Acad Dermatol 2005; 53:475-8. [PMID: 16112356 DOI: 10.1016/j.jaad.2005.05.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Revised: 05/01/2005] [Accepted: 05/03/2005] [Indexed: 11/17/2022]
Abstract
Although commonly used in the treatment of melanoma, sentinel lymph node biopsy has not yet been successfully used to detect lymphatic metastasis of basal cell carcinoma because of exceedingly low rates of metastasis. We describe the use of lymphatic mapping and sentinel lymph node biopsy in a patient after basal cell carcinoma was identified within a lymphatic vessel in the primary excisional specimen. As a result, the patient was found to have clusters of basal cell carcinoma in a sentinel lymph node resected from the right deltopectoral groove. Although metastatic basal cell carcinoma is exceedingly rare, we conclude that sentinel lymph node biopsy may be useful for certain high-risk lesions, such as lesions demonstrating histologic evidence of lymphatic invasion. Further experience is necessary to determine the clinical usefulness of sentinel node biopsy in these patients and its effect on patient survival.
Collapse
Affiliation(s)
- Michael Harwood
- Department of Dermatology, Brown Medical School, Providence, Rhode Island, USA
| | | | | | | |
Collapse
|
32
|
Ferlito A, Rinaldo A. Neck dissection: historical and current concepts. Am J Otolaryngol 2005; 26:289-95. [PMID: 16137525 DOI: 10.1016/j.amjoto.2005.01.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2004] [Indexed: 10/25/2022]
|
33
|
Wei WI, Ferlito A, Rinaldo A, Gourin CG, Lowry J, Ho WK, Leemans CR, Shaha AR, Suárez C, Clayman GL, Robbins KT, Bradley PJ, Silver CE. Management of the N0 neck--reference or preference. Oral Oncol 2005; 42:115-22. [PMID: 15979931 DOI: 10.1016/j.oraloncology.2005.04.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2005] [Accepted: 04/11/2005] [Indexed: 10/25/2022]
Abstract
For patients with squamous cell carcinoma of the upper aerodigestive tract, appropriate management of the regional lymph nodes is an important and often controversial issue that has significant influence on survival. Over the years radical treatment either by surgery or radiotherapy contributed to improvement in prognosis. Recently, a more conservative approach has achieved a similar level of cancer control with less morbidity. This review considers the issues of selection of patients for treatment of the neck, choice of modality and extent of therapy, treatment of the contralateral neck, management of recurrence and influence of the site and status of the primary lesion.
Collapse
Affiliation(s)
- William I Wei
- Division of Head and Neck Surgery, Otorhinolaryngology, Plastic and Reconstructive Surgery, Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, Peoples Republic of China
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
López Mollá C, Ferrer Ramírez MJ, Estellés E, Villanueva A, Sopena Monforte R, López Martínez R, Dalmau Galofre J. [Sentinel node in tumours of the lip and the oral cavity]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2005; 56:152-5. [PMID: 15871290 DOI: 10.1016/s0001-6519(05)78591-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study shows the results obtained by the application of the sentinel node (SN) in oral and lip cancer and performs a lymphatic map of these tumours. PATIENTS AND METHOD We prospectively studied 14 patients with lip and oral tumours, all of them N0. We injected colloidal particles of serum albumin labeled with Tc-99 peritumoraly and we located the SN intraoperatively. The SN was then sent for anatomopathological study. RESULTS Sentinel node was identified in all of the patients. In 11 of them the sentinel node was negative for metastases and correctly predicted the status of the neck. In 3 patients the sentinel node was the only node that contained metastases. There were no false negatives. The sensibility of the technique was 100%. CONCLUSIONS The results showed that this technique is a feasible method for tumours in these locations and can avoid neck dissections in N0 patients.
Collapse
|
35
|
Minamikawa T, Umeda M, Komori T. Reliability of sentinel lymph node biopsy with squamous cell carcinoma of the oral cavity. ACTA ACUST UNITED AC 2005; 99:532-8; discussion 539-41. [PMID: 15829872 DOI: 10.1016/j.tripleo.2004.08.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Although sentinel lymph node biopsy (SLNB) may reduce surgery-related complications related to unnecessary lymph node dissection and is now widely used for many patients with cutaneous melanoma and breast cancer, its use for oral cancer patients remains controversial. One of the main reasons for the reluctance to initiate SLNB for oral cancer is that the frequency of skip metastasis has not been clarified. The objectives of this study are to examine the frequency of skip metastasis and to evaluate SLNB for oral cancer. STUDY DESIGN To shed light on these concerns, we first conducted a retrospective study of 296 patients with squamous cell carcinoma of the oral cavity who underwent neck dissection. Next, the accuracy of lymph node biopsy with and without detecting sentinel lymph node was examined. RESULTS Ten patients showed skip neck metastasis in the level III-V region without level I-II involvement. Of these patients, 7 underwent neck dissection when their initially N0 neck progressed to N+, 2 underwent neck dissection when local recurrence occurred, and only 1 underwent surgery as an initial therapy. Most patients who underwent neck dissection as the initial therapy showed skip metastasis. Intraoperative lymph node biopsy without any attempt to detect sentinel lymph nodes by means of blue dye or lymphoscintigraphy was performed on 68 patients with oral cancer. Sixty-one (90%) were diagnosed correctly, whereas 7 diagnosed as N- actually had neck metastasis. SLNB with blue dye was performed on 21 patients. In 17 of them, sentinel lymph node was easily detected, resulting in a correct diagnosis for 16 patients (94%), while 1 with a false negative result actually had micrometastasis. CONCLUSION These findings seem to suggest that SLNB is useful and can be applied to patients with oral cancer who undergo surgery as the initial therapy.
Collapse
Affiliation(s)
- Tsutomu Minamikawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | | | | |
Collapse
|
36
|
Werner JA. Selective sentinel lymphadenectomy for head and neck squamous cell carcinoma. Cancer Treat Res 2005; 127:187-206. [PMID: 16209084 DOI: 10.1007/0-387-23604-x_10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Jochen A Werner
- Department of Otolaryngology, Head and Neck Surgery, Philipps University of Marburg, Germany
| |
Collapse
|
37
|
Faustina M, Diba R, Ahmadi MA, Gutstein BF, Esmaeli B. Patterns of regional and distant metastasis in patients with eyelid and periocular squamous cell carcinoma. Ophthalmology 2004; 111:1930-2. [PMID: 15465559 DOI: 10.1016/j.ophtha.2004.02.009] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2003] [Accepted: 02/10/2004] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To determine the frequency and location of regional lymph node metastasis in patients with squamous cell carcinoma (SCC) of the eyelid and periocular skin. Patterns of distant metastasis were also investigated. DESIGN Retrospective case series. PATIENTS One hundred eleven patients treated at The University of Texas M. D. Anderson Cancer Center for SCC of the eyelid and periocular skin between 1952 and 2000. METHODS The clinical records of the 111 patients were retrospectively reviewed. The clinical characteristics analyzed included age, gender, location of lesion, treatment modalities, patterns of regional nodal and distant metastasis, and perineural invasion. Follow-up time ranged from 6 to 484 months (median, 76.6). MAIN OUTCOME MEASURE Incidence of regional lymph node metastasis. RESULTS The most common sites of SCC were the lower eyelid (54 patients [48.6%]), the medial canthus (40 patients [36.0%]), and the upper eyelid (25 patients [22.5%]). Local treatment of SCC consisted of wide local excision with frozen section analysis to ensure negative margins in 96 patients (86.4%), radiotherapy (without surgery) in 7 patients, and primary exenteration because of extensive tumor in 7 patients. Local recurrence occurred in 41 patients (36.9%). Twenty-seven patients (24.3%) had regional nodal metastasis during the study period. Sixteen of these patients had regional lymph node metastasis at the time of the initial presentation to M. D. Anderson Cancer Center. Eleven developed regional nodal disease later. Seven patients (6.2%) had distant metastasis during the study period. Nine patients (8.1%) had perineural invasion. CONCLUSION This study indicates that the overall rate of regional lymph node metastasis in patients with SCC of the eyelid or periocular skin may be as high as 24%. Thus, careful surveillance of the regional lymph nodes is an important aspect of the initial management of eyelid or periocular skin SCC. Consideration could be given to studying sentinel lymph node biopsy as a technique to stage SCC of the eyelid or periocular skin more accurately, especially in patients with recurrent, large, or highly invasive lesions or with perineural invasion.
Collapse
Affiliation(s)
- Misha Faustina
- Section of Ophthalmology, Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
| | | | | | | | | |
Collapse
|
38
|
Börjesson PKE, Postema EJ, de Bree R, Roos JC, Leemans CR, Kairemo KJA, van Dongen GAMS. Radioimmunodetection and radioimmunotherapy of head and neck cancer. Oral Oncol 2004; 40:761-72. [PMID: 15288829 DOI: 10.1016/j.oraloncology.2003.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2003] [Accepted: 11/21/2003] [Indexed: 11/25/2022]
Abstract
Radiolabeled monoclonal antibodies (MAbs) can add a dimension to diagnostic imaging and staging of metastatic head and neck cancer, as well as in eradication of this disease. The vast majority of malignancies arising in the oral cavity, pharynx and larynx are squamous cell carcinomas. This common cellular origin makes it attractive to search for appropriate tumor-associated antigens, which are preferentially expressed in these neoplasms. Radiolabeled MAbs directed against these antigens can be used for tumor detection and selective therapy, known as radioimmunoscintigraphy and radioimmunotherapy, respectively. The combination of MAbs with positron emission tomography (PET) is an attractive novel option to improve tumor detection and to facilitate MAb quantification in a therapeutic setting. Basic aspects of tumor targeting with MAbs, as well as a review of the clinical trials reported in the literature, including own results, are presented.
Collapse
Affiliation(s)
- Pontus K E Börjesson
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
39
|
Takes RP. Staging of the neck in patients with head and neck squamous cell cancer: Imaging techniques and biomarkers. Oral Oncol 2004; 40:656-67. [PMID: 15172634 DOI: 10.1016/j.oraloncology.2003.11.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2003] [Accepted: 11/10/2003] [Indexed: 10/26/2022]
Abstract
Regional metastasis is an important factor in the treatment and prognosis of head and neck cancer patients. Current treatment strategies rely on staging based on the still limited accuracy of imaging techniques to detect regional metastases. If more certainty about the nodal status could be attained, treatment strategies concerning the neck could be better adjusted to the individual patient. The continuing improvement of established imaging techniques and the introduction of new imaging modalities will add to better staging. Moreover, the additional use of biomarkers studied on a protein, RNA or DNA level may provide even better information about the chance of occult nodal metastasis in head and neck cancer patients.
Collapse
Affiliation(s)
- Robert P Takes
- Department of Otolaryngology/Head and Neck Surgery, University Medical Center Nijmegen, P.O. Box 9101, 6500 HB, The Netherlands.
| |
Collapse
|
40
|
Ferlito A, Rinaldo A, Robbins KT, Leemans CR, Shah JP, Shaha AR, Andersen PE, Kowalski LP, Pellitteri PK, Clayman GL, Rogers SN, Medina JE, Byers RM. Changing concepts in the surgical management of the cervical node metastasis. Oral Oncol 2003; 39:429-35. [PMID: 12747966 DOI: 10.1016/s1368-8375(03)00010-1] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Alfio Ferlito
- Department of Otolaryngology-Head and Neck Surgery, University of Udine, Policlinico Universitario, Piazzale S. Maria della Misericordia, I-33100, Udine, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|