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Joyce K, Leonard N, Theopold C. Aggressive Digital Papillary Adenocarcinoma Mimicking a Giant Cell Tumour - A Case Report and Review of the Literature. Cureus 2020; 12:e9531. [PMID: 32905077 PMCID: PMC7465832 DOI: 10.7759/cureus.9531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aggressive digital papillary adenocarcinoma (ADPAca) is a rare, underreported, and often misdiagnosed malignant tumour of the eccrine sweat gland, with high recurrence and metastatic potential. We present a case of a painless mass over the middle phalanx of the dominant index finger in a 51-year-old man. The mass was present for over 20 years, which had slowly increased in size. The patient only presented when it began to interfere with his profession as an electrician. The clinical presentation was consistent with a giant cell tumour. Histological diagnosis was of an ADPAca. Staging investigations were negative and he subsequently went on to have a ray amputation. The importance of high clinical suspicion of digit lesions is highlighted. No specific histologic features have been identified to predict recurrence or metastasis. We review the merits of performing sentinel node biopsy and alternative treatment options such as Moh’s micrographic surgery. We review the international literature to assess metastatic potential and follow-up requirements.
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Affiliation(s)
- Kenneth Joyce
- Plastic, Reconstructive, and Aesthetic Surgery, Mater Hospital, Dublin, IRL.,Plastic and Reconstructive Surgery, Mater Hospital, Dublin, IRL
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2
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Abstract
The purpose of this study was to present our experience and validate the use of sentinel lymph node (SLN) mapping in patients with head and neck cancers. A retrospective review of a pro-spectively collected database of patients with a diagnosis of squamous cell carcinomas of the head and neck from 2008 to 2011 was done. The group consisted of a total of 20 patients. The first node(s) highlighted with blue, or identified as radioactive by Tc99-sulfur radioactive colloid, was (were) identified as the SLNs. In the first seven patients, formal modified neck dissection was performed. In the remaining 13 patients, only a SLN biopsy procedure was done. At least one SLN was identified in all 20 patients (100%). Only one patient (5%) had positive nodes. In this case, the SLN was also positive. In the remaining 19 cases, all lymph nodes were negative. After an average of 24 months of follow-up, there have been three local recurrences (15%) but no evidence of distant metastatic disease. SLN mapping in head and neck cancers is a feasible technique with a high identification rate and a low false-negative rate. Although the detection rate of regional metastatic disease compares favorably with published data as well as the disease-free and overall survival, further studies are warranted before considering this technique to be the “gold standard” in patients with oral squamous cell carcinoma and a negative neck by clinical examination and imaging studies.
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3
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Peigné L, Godey F, Le Gallo M, Le Gall F, Fautrel A, Morcet J, Jégoux F. One-step nucleic acid amplification for detecting lymph node metastasis of head and neck squamous cell carcinoma. Oral Oncol 2020; 102:104553. [PMID: 32004908 DOI: 10.1016/j.oraloncology.2019.104553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/21/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND In head and neck squamous cell carcinoma (HNSCC) 30% of cN0 patients have occult metastasis. LN invasion is a major prognostic factor. Sentinel lymph node (SLN) is an option for cN0 neck management. One-step nucleic acid amplification (OSNA) used to analyze SLN in breast cancer is also a candidate to get more reliable intraoperative HNSCC lymph node (LN) staging. OBJECTIVE To compare OSNA analysis to pathological analysis in cN0 HNSCC. MATERIALS AND METHODS 157 LN from 26 cN0 HNSCC patients were prospectively analyzed (6.3LN/patient). Exclusion criteria were previous surgery or radiotherapy. Each node was cut into 4 equal pieces alternatively sent to pathological analysis and OSNA technique. IHC CK19 was performed on the primary tumor biopsy and RT-qPCR of CK19, PVA and EPCAM on the LN lysate of discordant cases. RESULTS OSNA was able to provide intraoperative result in all patients. OSNA detected 21 metastases. There were 139 concordant LN (88.5%). There were 18 initial discordant LN (11.5%), 13 (8.3%) were OSNA positive/pathological analysis negative, 5 (3.2%) were OSNA negative/pathological analysis positive. After elimination of allocation bias, false negative rate was 1.3%, sensitivity and specificity were 90% and 95.6%, PPV and NPV were 75% and 98.5%. CONCLUSION Our results suggest that OSNA should be considered to improve SNB analysis both for increasing micro metastasis diagnosis and offer extemporaneous results. Study registered under clinicaltrials.gov database number NCT02852343.
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Affiliation(s)
- Lucie Peigné
- Head Neck Surgery Department, University Hospital, Rennes, France
| | - Florence Godey
- Department of Biology, Eugène Marquis Comprehensive Cancer Center, CS 44 229, Av. De Bataille Flandres Dunkerques, 35042 Rennes Cedex, France
| | - Mathieu Le Gallo
- Chemistry, Oncogenesis, Stress, Signaling COSS, INSERM 1242, Rennes 1 University, CLCC Eugene Marquis, Rue de la bataille Flandres Dunkerques, Rennes, France
| | - François Le Gall
- Pathology Department, University Hospital, Rennes, France; Head Neck Surgery Department, University Hospital, Rennes, France
| | - Alain Fautrel
- H2P2, Histopathological Platform, University of Rennes, 35000 Rennes, France
| | - Jeff Morcet
- Clinical Investigation Center, CIC INSERM 1414, University Hospital of Rennes, France
| | - Franck Jégoux
- Head Neck Surgery Department, University Hospital, Rennes, France; Chemistry, Oncogenesis, Stress, Signaling COSS, INSERM 1242, Rennes 1 University, CLCC Eugene Marquis, Rue de la bataille Flandres Dunkerques, Rennes, France.
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4
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Garau LM, Muccioli S, Caponi L, Maccauro M, Manca G. Sentinel lymph node biopsy in oral–oropharyngeal squamous cell carcinoma: standards, new technical procedures, and clinical advances. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00338-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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5
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Wakisaka N, Endo K, Kitazawa T, Shimode Y, Kato K, Moriyama-Kita M, Koda W, Ikeda H, Ishikawa K, Ueno T, Nakanishi Y, Kondo S, Sugimoto H, Yoshimura K, Tsuji H, Kawashiri S, Omoto K, Yoshizaki T. Detection of sentinel lymph node using contrast-enhanced agent, Sonazoid ™, and evaluation of its metastasis with superb microvascular imaging in oral and oropharyngeal cancers: a preliminary clinical study. Acta Otolaryngol 2019; 139:94-99. [PMID: 30676845 DOI: 10.1080/00016489.2018.1535193] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In sentinel lymph node (SLN) biopsy for head and neck cancers, the radioisotope method has been the gold standard. However, this method has several problems, such as unavoidable radiation exposure and requirements of expensive equipment. AIMS/OBJECTIVES To overcome these problems, we evaluated the contrast-enhanced ultrasonography (CEUS)-guided SLN-detection method, and predicted the SLN metastatic status using novel ultrasound technology, superb microvascular imaging (SMI). METHODS Ten patients (6 with oral and 4 with oropharyngeal cancers) without neck lymph node metastasis were enrolled in this study. Ultrasound contrast agent, Sonazoid™, was infiltrated into the mucosa at the primary site to observe the lymphatic ducts and SLNs in the neck field. The detected SLNs were examined for blood flow using SMI to categorize the SLNs metastases-positive or negative. RESULTS SLNs were successfully detected in 8 out of 10 cases. In 7 out of the 8 cases, in whom SLNs were successfully detected, the metastatic status of SLNs was correctly diagnosed with SMI. CONCLUSIONS AND SIGNIFICANCE Although more clinical data are needed based on a larger cohort, establishing the CEUS-guided SLN-detection and criteria for the accurate diagnosis of SLN-metastases using SMI would be valuable as an alternative to radioisotope method, in oral and oropharyngeal cancers.
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Affiliation(s)
- Naohiro Wakisaka
- Department of Otolaryngology, and Head & Neck Surgery, Kanazawa University, Kanazawa, Japan
| | - Kazuhira Endo
- Department of Otolaryngology, and Head & Neck Surgery, Kanazawa University, Kanazawa, Japan
| | | | - Yuzo Shimode
- Department of Head and Neck Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Koroku Kato
- Department of Oral and Maxillofacial Surgery, Kanazawa University, Kanazawa, Japan
| | - Makiko Moriyama-Kita
- Department of Otolaryngology, and Head & Neck Surgery, Kanazawa University, Kanazawa, Japan
| | - Wataru Koda
- Department of Radiology, Kanazawa University, Kanazawa, Japan
| | - Hiroko Ikeda
- Division of Pathology, Kanazawa University, Kanazawa, Japan
| | - Kazuya Ishikawa
- Department of Otolaryngology, and Head & Neck Surgery, Kanazawa University, Kanazawa, Japan
| | - Takayoshi Ueno
- Department of Otolaryngology, and Head & Neck Surgery, Kanazawa University, Kanazawa, Japan
| | - Yosuke Nakanishi
- Department of Otolaryngology, and Head & Neck Surgery, Kanazawa University, Kanazawa, Japan
| | - Satoru Kondo
- Department of Otolaryngology, and Head & Neck Surgery, Kanazawa University, Kanazawa, Japan
| | - Hisashi Sugimoto
- Department of Otolaryngology, and Head & Neck Surgery, Kanazawa University, Kanazawa, Japan
| | - Kenichi Yoshimura
- Department of Biomedical Statistics, Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuji
- Department of Head and Neck Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Shuichi Kawashiri
- Department of Oral and Maxillofacial Surgery, Kanazawa University, Kanazawa, Japan
| | - Kiyoka Omoto
- Department of Laboratory Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Tomokazu Yoshizaki
- Department of Otolaryngology, and Head & Neck Surgery, Kanazawa University, Kanazawa, Japan
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6
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Riese C, Karstadt JA, Schramm A, Güleryüz S, Dressel G, Lorenz K, Klemenz B, Sailer A, Seitz S, Wilde F. Validity of sentinel node biopsy in early oral and oropharyngeal carcinoma. J Craniomaxillofac Surg 2018; 46:1748-1752. [DOI: 10.1016/j.jcms.2018.07.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/05/2018] [Accepted: 07/27/2018] [Indexed: 02/05/2023] Open
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7
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Velosa C, Shi Q, Stevens TM, Chiosea SI, Purgina B, Carroll W, Rosenthal E, Morlandt A, Loree T, Brandwein-Weber MS. Retracted: Worst Pattern Of Invasion and occult cervical metastases for oral squamous carcinoma. Head Neck 2017. [PMID: 28370646 DOI: 10.1002/hed.24754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 01/20/2017] [Accepted: 02/01/2017] [Indexed: 11/09/2022] Open
Abstract
The above article, published online in Wiley Online Library as the Version of Record on March 28, 2017 (doi 10.1002/hed.24754), has been retracted by agreement between the Editor-in-Chief, Ehab Y. Hanna, and Wiley Periodicals, Inc. The retraction has been agreed owing to a dispute as to authorship and inclusion of some data in the analysis. REFERENCE Velosa, C., Shi, Q., Stevens, T. M., Chiosea, S. I., Purgina, B., Carroll, W., Rosenthal, E., Morlandt, A., Loree, T. and Brandwein-Weber, M. S. (2017), Worst pattern of invasion and occult cervical metastases for oral squamous carcinoma. Head Neck. doi:10.1002/hed.24754.
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Affiliation(s)
- Claudia Velosa
- University of Alabama at Birmingham, Birmingham, Alabama
- Department of Pathology, Allegheny Health Network, Forbes Hospital, Pittsburgh, Pennsylvania
| | - Qiuying Shi
- University of Alabama at Birmingham, Birmingham, Alabama
- Department of Pathology, University of Kentucky at Lexington, Lexington, Kentucky
| | - Todd M Stevens
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Simion I Chiosea
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | - Eben Rosenthal
- University of Alabama at Birmingham, Birmingham, Alabama
- Stanford Cancer Center, Palo Alto, California
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8
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Abdul-Razak M, Chung H, Wong E, Palme C, Veness M, Farlow D, Coleman H, Morgan G. Sentinel lymph node biopsy for early oral cancers: Westmead Hospital experience. ANZ J Surg 2016; 87:65-69. [PMID: 27878928 DOI: 10.1111/ans.13853] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/23/2016] [Accepted: 10/18/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) has become an alternative option to elective neck dissection (END) for early oral cavity squamous cell carcinoma (OCSCC) outside of Australia. We sought to assess the technical feasibility of SLNB and validate its accuracy against that of END in an Australian setting. METHODS We performed a prospective cohort study consisting of 30 consecutive patients with cT1-2 N0 OCSCC referred to the Head and Neck Cancer Service, Westmead Hospital, Sydney, between 2011 and 2014. All patients underwent SLNB followed by immediate selective neck dissection (levels I-III). RESULTS A total of 30 patients were diagnosed with an early clinically node-negative OCSCC (seven cT1 and 23 cT2), with the majority located on the oral tongue. A median of three (range: 1-14) sentinel nodes were identified on lymphoscintigraphy, and all sentinel nodes were successfully retrieved, with 50% having a pathologically positive sentinel node. No false-negative sentinel nodes were identified using selective neck dissection as the gold standard. The negative predictive value (NPV) of SLNB was 100%, with 40% having a sentinel node identified outside the field of planned neck dissection on lymphoscintigraphy. Of these, one patient had a positive sentinel node outside of the ipsilateral supraomohyoid neck dissection template. CONCLUSION SLNB for early OCSCC is technically feasible in an Australian setting. It has a high NPV and can potentially identify at-risk lymphatic basins outside the traditional selective neck dissection levels even in well-lateralized lesions.
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Affiliation(s)
- Muzib Abdul-Razak
- Head and Neck Cancer Service, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Hsiang Chung
- Head and Neck Cancer Service, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia
| | - Eva Wong
- Head and Neck Cancer Service, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia
| | - Carsten Palme
- Head and Neck Cancer Service, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia.,Sydney Head and Neck Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Michael Veness
- Head and Neck Cancer Service, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - David Farlow
- Department of Nuclear Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Hedley Coleman
- Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia
| | - Gary Morgan
- Head and Neck Cancer Service, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
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9
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Meerwein CM, Sekine T, Veit-Haibach P, Bredell MG, Huber GF, Huellner MW. Multi-slice SPECT/CT vs. lymphoscintigraphy and intraoperative gamma ray probe for sentinel node mapping in HNSCC. Eur Arch Otorhinolaryngol 2016; 274:1633-1642. [PMID: 27837418 DOI: 10.1007/s00405-016-4379-5] [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: 10/24/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
To assess the diagnostic potential of multi-slice single-photon emission computed tomography/computed tomography (SPECT/CT) for preoperative sentinel node (SN) mapping in early stage head and neck squamous cell carcinoma (HNSCC). Retrospective case-control study including data of consecutive HNSCC patients treated between November 2011 and December 2015. The diagnostic accuracy of multi-slice SPECT/CT was assessed with regard to the gold standard intraoperative gamma ray detection probe, using McNemar's test and calculating the area under the ROC curve. Additionally, the hot spot yield of SPECT/CT and planar lymphoscintigraphy (LS) was compared. Compared to the intraoperative gold standard, SPECT/CT showed an overall positive predictive value of 60.3% [confidence interval (CI) 46.6-73.0%)], a negative predictive value of 96.3% (CI 93.6-98.1%), and an accuracy of 90.8% (CI 89.1-92.4%). SPECT/CT detected more hot spots than LS and provided detailed anatomical information as well as relevant additional findings with potential impact on further patient management. Sentinel lymph node biopsy proved to be a reliable and safe procedure with an excellent SN excision rate (97%). Multi-slice SPECT/CT is a highly accurate diagnostic test and matches the gold standard intraoperative gamma ray detection probe.
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Affiliation(s)
- C M Meerwein
- Department of Otorhinolaryngology, University Hospital Zurich, Zurich, Switzerland. .,University of Zurich, Zurich, Switzerland. .,Division of Otorhinolaryngology, Frauenklinikstrasse 24, 8091, Zurich, Switzerland.
| | - T Sekine
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,Department of Radiology, Nippon Medical School, Tokyo, Japan
| | - P Veit-Haibach
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - M G Bredell
- Department of Craniomaxillo-Facial Surgery, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - G F Huber
- Department of Otorhinolaryngology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - M W Huellner
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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10
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Miura K, Hirakawa H, Uemura H, Yoshimoto S, Shiotani A, Sugasawa M, Homma A, Yokoyama J, Tsukahara K, Yoshizaki T, Yatabe Y, Matsuo K, Ohkura Y, Kosuda S, Hasegawa Y. Sentinel node biopsy for oral cancer: A prospective multicenter Phase II trial. Auris Nasus Larynx 2016; 44:319-326. [PMID: 27496008 DOI: 10.1016/j.anl.2016.07.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 06/30/2016] [Accepted: 07/12/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE A recent study identified a survival benefit with prophylactic neck dissection (ND) at the time of primary surgery as compared with watchful waiting followed by therapeutic neck dissection for nodal relapse, in patients with cN0 oral squamous cell carcinoma (OSCC). Alternative management of cN0 neck cancer is recommended to minimize the adverse effects of ND, indicating the need for sentinel node biopsy (SNB) and limited neck dissection. We conducted a multicenter Phase II study to examine the feasibility of SNB for clinically N0 OSCC. METHODS Previously untreated N0 OSCC patients (n=57) with clinical late-T2 or T3 tumors were enrolled across 10 institutions. SNB navigated with multislice frozen section analysis of sentinel nodes (SNs) and SNB supported sentinel node lymphatic basin dissection (SN basin dissection) were performed in a one-stage procedure. The endpoint was to investigate the rate of false-negative metastases after SN basin dissection and SNB alone. RESULTS Most tumors were late-T2 lesions (n=50; 87.7%). SNs were identified in all patients. A total of 196 SNs were detected. Among these SNs, 35 (17.8%) were positive for metastasis (9 in level I, 12 in level II, 12 in level III, 1 in level V and 2 in the contralateral region of the neck). The false-negative rate of SNB supported by SN basin dissection and SNB alone was 4.5% and 9.1%, respectively. The concordance of the SN status in intraoperative frozen sections with the permanent histopathology was 97.4% (191/196). The sensitivity and specificity of intraoperative pathological evaluation were 85.7% (30/35) and 100% (30/30), respectively. The 3-year overall survival (OS) and disease-free survival was 89.5% and 82.5%, respectively. The OS of SN-negative patients was significantly longer than that of SN-positive patients (P=0.047). CONCLUSION The current study verified that SN basin dissection was a useful back-up procedure for SNB performed as a one-stage procedure, showing a low false-negative rate. SNB alone is an appropriate staging method for patients with clinical N0 staging, and a reliable procedure to determine the appropriate levels for neck dissection.
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Affiliation(s)
- Kouki Miura
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, Tokyo 108-8329, Japan
| | - Hitoshi Hirakawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan; Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 903-0213 Okinawa, Japan
| | - Hirokazu Uemura
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara 634-8521, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Akihiro Shiotani
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Masashi Sugasawa
- Department of Head and Neck Surgery, Saitama Medical University International Medical Center, Saitama 350-1298, Japan
| | - Akihiro Homma
- Department of Otolaryngology, Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Junkichi Yokoyama
- Department of Otolaryngology, Head and Neck Surgery, Moriyama Memorial Hospital, Tokyo 134-0088, Japan
| | - Kiyoaki Tsukahara
- Department of Otolaryngology - Head and Neck Surgery, Tokyo Medical University Hospital, Tokyo 160-0022, Japan
| | - Tomokazu Yoshizaki
- Division of Otolaryngology, Head and Neck Surgery, Graduate School of Medical Science, Kanazawa University 920-0942, Kanazawa, Japan
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Keitaro Matsuo
- Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya 464-8681, Japan
| | - Yasuo Ohkura
- Department of Pathology, Kyorin University School of Medicine, Tokyo 181-8612, Japan
| | - Shigeru Kosuda
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University School of Medicine, Maebashi 371-8511, Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan.
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11
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Farmer RW, McCall L, Civantos FJ, Myers JN, Yarbrough WG, Murphy B, O'Leary M, Zitsch R, Siegel BA. Lymphatic drainage patterns in oral squamous cell carcinoma: findings of the ACOSOG Z0360 (Alliance) study. Otolaryngol Head Neck Surg 2015; 152:673-7. [PMID: 25749001 DOI: 10.1177/0194599815572585] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/22/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of our study was to correlate sentinel lymph nodes (SLN) found on planar lymphoscintigraphy (LS) to SLN found with gamma probe-directed sentinel lymph node biopsy (SLNB) for T1/T2 N0 oral cavity cancer. STUDY DESIGN Prospective cooperative group trial. SETTING Academic medical centers. SUBJECTS AND METHODS One hundred forty adults with untreated T1/T2 N0 squamous cell carcinoma (SCC) of the oral cavity underwent planar LS, resection, SLNB, and neck dissection. Location of SLN by planar LS and SLNB and of metastases were compared to each other and historical data of regional metastases. RESULTS SLNs located by planar LS and SLNB were predominantly in levels I through IV. There was heterogeneity in the number of SLNs found at planar LS and at SLNB, which was significantly different in levels II and III (P < .0001). In 14 of 33 cases with bilateral drainage on planar LS, SLNB detected only unilateral SLN. Sensitivity of planar LS in predicting the level of SLN was 41% to 63%, and specificity was 68% to 95%. Comparison of locations of the metastases to historical data showed fewer metastases to level I in our study (P = .03). Metastases occurred predominantly in levels I through III. In 1 case of a lateral tongue cancer, a contralateral SLN was the only positive node. CONCLUSION Lymphatic drainage patterns and metastases involved predominantly levels I through III. Planar LS is not sensitive for predicting the levels of SLN, and in levels II and III, the rate of detection of SLN between the 2 modalities is significantly different.
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Affiliation(s)
- Roger W Farmer
- Department of Otolaryngology and Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, West Virginia, USA
| | - Linda McCall
- Alliance Statistics and Data Center, Duke University, Durham, North Carolina, USA
| | - Francisco J Civantos
- Department of Otolaryngology-Head and Neck Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Wendell G Yarbrough
- Department of Surgery, Section of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Barbara Murphy
- Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee, USA
| | - Miriam O'Leary
- Department of Otolaryngology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Robert Zitsch
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Barry A Siegel
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology and the Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
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12
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Karino M, Nakatani E, Hideshima K, Nariai Y, Tsunematsu K, Ohira K, Kanno T, Asahina I, Kagimura T, Sekine J. Applicability of preoperative nuclear morphometry to evaluating risk for cervical lymph node metastasis in oral squamous cell carcinoma. PLoS One 2014; 9:e116452. [PMID: 25549090 PMCID: PMC4280216 DOI: 10.1371/journal.pone.0116452] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/08/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We previously reported the utility of preoperative nuclear morphometry for evaluating risk for cervical lymph node metastases in tongue squamous cell carcinoma. The risk for lymph node metastasis in oral squamous cell carcinoma, however, is known to differ depending on the anatomical site of the primary tumor, such as the tongue, gingiva, mouth floor, and buccal mucosa. In this study, we evaluated the applicability of this morphometric technique to evaluating the risk for cervical lymph node metastasis in oral squamous cell carcinoma. METHODS A digital image system was used to measure the mean nuclear area, mean nuclear perimeter, nuclear circular rate, ratio of nuclear length to width (aspect ratio), and nuclear area coefficient of variation (NACV). Relationships between these parameters and nodal status were evaluated by t-test and logistic regression analysis. RESULTS Eighty-eight cases of squamous cell carcinoma (52 of the tongue, 25 of the gingiva, 4 of the buccal mucosa, and 7 of the mouth floor) were included: 46 with positive node classification and 42 with negative node classification. Nuclear area and perimeter were significantly larger in node-positive cases than in node-negative cases; however, there were no significant differences in circular rate, aspect ratio, or NACV. We derived two risk models based on the results of multivariate analysis: Model 1, which identified age and mean nuclear area and Model 2, which identified age and mean nuclear perimeter. It should be noted that primary tumor site was not associated the pN-positive status. There were no significant differences in pathological nodal status by aspect ratio, NACV, or primary tumor site. CONCLUSION Our method of preoperative nuclear morphometry may contribute valuable information to evaluations of the risk for lymph node metastasis in oral squamous cell carcinoma.
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Affiliation(s)
- Masaaki Karino
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Eiji Nakatani
- Translational Research Informatics Center, Kobe, Japan
| | - Katsumi Hideshima
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Yoshiki Nariai
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Kohji Tsunematsu
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Koichiro Ohira
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Izumi Asahina
- Department of Regenerative Oral Surgery, Nagasaki University Graduate School of Medical Science, Nagasaki, Japan
| | | | - Joji Sekine
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
- * E-mail:
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Hernando J, Villarreal P, Alvarez-Marcos F, Gallego L, García-Consuegra L, Junquera L. Comparison of related complications: sentinel node biopsy versus elective neck dissection. Int J Oral Maxillofac Surg 2014; 43:1307-12. [PMID: 25128262 DOI: 10.1016/j.ijom.2014.07.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 07/16/2014] [Accepted: 07/18/2014] [Indexed: 02/05/2023]
Abstract
Sentinel node biopsy (SNB) is considered a feasible neck staging tool in early oral squamous cell carcinoma. The aim of this study was to compare postoperative morbidity in patients who had undergone SNB and elective neck dissection (END). Seventy-three consecutive patients were included between the years 2005 and 2009. The patients were divided into two groups according to neck management: SNB and END groups. Kaplan-Meier survival analysis was used to compare disease-free survival (DFS) and overall survival (OS) between the groups. Shoulder function, length of the surgical scar, and the degree of cervical lymphoedema were assessed. Neck haematoma and the presence of oro-cervical communication were also analyzed. Thirty-two patients underwent SNB and 41 underwent an END (levels I-III). Seven regional recurrences were recorded in the END group. Three neck recurrences occurred in the SNB group. No significant differences were found in DFS or OS between the groups. There were statistically significant differences between the groups in shoulder function and average scar length. However, differences in degree of lymphoedema were not statistically significant. Neck hematomas and oro-cervical communications occurred only in the END group. From this study, it can be concluded that SNB presents less postoperative morbidity than END.
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Affiliation(s)
- J Hernando
- Department of Oral and Maxillofacial Surgery, Donostia University Hospital, San Sebastián, Spain
| | - P Villarreal
- Oral and Maxillofacial Surgeon, Private Practice, Oviedo, Spain
| | - F Alvarez-Marcos
- Department of Surgery, University Central Hospital, Oviedo, Spain
| | - L Gallego
- Department of Oral and Maxillofacial Surgery, Cabueñes Hospital, Gijón, Spain
| | - L García-Consuegra
- Department of Oral and Maxillofacial Surgery, University Central Hospital, Oviedo, Spain
| | - L Junquera
- Department of Oral and Maxillofacial Surgery, University Central Hospital, Oviedo, Spain.
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14
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Lymphoscintigraphy in Oral Squamous Cell Carcinoma Sentinel Node Biopsy and Its Role in the Surgical Planning. Clin Nucl Med 2014; 39:e142-5. [DOI: 10.1097/rlu.0b013e3182a755a9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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15
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Künzel J, Psychogios G, Koch M, Mantsopoulos K, Kapsreiter M, Iro H. Results of treatment for pT1/pT2 carcinomas of the floor of mouth. Acta Otolaryngol 2013; 133:1000-5. [PMID: 23869669 DOI: 10.3109/00016489.2013.796090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONCLUSION In pT2 floor of mouth cancer (FOMC), a standardized neck dissection (ND) should be carried out, due to the high risk of occult metastases. In cases of pT1 carcinomas with a clinically negative neck using high imaging standards and expertise a tight 'wait and watch' strategy can be used. OBJECTIVE To report on the oncologic results with primary surgical treatment of pT1/pT2 FOMC and to examine the benefit of elective ND in cN0. METHODS This was a retrospective study design including 216 patients who were treated between 1980 and 2010 for pT1/2 FOMC. The 5-year disease-specific survival (DSS), local and (loco)regional control based on the T and N classification and depth of infiltration were investigated. RESULTS DSS was 79.5% and (loco)regional control was 89.8%. DSS in patients staged pN0 was significantly higher, at 84.6%, than in those staged pN+, at 60%. ND was performed in 165 patients, and adjuvant therapy was administered in 124 patients. Ninety patients (41.7%) were staged cN0, and 53.3% of them underwent elective ND. The risk of occult metastases was 4.8% in pT1 and 28.6% in pT2. A depth of infiltration of ≥ 5 mm showed a markedly higher relative frequency of occult neck metastases and pN+ status.
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Affiliation(s)
- Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg Medical School, Germany
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Zafereo ME. Evaluation and Staging of Squamous Cell Carcinoma of the Oral Cavity and Oropharynx. Otolaryngol Clin North Am 2013; 46:599-613. [DOI: 10.1016/j.otc.2013.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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