1
|
Mukherjee C, Arora A, Nandi S, Saini S. A Prospective Cohort Study on Neck Lymph Node Mapping in Oral Cancers Using Methylene Blue Dye. Indian J Otolaryngol Head Neck Surg 2024; 76:3330-3337. [PMID: 39130243 PMCID: PMC11306817 DOI: 10.1007/s12070-024-04682-z] [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: 01/18/2024] [Accepted: 04/01/2024] [Indexed: 08/13/2024] Open
Abstract
In the current scenario, the management of N0 neck in early-stage oral cancer is debatable, whether or not they should undergo elective neck dissection. Most of the time these patients are either over-treated or under-treated. Sentinel lymph node (SLN) biopsy is a good option to identify occult LN in this cohort of patients for guiding neck dissection. With a focus on SLN biopsy using methylene blue dye, this study aims to evaluate its feasibility and accuracy in node-negative oral squamous cell carcinoma. A prospective observational study was conducted involving operable squamous cell carcinoma patients with clinically and radiologically node-negative neck. Methylene blue was injected in the peritumoral area and after that SLN was identified and then neck dissection was completed. Of 47 patients, SLN was identified in 82.98%, with 53.85% having more than two SLN. Common locations were in levels IB, IA and IIA. Occult metastasis was observed in 12.82% of cases, predominantly in T2 patients. Sensitivity, specificity and NPV were 50%, 100% and 88.89% respectively. The study affirms the feasibility and accuracy of methylene blue-assisted SLN biopsy in oral cancer. Despite a high detection rate, methylene blue dye alone should not be used for SLN identification in oral cavity cancer. However, it can be used as an adjunct of lymphoscintigraphy to increase the yield of the procedure. Multi-institutional trials with larger cohorts may provide valuable insights and more information for comprehensively addressing the limitations of this technique and its broader applicability in decision-making, particularly in resource-constrained countries like India where lymphoscintigraphy is not readily accessible.
Collapse
Affiliation(s)
- Chiranjit Mukherjee
- Department of Surgical Oncology, CRI, Himalayan Institute of Medical Science, SRHU, Dehradun, India
| | - Anshika Arora
- Department of Surgical Oncology, CRI, Himalayan Institute of Medical Science, SRHU, Dehradun, India
| | - Sourabh Nandi
- Department of Surgical Oncology, CRI, Himalayan Institute of Medical Science, SRHU, Dehradun, India
| | - Sunil Saini
- Department of Surgical Oncology, CRI, Himalayan Institute of Medical Science, SRHU, Dehradun, India
| |
Collapse
|
2
|
Wang B, Ma X, Zhang X, Zhang X, Guan S, Xiao T, Li X. Application value of a hybrid tracer during sentinel lymph node biopsy for head and neck malignancies: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108340. [PMID: 38653162 DOI: 10.1016/j.ejso.2024.108340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
To address the limitations of conventional sentinel lymph node biopsy (SLNB), a novel hybrid tracer (indocyanine green [ICG]-99mTc-nanocolloid) has been developed. This meta-analysis aimed to compare the differences between the novel hybrid tracer and conventional methods using ICG or radioisotope (RI) for SLNB in head and neck malignancies. This study was registered in the International Prospective Register of Systematic Reviews (CRD42023409127). PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched. This study included raw data on the number of sentinel lymph nodes (SLNs) identified using different modalities during surgery for head and neck malignancies. The identification rate of SLNs was the main outcome of interest. Prognostic data and complication rate cannot be deduced from this article. The heterogeneity test (I2) determined the use of a fixed- or random-effects model for the pooled risk ratio (RR). Overall, 1275 studies were screened, of which 11 met the inclusion criteria for the meta-analysis. In SLN identification of head and neck malignancies, ICG-99mTc-nanocolloid was superior to ICG or RI. In the subgroup analyses, the detection rates of ICG and RI tracers in SLNB were comparable, regardless of the device, tumor type, or tumor stage. In conclusion, in SLN identification of head and neck malignancies, the use of ICG-99mTc-nanocolloid is superior to the single technique of ICG or RI. This study suggests that Hospitals using ICG or RI may find it beneficial to change their practice to ICG-99mTc-nanocolloid, especially in the head and neck area, owing to its superior effectiveness.
Collapse
Affiliation(s)
- Bowen Wang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Hebei Medical University& Hebei Key Laboratory of Stomatology& Hebei Clinical Research Center for Oral Diseases& Hebei Technology Innovation Center of Oral Health, Shijiazhuang, 050017, China
| | - Xingyue Ma
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Hebei Medical University& Hebei Key Laboratory of Stomatology& Hebei Clinical Research Center for Oral Diseases& Hebei Technology Innovation Center of Oral Health, Shijiazhuang, 050017, China
| | - Xiao Zhang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Hebei Medical University& Hebei Key Laboratory of Stomatology& Hebei Clinical Research Center for Oral Diseases& Hebei Technology Innovation Center of Oral Health, Shijiazhuang, 050017, China
| | - Xiaoyan Zhang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Hebei Medical University& Hebei Key Laboratory of Stomatology& Hebei Clinical Research Center for Oral Diseases& Hebei Technology Innovation Center of Oral Health, Shijiazhuang, 050017, China
| | - Shuai Guan
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Hebei Medical University& Hebei Key Laboratory of Stomatology& Hebei Clinical Research Center for Oral Diseases& Hebei Technology Innovation Center of Oral Health, Shijiazhuang, 050017, China
| | - Tiepeng Xiao
- Department of Orthodontics, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Xiangjun Li
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Hebei Medical University& Hebei Key Laboratory of Stomatology& Hebei Clinical Research Center for Oral Diseases& Hebei Technology Innovation Center of Oral Health, Shijiazhuang, 050017, China.
| |
Collapse
|
3
|
Caldarella C, De Risi M, Massaccesi M, Miccichè F, Bussu F, Galli J, Rufini V, Leccisotti L. Role of 18F-FDG PET/CT in Head and Neck Squamous Cell Carcinoma: Current Evidence and Innovative Applications. Cancers (Basel) 2024; 16:1905. [PMID: 38791983 PMCID: PMC11119768 DOI: 10.3390/cancers16101905] [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: 04/05/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
This article provides an overview of the use of 18F-FDG PET/CT in various clinical scenarios of head-neck squamous cell carcinoma, ranging from initial staging to treatment-response assessment, and post-therapy follow-up, with a focus on the current evidence, debated issues, and innovative applications. Methodological aspects and the most frequent pitfalls in head-neck imaging interpretation are described. In the initial work-up, 18F-FDG PET/CT is recommended in patients with metastatic cervical lymphadenectomy and occult primary tumor; moreover, it is a well-established imaging tool for detecting cervical nodal involvement, distant metastases, and synchronous primary tumors. Various 18F-FDG pre-treatment parameters show prognostic value in terms of disease progression and overall survival. In this scenario, an emerging role is played by radiomics and machine learning. For radiation-treatment planning, 18F-FDG PET/CT provides an accurate delineation of target volumes and treatment adaptation. Due to its high negative predictive value, 18F-FDG PET/CT, performed at least 12 weeks after the completion of chemoradiotherapy, can prevent unnecessary neck dissections. In addition to radiomics and machine learning, emerging applications include PET/MRI, which combines the high soft-tissue contrast of MRI with the metabolic information of PET, and the use of PET radiopharmaceuticals other than 18F-FDG, which can answer specific clinical needs.
Collapse
Affiliation(s)
- Carmelo Caldarella
- Nuclear Medicine Unit, Department of Radiology and Oncologic Radiotherapy, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.C.); (M.D.R.); (L.L.)
| | - Marina De Risi
- Nuclear Medicine Unit, Department of Radiology and Oncologic Radiotherapy, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.C.); (M.D.R.); (L.L.)
| | - Mariangela Massaccesi
- Radiation Oncology Unit, Department of Radiology and Oncologic Radiotherapy, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Francesco Miccichè
- Radiation Oncology Unit, Ospedale Isola Tiberina—Gemelli Isola, 00186 Rome, Italy;
| | - Francesco Bussu
- Otorhinolaryngology Operative Unit, Azienda Ospedaliero Universitaria Sassari, 07100 Sassari, Italy;
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Jacopo Galli
- Otorhinolaryngology Unit, Department of Neurosciences, Sensory Organs and Thorax, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Section of Otolaryngology, Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Vittoria Rufini
- Nuclear Medicine Unit, Department of Radiology and Oncologic Radiotherapy, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.C.); (M.D.R.); (L.L.)
- Section of Nuclear Medicine, Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Lucia Leccisotti
- Nuclear Medicine Unit, Department of Radiology and Oncologic Radiotherapy, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.C.); (M.D.R.); (L.L.)
- Section of Nuclear Medicine, Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| |
Collapse
|
4
|
Bhattacharya K, Mahajan A, Vaish R, Rane S, Shukla S, D'Cruz AK. Imaging of Neck Nodes in Head and Neck Cancers - a Comprehensive Update. Clin Oncol (R Coll Radiol) 2023; 35:429-445. [PMID: 37061456 DOI: 10.1016/j.clon.2023.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/08/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
Cervical lymph node metastases from head and neck squamous cell cancers significantly reduce disease-free survival and worsen overall prognosis and, hence, deserve more aggressive management and follow-up. As per the eighth edition of the American Joint Committee on Cancer staging manual, extranodal extension, especially in human papillomavirus-negative cancers, has been incorporated in staging as it is important in deciding management and significantly impacts the outcome of head and neck squamous cell cancer. Lymph node imaging with various radiological modalities, including ultrasound, computed tomography and magnetic resonance imaging, has been widely used, not only to demonstrate nodal involvement but also for guided histopathological evaluation and therapeutic intervention. Computed tomography and magnetic resonance imaging, together with positron emission tomography, are used widely for the follow-up of treated patients. Finally, there is an emerging role for artificial intelligence in neck node imaging that has shown promising results, increasing the accuracy of detection of nodal involvement, especially normal-appearing nodes. The aim of this review is to provide a comprehensive overview of the diagnosis and management of involved neck nodes with a focus on sentinel node anatomy, pathogenesis, imaging correlates (including radiogenomics and artificial intelligence) and the role of image-guided interventions.
Collapse
Affiliation(s)
- K Bhattacharya
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - A Mahajan
- The Clatterbridge Cancer Centre, NHS Foundation Trust, Liverpool, UK.
| | - R Vaish
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - S Rane
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - S Shukla
- Homi Bhabha Cancer Hospital, Varanasi, Uttar Pradesh, India
| | - A K D'Cruz
- Apollo Hospitals, India; Union International Cancer Control (UICC), Geneva, Switzerland; Foundation of Head Neck Oncology, India
| |
Collapse
|
5
|
Mohamad I, Glaun MDE, Prabhash K, Busheri A, Lai SY, Noronha V, Hosni A. Current Treatment Strategies and Risk Stratification for Oral Carcinoma. Am Soc Clin Oncol Educ Book 2023; 43:e389810. [PMID: 37200591 DOI: 10.1200/edbk_389810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Management of oral cavity squamous cell carcinoma (OSCC) involves a multidisciplinary team approach. Surgery is ideally the primary treatment option for nonmetastatic OSCC, and less invasive curative surgical approaches are preferred in early-stage disease to minimize surgical-related morbidity. For patients at high risk of recurrence, adjuvant treatment using radiation therapy or chemoradiation is often used. Systemic therapy may also be used in the neoadjuvant setting (for advanced-stage disease with the intent of mandibular preservation) or in the palliative setting (for nonsalvageable locoregional recurrence and/or distant metastases). Patient involvement in treatment decision is the key for patient-driven management, particularly in clinical situation with poor prognosis, for example, early postoperative recurrence before planned adjuvant therapy.
Collapse
Affiliation(s)
- Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Mica D E Glaun
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Homi Bhabha National Institute, Mumbai, India
| | - Ahmed Busheri
- Department of Radiation Oncology, Kuwait Cancer Control Center, Kuwait
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Homi Bhabha National Institute, Mumbai, India
| | - Ali Hosni
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| |
Collapse
|
6
|
Jang SS, Davis ME, Vera DR, Lai SY, Guo TW. Role of sentinel lymph node biopsy for oral squamous cell carcinoma: Current evidence and future challenges. Head Neck 2023; 45:251-265. [PMID: 36193862 PMCID: PMC11081060 DOI: 10.1002/hed.27207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/24/2022] [Accepted: 09/19/2022] [Indexed: 12/14/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) has been used across oncological specialties for prognostication, staging, and identification of occult nodal metastasis. Recent studies demonstrated the potential clinical utility of SLNB in oral cavity squamous cell carcinoma (OCSCC). Elective neck dissection is the current standard of care in early management of OCSCC with depth of invasion greater than 2-4 mm; however, majority of patients ultimately do not have nodal disease on final pathology. SLNB is an alternative procedure widely adopted in early cancer management in many oncological subspecialities. Several considerations such as depth of invasion, nodal mapping, histopathology methods, operator variability, postoperative complications, and advancement in preoperative and intraoperative imaging technology can guide the appropriate application to SLNB in OCSCC. The aim of this review is to discuss the current evidence for SLNB in the treatment of early stage OCSCC, imaging technologies that support SLNB procedures, and studies that are currently underway.
Collapse
Affiliation(s)
- Sophie S Jang
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Diego, La Jolla, California, USA
| | - Morgan E Davis
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Diego, La Jolla, California, USA
| | - David R Vera
- Department of Radiology, University of California, San Diego, La Jolla, California, USA
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Theresa W Guo
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Diego, La Jolla, California, USA
| |
Collapse
|
7
|
Wu YX, Mao QY, Kang YF, Xie S, Shan XF, Cai ZG. In Vivo Oral Sentinel Lymph Node Mapping by Near-Infrared Fluorescent Methylene Blue in Rats. Diagnostics (Basel) 2022; 12:diagnostics12112574. [PMID: 36359418 PMCID: PMC9689899 DOI: 10.3390/diagnostics12112574] [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: 09/29/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to demonstrate the feasibility of near-infrared (NIR) fluorescence imaging using methylene blue (MB) for detecting oral sentinel lymph nodes (SLNs) in rats and compared MB’s tracer effects with those of indocyanine green (ICG) in SLN mapping. Different concentrations of MB were injected into the rats’ left lingual submucosa to determine the optimal concentration by using a continuous (1 h) MI-1 fluorescence imaging system. To compare the tracer effects of the optimal MB concentration with ICG in oral SLN mapping, MI-1 imaging was continuously monitored for 12 h. The mean signal-to-background ratio (SBR) of the SLNs and SLN fluorescence area fraction were analyzed. SLNs and lymphatic vessels were clearly visible in all rats. The optimal injection dose of MB infected into lingual submucosa for NIR fluorescence imaging was 0.2 mL of 6.68 mM MB. During continuous monitoring for 12 h, the mean SBR of the SLNs was significantly higher in the ICG groups than in the MB groups (p < 0.001). However, the area fraction of SLN fluorescence in the ICG groups increased continuously, owing to strong fluorescent contamination. This study examined the feasibility of detection of draining lymph nodes in the oral cavity of rats using MB NIR fluorescence imaging. MB causes less fluorescent contamination than does ICG, which shows promise for clinical research and application.
Collapse
Affiliation(s)
- Yu-Xiao Wu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
- National Center of Stomatology, Beijing 100081, China
- National Clinical Research Center for Oral Diseases, Beijing 100081, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Qian-Ying Mao
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
- National Center of Stomatology, Beijing 100081, China
- National Clinical Research Center for Oral Diseases, Beijing 100081, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Yi-Fan Kang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
- National Center of Stomatology, Beijing 100081, China
- National Clinical Research Center for Oral Diseases, Beijing 100081, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Shang Xie
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
- National Center of Stomatology, Beijing 100081, China
- National Clinical Research Center for Oral Diseases, Beijing 100081, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Xiao-Feng Shan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
- National Center of Stomatology, Beijing 100081, China
- National Clinical Research Center for Oral Diseases, Beijing 100081, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
- National Center of Stomatology, Beijing 100081, China
- National Clinical Research Center for Oral Diseases, Beijing 100081, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
- Correspondence: ; Tel.: +86-13910733943; Fax: +86-10-62173402
| |
Collapse
|
8
|
Singh A, Roy S, Tuljapurkar V, Nair D, Chaturvedi P. Critical Review of the Current Evidence on Sentinel Node Biopsy in Oral Cancer. Curr Oncol Rep 2022; 24:783-791. [PMID: 35298797 DOI: 10.1007/s11912-021-01171-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW With contemporary surgery of the cN0 neck in early oral cancer becoming more selective, sentinel node biopsy (SNB) is gaining popularity as a possible alternate option to elective neck dissection (END). This review attempts to critically appraise the current evidence and highlight pertinent arguments for the use of SNB in early oral cancers. RECENT FINDINGS Based on the recent randomized trials, it is imperative to perform an END at the time of primary resection in cN0 oral cancers. The much criticized false negative rate of SNB can be argued to be equal to the regional failure rate after END for pN0 necks, possibly making a case for SNB due to the reduction in number of neck dissections. There still lies ambiguity on the technique, protocols, and benefit of SNB over END. The role of extended histopathological techniques and the implications of micrometastasis and isolated tumor cells for treatment intensification remain questionable. Currently, SNB is an intermediary between routine imaging and END that needs to evolve before it can become a practice changing alternative to END itself. More efforts are needed in standardizing the protocols for SNB.
Collapse
Affiliation(s)
- Arjun Singh
- Head and Neck Oncology Department, Tata Memorial Hospital and HBNI, Mumbai, India
| | - Satadru Roy
- Head and Neck Oncology Department, Tata Memorial Centre and HBNI, Mumbai, India
| | - Vidisha Tuljapurkar
- Head and Neck Oncology Department, Tata Memorial Centre and HBNI, Mumbai, India
| | - Deepa Nair
- Head and Neck Oncology Department, Tata Memorial Centre and HBNI, Mumbai, India
| | - Pankaj Chaturvedi
- Head and Neck Oncology Department, Tata Memorial Hospital and HBNI, Mumbai, India.
| |
Collapse
|
9
|
Beulque E, Cortese S, Mastronicola R, Dolivet G. [Surgical de-escalation for head and neck cancer surgery]. Bull Cancer 2021; 108:948-952. [PMID: 34556292 DOI: 10.1016/j.bulcan.2021.06.008] [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: 04/30/2021] [Revised: 05/26/2021] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
Head and neck cancer surgery often has functional and aesthetic consequences. De-escalation surgery is a major concern for surgeons with a constant desire to develop surgical techniques with less invasive approaches and to preserve anatomical structures as much as possible. This was made possible by the appearance of minimally transoral and endonasal surgery as well as by the limitation of the surgical procedure by neoadjuvant treatments or by the limitation of surgical excision without compromising the oncological outcome and patient survival. This evolution continues with the arrival of new technologies such as virtual reality or artificial intelligence.
Collapse
Affiliation(s)
- Emilie Beulque
- Institut de cancérologie de Lorraine, département de chirurgie, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy cedex, France.
| | - Sophie Cortese
- Institut de cancérologie de Lorraine, département de chirurgie, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy cedex, France
| | - Romina Mastronicola
- Institut de cancérologie de Lorraine, département de chirurgie, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy cedex, France
| | - Gilles Dolivet
- Institut de cancérologie de Lorraine, département de chirurgie, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy cedex, France
| |
Collapse
|
10
|
King C, Elsherif N, Kirwan R, Schilling C, Hall G, Morgan P, Collins L, Sandison A, Odell E, Thavaraj S. Serial step sections at narrow intervals with immunohistochemistry are required for accurate histological assessment of sentinel lymph node biopsy in oral squamous cell carcinoma. Head Neck 2021; 43:2985-2993. [PMID: 34128276 DOI: 10.1002/hed.26784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/21/2021] [Accepted: 06/07/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy is an accurate staging modality in early oral squamous cell carcinoma (OSCC), but its accuracy relies on labor-intensive histopathology protocols. We sought to determine whether serial step sections with immunohistochemistry (SSSIHC) at narrow intervals of the entire SLN are required to accurately exclude metastasis. METHODS Consecutive SLN biopsies over a 13-year period were retrospectively evaluated. If the index section was negative for carcinoma, the entire SLN was subjected to SSSIHC at 150 μm intervals. The first section level and total number of section levels to contain carcinoma were recorded. RESULTS One hundred and eighteen SLN+ from 90 patients were included. SSSIHC upstaged the nodal status in 19.5% of patients. Metastasis was identified in 16.7% and 10.2% beyond section levels 4 and 6, respectively. Among SLNs requiring SSSIHC, 47.5% contained carcinoma in a single section level. CONCLUSION SSSIHC of the entire SLN at 150 μm intervals are required to identify occult metastasis in OSCC.
Collapse
Affiliation(s)
- Claire King
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nusaybah Elsherif
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ruaidhrí Kirwan
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Clare Schilling
- Head & Neck Surgery, University College London Hospital, London, UK.,Head and Neck Academic Centre, University College London, London, UK
| | - Gillian Hall
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Peter Morgan
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Oral, Dental and Craniofacial Science, King's College London, London, UK
| | - Lisette Collins
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ann Sandison
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Edward Odell
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Oral, Dental and Craniofacial Science, King's College London, London, UK
| | - Selvam Thavaraj
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Oral, Dental and Craniofacial Science, King's College London, London, UK
| |
Collapse
|
11
|
Chen Y, Xiao Q, Zou W, Xia C, Yin H, Pu Y, Wang Y, Zhang K. Sentinel lymph node biopsy in oral cavity cancer using indocyanine green: A systematic review and meta-analysis. Clinics (Sao Paulo) 2021; 76:e2573. [PMID: 34287476 PMCID: PMC8266175 DOI: 10.6061/clinics/2021/e2573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/03/2021] [Indexed: 11/18/2022] Open
Abstract
This meta-analysis was conducted to evaluate the value of indocyanine green (ICG) in guiding sentinel lymph node biopsy (SLNB) for patients with oral cavity cancer. An electronic database search (PubMed, MEDLINE, Cochrane Library, Embase, and Web of Science) was performed from their inception to June 2020 to retrieve clinical studies of ICG applied to SLNB for oral cavity cancer. Data were extracted from 14 relevant articles (226 patients), and 9 studies (134 patients) were finally included in the meta-analysis according to the inclusion and exclusion criteria. The pooled sentinel lymph node (SLN) sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 88.0% (95% confidence interval [CI], 74.0-96.0), 64.0% (95% CI, 61.0-66.0), 2.45 (95% CI, 1.31-4.60), 0.40 (95% CI, 0.17-0.90), and 7.30 (95% CI, 1.74-30.68), respectively. The area under the summary receiver operating characteristic curve was 0.8805. In conclusion, ICG applied to SLNB can effectively predict the status of regional lymph nodes in oral cavity cancer.
Collapse
Affiliation(s)
- Yongfeng Chen
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Qi Xiao
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weina Zou
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chengwan Xia
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hongling Yin
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yumei Pu
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yuxin Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
- Corresponding authors. E-mails: /
| | - Kai Zhang
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Corresponding authors. E-mails: /
| |
Collapse
|
12
|
Skanjeti A, Dhomps A, Paschetta C, Tordo J, Delgado Bolton RC, Giammarile F. Lymphoscintigraphy for Sentinel Node Mapping in Head and Neck Cancer. Semin Nucl Med 2020; 51:39-49. [PMID: 33246538 DOI: 10.1053/j.semnuclmed.2020.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of this comprehensive review is to describe and analyze the role of the sentinel node mapping in head and neck cancers. For this purpose, head and neck neoplasms have been categorized in cutaneous malignancies and neoplasms of the upper aerodigestive tract. A concise description of lymphatic drainage will be the "prelude" for each section, as well as the description of the injection techniques, when specific. Concisely, the attention has been focused on detection rate of the sentinel node by lymphoscintigraphy for each cancer, and for those patients in which the sentinel lymph node has been identified, true-positives rates, false-negative rates, and overall accuracy has been pointed out. Overall, in cutaneous neoplasms of the head and neck, the detection rate is higher than 90%, however the false-negative rate is still an issue, in particular in melanoma, inducing the need for newer developments. In fact, new tracers and techniques are already available, while prospective multicenter trials exploring the outcome impact are needed in the near future. For the upper aerodigestive tract and in particular oral cavity and oropharynx, sentinel lymph node identification by lymphoscintigraphy allows avoiding unnecessary neck dissection and/or node irradiation. Even in this case, the main limit remains the risk of false-negative rates. While, for patients affected by laryngeal and hypopharyngeal cancers the data seem very limited and, although the feasibility has been demonstrated, performances of this lymphoscintigraphy still need to be confirmed by multicenter studies.
Collapse
Affiliation(s)
- Andrea Skanjeti
- Nuclear Medicine Department, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, Lyon, France
| | - Anthony Dhomps
- Nuclear Medicine Department, Hospices Civils de Lyon, Lyon, France
| | | | - Jérémie Tordo
- Nuclear Medicine Department, Hospices Civils de Lyon, Lyon, France
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency (IAEA), Vienna, Austria; Centre Léon Bérard, Lyon, France.
| |
Collapse
|
13
|
Marttila E, Keski-Säntti H, Hagström J, Snäll J, Wilkman T. Sentinel lymph node biopsies in early stage oral and oropharyngeal carcinoma: a retrospective single-centre experience. Br J Oral Maxillofac Surg 2020; 58:1078-1083. [PMID: 32522437 DOI: 10.1016/j.bjoms.2020.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/15/2020] [Indexed: 11/19/2022]
Abstract
The aim of this retrospective study was to analyse a consecutive series of patients with oral and oropharyngeal carcinoma who had had sentinel lymph node biopsy (SLNB) at our hospital during 2008-2017. A total of 70 patients with clinically and radiologically confirmed primary oral (n=67) or oropharyngeal (n=3) carcinoma, with no signs of metastatic lymph nodes preoperatively (clinically N0) were included. Patients' clinical and personal data, characteristics of the tumours, sentinel lymph node (SLN) status and outcomes were recorded. Eight patients had invaded SLN. Two patients with clear sentinel lymph node biopsies had recurrences in the cervical lymph nodes with no new primary tumour as origin. The negative predictive value (NPV) and sensitivity for SLNB were 97% and 80%, respectively. The depth of invasion was an individual predictor for cervical lymph node metastasis (p=0.043). Single photo emission computed tomography (SPECT) detected fewer SLN in patients with invaded lymph nodes than in patients with clear lymph nodes (p=0.018). Our data support the use of SLNB as a minimally invasive method for staging the cervical lymph nodes among patients with cN0 oral and oropharyngeal carcinoma. Our results further confirm that greater depth of invasion is associated with cervical lymph node metastases.
Collapse
Affiliation(s)
- E Marttila
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, PO Box 220, FI-00029 Helsinki.
| | - H Keski-Säntti
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, PO Box 263, FI-00029 Helsinki.
| | - J Hagström
- Department of Pathology, Helsinki University Hospital and University of Helsinki, PO Box 400, FI-00029 Helsinki.
| | - J Snäll
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, PO Box 220, FI-00029 Helsinki.
| | - T Wilkman
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, PO Box 220, FI-00029 Helsinki.
| |
Collapse
|
14
|
Should a neck dissection be performed on patients with cN0 adenoid cystic carcinoma? A REFCOR propensity score matching study. Eur J Cancer 2020; 130:250-258. [PMID: 32008920 DOI: 10.1016/j.ejca.2019.12.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/17/2019] [Accepted: 12/26/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patterns of nodal involvement in adenoid cystic carcinoma (ACC) of the head and neck have not been sufficiently assessed to guide a decision of prophylactic neck dissection (ND). The objective of this study is to analyse the influence of ND on event-free survival (EFS) for patients with cN0 ACC. PATIENTS AND METHODS A multicentre prospective study was conducted between 2009 and 2018. Patients presenting cN0 non-metastatic ACC on any site, and who received surgery on the tumour, were included. EFS was the main judgement criterion. A comparative survival analysis between the groups that received a ND versus those that did not was performed, using a propensity score. Analyses were carried out using the R software. RESULTS Between 2009 and 2018, 322 patients with cN0 ACC were included, out of which 58% were female. The average age was 53 years. Tumours were in minor salivary glands in 58% of cases, and 52% had T3/T4 stages. ND was performed on 46% of patients. Out of them, seven had histological lymph node invasion, out of which six had tumour infiltration in the mucosa of oral cavity. After propensity score, the median EFS for N0 patients with ND was 72 months (95% Confidence Interval (CI) [48-81]), compared to 73 months (95% CI [52-85]) for patients without ND (HR = 1.33; 95% CI [0.82-2.16]; p = 0.2). CONCLUSION ND of cN0 patients does not provide any benefit on EFS, which suggests that its application on such patients is not necessary.
Collapse
|
15
|
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]
|
16
|
Moya-Plana A, Aupérin A, Guerlain J, Gorphe P, Casiraghi O, Mamelle G, Melkane A, Lumbroso J, Janot F, Temam S. Sentinel node biopsy in early oral squamous cell carcinomas: Long-term follow-up and nodal failure analysis. Oral Oncol 2018; 82:187-194. [DOI: 10.1016/j.oraloncology.2018.05.021] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/20/2018] [Accepted: 05/25/2018] [Indexed: 02/06/2023]
|
17
|
Siddiq S, Cartlidge D, Stephen S, Sathasivam HP, Fox H, O'Hara J, Meikle D, Iqbal MS, Kelly CG, Robinson M, Paleri V. Robotic lateral oropharyngectomy following diagnostic tonsillectomy is oncologically safe in patients with high risk human papillomavirus related squamous cell cancer. Eur Arch Otorhinolaryngol 2018; 275:1853-1860. [PMID: 29754260 DOI: 10.1007/s00405-018-4968-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 04/06/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE Diagnostic tonsillectomy is rarely an oncologic operation owing to close or positive margins. The standard of care is for further treatment to the primary site, typically with adjuvant radiotherapy. METHODS 14 patients with close or positive margins following a diagnostic tonsillectomy underwent transoral robotic surgery (TORS) and lateral oropharyngectomy; five patients with the longest follow-up had their excision specimens examined with a step serial sectioning technique (SSS). RESULTS Conventional histopathological examination of the TORS resection specimens did not demonstrate residual carcinoma in 13 patients, confirmed by examination using SSS in 5 patients. There were no post-operative complications or long-term functional deficit. Seven patients received surgery alone with 100% overall and disease specific survival, respectively (median follow-up 27.5 months; range 5.2-50.4). CONCLUSIONS This prospective study suggests that TORS lateral oropharyngectomy alone is an oncologically safe treatment when close or positive margins are identified on diagnostic tonsillectomy in HPV-positive SCC.
Collapse
Affiliation(s)
- Somiah Siddiq
- Head and Neck unit, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B9 5SS, UK
| | - David Cartlidge
- Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK
| | - Sarah Stephen
- Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK
| | - Hans P Sathasivam
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Hannah Fox
- Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK
| | - James O'Hara
- Otolaryngology, Head and Neck Surgery, Newcastle upon Tyne Hospitals and Newcastle University, Newcastle upon Tyne, NE7 7DN, UK
| | - David Meikle
- Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK
| | - Muhammad Shahid Iqbal
- Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK
| | - Charles G Kelly
- Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK
| | - Max Robinson
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
- The Institute of Cancer Research, London, UK.
| |
Collapse
|
18
|
Boeve K, Schepman K, Schuuring E, Roodenburg J, Halmos G, Dijk B, Boorsma R, Visscher J, Brouwers A, Vegt B, Witjes M. High sensitivity and negative predictive value of sentinel lymph node biopsy in a retrospective early stage oral cavity cancer cohort in the Northern Netherlands. Clin Otolaryngol 2018; 43:1080-1087. [DOI: 10.1111/coa.13107] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 02/05/2023]
Affiliation(s)
- K. Boeve
- Department of Oral and Maxillofacial Surgery University of Groningen University Medical Center Groningen Groningen The Netherlands
- Department of Pathology & Medical Biology University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - K.P. Schepman
- Department of Oral and Maxillofacial Surgery University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - E. Schuuring
- Department of Pathology & Medical Biology University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - J.L.N. Roodenburg
- Department of Oral and Maxillofacial Surgery University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - G.B. Halmos
- Department of Otorhinolaryngology/Head & Neck Surgery University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - B.A.C. Dijk
- Department of Epidemiology University of Groningen University Medical Center Groningen Groningen The Netherlands
- Department of Research Comprehensive Cancer Organization The Netherlands (IKNL) Utrecht The Netherlands
| | | | - J.G.A.M. Visscher
- Department of Oral and Maxillofacial Surgery Medical Center Leeuwarden Leeuwarden The Netherlands
| | - A.H. Brouwers
- Department of Nuclear Medicine & Molecular Imaging University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - B. Vegt
- Department of Pathology & Medical Biology University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - M.J.H. Witjes
- Department of Oral and Maxillofacial Surgery University of Groningen University Medical Center Groningen Groningen The Netherlands
| |
Collapse
|
19
|
Garrel R, Poissonnet G, Temam S, Dolivet G, Fakhry N, de Raucourt D. Review of sentinel node procedure in cN0 head and neck squamous cell carcinomas. Guidelines from the French evaluation cooperative subgroup of GETTEC. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:89-93. [DOI: 10.1016/j.anorl.2016.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
20
|
Sharma D, Koshy G, Grover S, Sharma B. Sentinel Lymph Node Biopsy: A new approach in the management of head and neck cancers. Sultan Qaboos Univ Med J 2017; 17:e3-e10. [PMID: 28417021 PMCID: PMC5380418 DOI: 10.18295/squmj.2016.17.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/21/2016] [Accepted: 10/06/2016] [Indexed: 12/14/2022] Open
Abstract
Cervical lymph node metastasis affects the prognosis and overall survival rate of and therapeutic planning for patients with head and neck squamous cell carcinomas (HNSCCs). However, advanced diagnostic modalities still lack accuracy in detecting occult neck metastasis. A sentinel lymph node biopsy is a minimally invasive auxiliary method for assessing the presence of occult metastatic disease in a patient with a clinically negative neck. This technique increases the specificity of neck dissection and thus reduces morbidity among oral cancer patients. The removal of sentinel nodes and dissection of the levels between the primary tumour and the sentinel node or the irradiation of target nodal basins is favoured as a selective treatment approach; this technique has the potential to become the new standard of care for patients with HNSCCs. This article presents an update on clinical applications and novel developments in this field.
Collapse
Affiliation(s)
- Deepti Sharma
- Department of Oral & Maxillofacial Pathology, Christian Dental College & Hospital, Ludhiana, Punjab, India
| | - George Koshy
- Department of Oral & Maxillofacial Pathology, Christian Dental College & Hospital, Ludhiana, Punjab, India
| | - Sonal Grover
- Department of Oral & Maxillofacial Pathology, Christian Dental College & Hospital, Ludhiana, Punjab, India
| | - Bhushan Sharma
- Department of Oral & Maxillofacial Pathology, Christian Dental College & Hospital, Ludhiana, Punjab, India
| |
Collapse
|
21
|
Sentinel Node in Oral Cancer: The Nuclear Medicine Aspects. A Survey from the Sentinel European Node Trial. Clin Nucl Med 2017; 41:534-42. [PMID: 27088386 DOI: 10.1097/rlu.0000000000001241] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Nuclear imaging plays a crucial role in lymphatic mapping of oral cancer. This evaluation represents a subanalysis of the original multicenter SENT trial data set, involving 434 patients with T1-T2, N0, and M0 oral squamous cell carcinoma. The impact of acquisition techniques, tracer injection timing relative to surgery, and causes of false-negative rate were assessed. METHODS Three to 24 hours before surgery, all patients received a dose of Tc-nanocolloid (10-175 MBq), followed by lymphoscintigraphy. According to institutional protocols, all patients underwent preoperative dynamic/static scan and/or SPECT/CT. RESULTS Lymphoscintigraphy identified 723 lymphatic basins. 1398 sentinel lymph nodes (SNs) were biopsied (3.2 SN per patient; range, 1-10). Dynamic scan allowed the differentiation of sentinel nodes from second tier lymph nodes. SPECT/CT allowed more accurate anatomical localization and estimated SN depth more efficiently. After pathological examination, 9.9% of the SN excised (138 of 1398 SNs) showed metastases. The first neck level (NL) containing SN+ was NL I in 28.6%, NL IIa in 44.8%, NL IIb in 2.8%, NL III in 17.1%, and NL IV in 6.7% of positive patients. Approximately 96% of positive SNs were localized in the first and second lymphatic basin visualized using lymphoscintigraphy. After neck dissection, the SN+ was the only lymph node containing metastasis in approximately 80% of patients. CONCLUSIONS Best results were observed using a dynamic scan in combination with SPECT/CT. A shorter interval between tracer injection, imaging, and surgery resulted in a lower false-negative rate. At least 2 NLs have to be harvested, as this may increase the detection of lymphatic metastases.
Collapse
|
22
|
Sentinel Lymph Node Biopsy in N0 Neck for Squamous Cell Carcinoma of Oral Cavity: a Prospective Study. Indian J Surg Oncol 2016; 7:375-379. [PMID: 27872522 DOI: 10.1007/s13193-016-0560-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 09/12/2016] [Indexed: 10/21/2022] Open
Abstract
Oral cancers in India are very common. SLNB (sentinel lymph node biopsy) for the management of the cN0 neck provides proper staging with less morbidity. The study aims at assessment of the technical feasibility and accuracy of SLNB. Two by two table and Kappa statistic was used to compare SLN and END. In 14 cases out of 16 cases, SLN was identified. Sensitivity and specificity of 100 % were found. One hundred percent agreement was observed between SLN and END using kappa statistics. A meta-analysis of 19 studies showed 97.7 % sentinel node identification rate and 92.6 % sensitivity with a false negative rate of 3 %. In patients with N0 neck and negative SLN, neck dissection can be avoided decreasing morbidity of SOND. SLN biopsy has potential to become standard of care for managing N0 neck; however, long-term oncological results need to be evaluated.
Collapse
|
23
|
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.
Collapse
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.
| |
Collapse
|
24
|
Peng H, Wang SJ, Niu X, Yang X, Chi C, Zhang G. Sentinel node biopsy using indocyanine green in oral/oropharyngeal cancer. World J Surg Oncol 2015; 13:278. [PMID: 26381239 PMCID: PMC4574454 DOI: 10.1186/s12957-015-0691-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 09/07/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUNDS Radioactive tracer-based detection has been proposed as a standard procedure in identifying sentinel nodes for cN0 oral/oropharyngeal carcinoma. However, access to radioactive isotopes may be limited in some surgical centers, and there is potential risk of the radioactive tracers to the operators. This study was designed to evaluate the feasibility of near-infrared fluorescence imaging with indocyanine green combined with blue dye mapping in sentinel node biopsy for cN0 oral/oropharyngeal carcinoma. METHODS Twenty-six cases of previously untreated oral/oropharyngeal carcinoma staged cT1-2N0M0 were enrolled in this study. One milliliter of indocyanine green (5 mg/ml) and 1.5 ml of methylene blue (1 mg/ml) were injected sequentially around the primary tumor in a four-quadrant pattern before skin incision. After elevation of the platysma flap and posterior retraction of the sternocleidomastoid muscle, fluorescence images were taken with a near-infrared detector, with special attention paid to any blue-dyed lymph nodes. Lymph nodes identified first with fluorescent hot spots with or without blue dye were defined as sentinel nodes, and they were harvested and sent for pathologic study. RESULTS Sentinel nodes were successfully harvested in all 26 cases. The number of sentinel nodes (SNs) per case varied from 1 to 9, with an average of 3.4. Routine pathology demonstrated occult metastasis exclusively in SNs in four cases (15.4 %). No tracer-associated side effects occurred in this series. CONCLUSIONS Near-infrared imaging using indocyanine green combined with methylene blue mapping is a feasible and reliable new method for SN biopsy in cN0 oral/oropharyngeal carcinoma.
Collapse
Affiliation(s)
- Hanwei Peng
- Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, No.7 Raoping Road, Shantou City, Guangdong Province, 515031, China.
| | - Steven J Wang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Xiaohua Niu
- Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, No.7 Raoping Road, Shantou City, Guangdong Province, 515031, China
- Current address: Key Lab of Major Obstetrics Disease of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xihong Yang
- Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, No.7 Raoping Road, Shantou City, Guangdong Province, 515031, China
| | - Chongwei Chi
- Intelligent Medical Research Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Guojun Zhang
- Breast Cancer Center, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| |
Collapse
|
25
|
Pinto A, Wieshmann H, Triantafyllou A, Shaw R. Tattoo-pigmented cervical lymph node that masqueraded as the sentinel lymph node in oral squamous cell carcinoma. Br J Oral Maxillofac Surg 2015; 53:886-7. [PMID: 26188933 DOI: 10.1016/j.bjoms.2015.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 06/15/2015] [Indexed: 11/25/2022]
Abstract
We describe a case of a pigmented cervical lymph node mimicking the sentinel node during sentinel lymph node biopsy (SLNB) on a patient with oral squamous cell carcinoma (OSCC). The patient had extensive tattoos on his neck. This pigmented lymph node was not identified to be the sentinel lymph node using static and dynamic lymphoscintigraphy. Subsequent histological analysis revealed tattoo pigment within this lymph node. It is important during cervical SLNB to be aware that cutaneous tattoos can pigment lymph nodes.
Collapse
|
26
|
de Bree R, Nieweg OE. The history of sentinel node biopsy in head and neck cancer: From visualization of lymphatic vessels to sentinel nodes. Oral Oncol 2015; 51:819-23. [PMID: 26126813 DOI: 10.1016/j.oraloncology.2015.06.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 06/13/2015] [Accepted: 06/16/2015] [Indexed: 02/06/2023]
Abstract
The aim of this report is to describe the history of sentinel node biopsy in head and neck cancer. Sentinel node biopsy is a minimally invasive technique to select patients for treatment of metastatic lymph nodes in the neck. Although this procedure has only recently been accepted for early oral cancer, the first studies on visualization of the cervical lymphatic vessels were reported in the 1960s. In the 1980s mapping of lymphatic drainage from specific head and neck sites was introduced. Sentinel node biopsy was further developed in the 1990s and after validation in this century the procedure is routinely performed in early oral cancer in several head and neck centers. New techniques may improve the accuracy of sentinel node biopsy further, particularly in difficult subsites like the floor of mouth.
Collapse
Affiliation(s)
- Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, UMCU Utrecht, Utrecht, The Netherlands; Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
| | - Omgo E Nieweg
- Melanoma Institute Australia, North Sydney, Australia; The Mater Hospital, North Sydney, Australia; Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
27
|
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
|
28
|
|
29
|
Sentinel lymph node biopsy in oral and oropharyngeal squamous cell carcinoma: current status and unresolved challenges. Eur J Nucl Med Mol Imaging 2015; 42:1469-80. [PMID: 25916741 DOI: 10.1007/s00259-015-3049-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/15/2015] [Indexed: 12/14/2022]
Abstract
Because imaging with ultrasound, computed tomography, magnetic resonance imaging or positron emission tomography is unreliable for preoperative lymph node staging of early-stage oral and oropharyngeal squamous cell carcinoma (OSCC), elective neck dissection has been typically performed. The targeted sampling of sentinel lymph nodes (SLN) identified by lymphoscintigraphy and detected by gamma probe has become an effective alternative for the selection of patients for regional nodal resection. With careful consideration to technique, high SLN detection rates have been reported. Advanced techniques including intraoperative handheld gamma camera imaging and freehand single photon emission computed tomography (SPECT) are expected to increase surgical confidence in these procedures. This review gives an update on SLN biopsy in patients with OSCC including clinical standards and controversial aspects.
Collapse
|
30
|
Denoth S, Broglie MA, Haerle SK, Huber GF, Haile SR, Soltermann A, Jochum W, Stoeckli SJ. Histopathological mapping of metastatic tumor cells in sentinel lymph nodes of oral and oropharyngeal squamous cell carcinomas. Head Neck 2014; 37:1477-82. [DOI: 10.1002/hed.23782] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 03/07/2014] [Accepted: 05/28/2014] [Indexed: 12/16/2022] Open
Affiliation(s)
- Seraina Denoth
- Department of Otorhinolaryngology, Head and Neck Surgery; Kantonsspital St. Gallen; Switzerland
| | - Martina A. Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery; Kantonsspital St. Gallen; Switzerland
| | - Stephan K. Haerle
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospital Zurich; Switzerland
| | - Gerhard F. Huber
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospital Zurich; Switzerland
| | - Sarah R. Haile
- Clinical Trials Unit; Kantonsspital St. Gallen; Switzerland
| | - Alex Soltermann
- Department of Clinical Pathology; University Hospital of Zurich; Switzerland
| | - Wolfram Jochum
- Institute of Pathology, Kantonsspital St. Gallen; Switzerland
| | - Sandro J. Stoeckli
- Department of Otorhinolaryngology, Head and Neck Surgery; Kantonsspital St. Gallen; Switzerland
| |
Collapse
|
31
|
Bluemel C, Herrmann K, Kübler A, Buck AK, Geissinger E, Wild V, Hartmann S, Lapa C, Linz C, Müller-Richter U. Intraoperative 3-D imaging improves sentinel lymph node biopsy in oral cancer. Eur J Nucl Med Mol Imaging 2014; 41:2257-64. [DOI: 10.1007/s00259-014-2870-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/18/2014] [Indexed: 01/28/2023]
|
32
|
Bluemel C, Herrmann K, Müller-Richter U, Lapa C, Higuchi T, Wild V, Buck AK, Kübler A, Linz C. Freehand SPECT-guided sentinel lymph node biopsy in early oral squamous cell carcinoma. Head Neck 2014; 36:E112-6. [PMID: 24375962 DOI: 10.1002/hed.23596] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/15/2013] [Accepted: 12/20/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In oral squamous cell carcinoma (OSCC), cervical lymph node status is the most important prognostic factor. Compared to elective neck dissection, reduced morbidity and better quality of life was demonstrated for sentinel lymph node biopsy, which is controversial because of the reduced detection rate of sentinel lymph nodes in close proximity to the injection site (also known as the shine-through phenomenon). METHODS We report the case of a 44-year-old woman with a biopsy-proven early OSCC of the anterior floor of the mouth, who received SLNB guided with freehand single-photon emission CT (fhSPECT), a system for the 3D visualization of radioactivity in the body. RESULTS One level III sentinel lymph node and 1 level I sentinel lymph node, in close proximity to the injection site, were detected and dissected. The level I sentinel lymph node contained a metastasis. CONCLUSION Using fhSPECT, the issue outlined was overcome, and the precise histopathological lymph node status (pN1; 1 of 49) was determined.
Collapse
Affiliation(s)
- Christina Bluemel
- Department of Nuclear Medicine, University Hospital of Würzburg, Würzburg, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Marcinow AM, Hall N, Byrum E, Teknos TN, Old MO, Agrawal A. Use of a novel receptor-targeted (CD206) radiotracer, 99mTc-tilmanocept, and SPECT/CT for sentinel lymph node detection in oral cavity squamous cell carcinoma: initial institutional report in an ongoing phase 3 study. JAMA Otolaryngol Head Neck Surg 2013; 139:895-902. [PMID: 24051744 DOI: 10.1001/jamaoto.2013.4239] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
IMPORTANCE Sentinel lymph node biopsy has been proposed as an alternative to up-front elective neck dissection (END) for determination of pathologic nodal status in patients undergoing surgical treatment for oral cavity squamous cell carcinoma (OSCC) with clinically negative neck (cN0). Sentinel lymph node biopsy using current standard tracer agents and imaging adjuncts such as radiolabeled sulfur-colloid and planar lymphoscintigraphy (LS), however, is associated with several drawbacks. OBJECTIVE To assess the preliminary utility of technetium Tc 99m (99mTc)-tilmanocept, a novel molecular imaging agent for sentinel lymph node (SLN) mapping, in OSCC. DESIGN, SETTING, AND PARTICIPANTS Prospective, nonrandomized, single-arm, part of an ongoing phase 3 clinical trial. Patients had previously untreated, clinically and radiographically node-negative OSCC (T1-4aN0M0) at an academic tertiary referral center. INTERVENTIONS Patients received a single dose of 50 µg 99mTc-tilmanocept injected peritumorally followed by dynamic planar LS and fused single-photon emission computed tomography/computed tomography (SPECT/CT) prior to surgery. Surgical intervention consisted of excision of the primary tumor and radioguided SLN dissection followed by planned END. The excised lymph nodes (SLNs and non-SLNs) underwent histopathologic evaluation for presence of metastatic disease. MAIN OUTCOMES AND MEASURES False-negative rate and negative predictive value of SLNB using 99mTc-tilmanocept and comparison of planar LS with SPECT/CT in SLN localization. RESULTS Twelve of 20 patients (60%) had metastatic neck disease on pathologic examination. All 12 had at least 1 SLN positive for metastases. No patients had a positive END node who did not have at least 1 positive SLN. These data yield a false-negative rate of 0% and negative predictive value of 100% using 99mTc-tilmanocept in this setting. Dynamic planar LS and SPECT/CT revealed a mean (range) number of hot spots per patient of 2.9 (1-7) and 3.7 (1-12), respectively. Compared with planar LS, SPECT/CT identified additional putative SLNs in 11 of 20 cases (55%). CONCLUSIONS AND RELEVANCE The high negative predictive value and low false-negative rate in identification of occult metastases shows 99mTc-tilmanocept to be a promising agent in SLN identification in patients with OSCC. Use of SPECT/CT improves preoperative SLN localization including delineation of SLN locations near the primary tumor when compared with planar LS imaging. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00911326.
Collapse
Affiliation(s)
- Anna M Marcinow
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | | | | | | | | | | |
Collapse
|
34
|
Bell RB. Commentary--Digging deeper into tumor invasion as a prognostic factor for oral squamous cell carcinoma. J Oral Maxillofac Surg 2013; 72:415-8. [PMID: 24054710 DOI: 10.1016/j.joms.2013.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 07/22/2013] [Indexed: 12/01/2022]
Affiliation(s)
- R Bryan Bell
- Medical Director, Oral Head and Neck Cancer Program and Clinic, Providence Cancer Center, Providence Portland Medical Center; Affiliate Professor, Oregon Health and Science University, Head and Neck Surgical Associates, Portland, OR.
| |
Collapse
|
35
|
Bell RB, Markiewicz MR, Dierks EJ, Gregoire CE, Rader A. Thin Serial Step Sectioning of Sentinel Lymph Node Biopsy Specimen May Not Be Necessary to Accurately Stage the Neck in Oral Squamous Cell Carcinoma. J Oral Maxillofac Surg 2013; 71:1268-77. [DOI: 10.1016/j.joms.2012.12.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 12/30/2012] [Accepted: 12/30/2012] [Indexed: 11/26/2022]
|
36
|
Mizokami D, Kosuda S, Tomifuji M, Araki K, Yamashita T, Shinmoto H, Shiotani A. Superparamagnetic iron oxide-enhanced interstitial magnetic resonance lymphography to detect a sentinel lymph node in tongue cancer patients. Acta Otolaryngol 2013; 133:418-23. [PMID: 23163889 DOI: 10.3109/00016489.2012.744143] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION This is the first report on human sentinel node (SN) detection by interstitial magnetic resonance (MR) lymphography with superparamagnetic iron oxide (SPIO) in tongue cancer patients who also underwent lymphoscintigraphy. Our results indicate that further studies are warranted, as this novel method may replace current scintigraphic techniques. OBJECTIVES To examine the feasibility of interstitial MR lymphography using SPIO for SN detection in the head and neck region. METHODS MR images were acquired sequentially at 10 min, 30 min, and 24 h after submucosally injecting 0.1 ml SPIO (ferucarbotran) around the tumor in three patients with tongue cancer without cervical lymph node metastasis (clinical T2N0M0). RESULTS The SNs were clearly visualized in the 10 min interstitial MR lymphography images and were completely concordant with those visualized by (99m)Tc-radiocolloid lymphoscintigraphy and a gamma probe in all cases. Iron incorporation into the SNs was confirmed by pathological examination.
Collapse
Affiliation(s)
- Daisuke Mizokami
- Department of Otolaryngology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | | | | | | | | | | | | |
Collapse
|
37
|
Mirghani H, Ferchiou M, Moreau F, Vourexakis Z, Amen F, Breuskin I, Lefèvre M, Casiraghi O, Drusch F, Soussan P, Vielh P, St Guily JL. Oropharyngeal cancers: significance of HPV16 detection in neck lymph nodes. J Clin Virol 2013; 57:120-4. [PMID: 23478163 DOI: 10.1016/j.jcv.2013.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 02/05/2013] [Accepted: 02/11/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND An increasing proportion of oropharyngeal squamous cell carcinomas (OPSCCs) is associated with human papillomavirus (HPV) type 16 infection. Several authors have suggested that HR-HPV DNA could be used as a marker of metastases in cervical cancers. Although HPV16 DNA has been detected in neck lymph node (LN) metastases of HPV16-positive OPSCC, its significance remains controversial. Does this presence correlate to metastatic involvement or is it just the consequence of LN filter function? OBJECTIVES This study aims to analyse the relationship between HPV16 detection in neck LNs of HPV16-positive OPSCC and their pathological status. STUDY DESIGN HP16-viral load (VL) was quantified by real-time-polymerase-chain reaction in primary tumours and neck LNs, in 11 patients with HPV16-positive OPSCC and in three patients with HPV16-negative OPSCC. HPV16 in situ hybridisation and p16 immunohistochemistry were performed in all LNs. RESULTS A total of 45 LN levels were assessed. HPV16 DNA was not identified in HPV16-negative OPSCC LNs. All metastatic LNs from HPV16-positive OPSCC had a high VL and the viral DNA was located within tumoural cells. Among 27 pathologically tumour-free LN (PTFLN) levels 16/27 had no detectable VL, whereas the VL was low or medium (<10(5)copies/million cells) in 8/27 and high (>10(5)copies/million cells) in 3/27 PTFLN. In the latter group, no metastatic cell was identified and the viral DNA was located in immune cells. CONCLUSION HPV16 detection in LN is explained by its presence within either metastatic cells or immune cells. HPV16 detection in PTFLN is not necessarily correlated to occult LN metastases.
Collapse
Affiliation(s)
- Haïtham Mirghani
- Department of Head and Neck, Institut de Cancérologie Gustave Roussy, Villejuif, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Züllig L, Roessle M, Weber C, Graf N, Haerle SK, Jochum W, Stoeckli SJ, Moch H, Huber GF. High sex determining region Y-box 2 expression is a negative predictor of occult lymph node metastasis in early squamous cell carcinomas of the oral cavity. Eur J Cancer 2013; 49:1915-22. [PMID: 23414798 DOI: 10.1016/j.ejca.2013.01.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 12/14/2012] [Accepted: 01/08/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND The transcription factor sex determining region Y (SRY)-box 2 (SOX2) (3q26.3-q27) has been recently identified as a recurrently activated major oncogene in squamous cell carcinoma of various sites. Its prognostic value in head and neck squamous cell carcinoma (HNSCC) is currently unclear. AIM To correlate SOX2 protein expression with the occurrence of occult lymph node metastasis and relapse free survival in early oral SCC. METHODS SOX2 expression in 120 T1/T2 oral SCC patients was evaluated using a tissue microarray technique. Intensity of SOX2 expression was quantified by assessing the Intensity/Reactivity Scores (IRSs). These scores were correlated with the lymph node status of biopsied sentinel lymph nodes and recurrence. Log rank univariate and Cox regression multivariate analysis was used to determine statistical significance. RESULTS Twenty-six of 120 primary tumours (21.7%) showed high SOX2 expression. High expression levels of SOX2 significantly correlated with negative lymph node status in univariate (p=0.001) and multivariate analysis (p=0.003). Sensitivity was found to be 95.6% with a negative predictive value of 92.3%. Specificity was 32% with a positive predictive value of 45.7%. CONCLUSION SOX2 up-regulation is frequent in early SCC of the oral cavity and associated with decreased risk of lymphatic metastasis. SOX2 immunohistochemistry may be used as a predictor for lymph node metastasis in squamous cell carcinoma of the oral cavity.
Collapse
Affiliation(s)
- L Züllig
- Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Frauenklinikstrasse 24, 8091 Zürich, Switzerland
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
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
|
40
|
Melkane AE, Mamelle G, Wycisk G, Temam S, Janot F, Casiraghi O, Lumbroso J. Sentinel node biopsy in early oral squamous cell carcinomas: A 10-year experience. Laryngoscope 2012; 122:1782-8. [DOI: 10.1002/lary.23383] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 03/19/2012] [Accepted: 04/02/2012] [Indexed: 02/06/2023]
|
41
|
Concomitant radio- and fluorescence-guided sentinel lymph node biopsy in squamous cell carcinoma of the oral cavity using ICG-(99m)Tc-nanocolloid. Eur J Nucl Med Mol Imaging 2012; 39:1128-36. [PMID: 22526966 DOI: 10.1007/s00259-012-2129-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 03/20/2012] [Indexed: 12/16/2022]
Abstract
PURPOSE For oral cavity malignancies, sentinel lymph node (SLN) mapping is performed by injecting a radiocolloid around the primary tumour followed by lymphoscintigraphy. Surgically, SLNs can then be localized using a handheld gamma ray detection probe. The aim of this study was to evaluate the added value of intraoperative fluorescence imaging to the conventional radioguided procedure. For this we used indocyanine green (ICG)-(99m)Tc-nanocolloid, a hybrid tracer that is both radioactive and fluorescent. METHODS Fourteen patients with oral cavity squamous cell carcinoma were peritumourally injected with ICG-(99m)Tc-nanocolloid. SLNs were preoperatively identified with lymphoscintigraphy followed by single photon emission computed tomography (SPECT)/CT for anatomical localization. During surgery, SLNs were detected with a handheld gamma ray detection probe and a handheld near-infrared fluorescence camera. Pre-incision and post-excision imaging with a portable gamma camera was performed to confirm complete removal of all SLNs. RESULTS SLNs were preoperatively identified using the radioactive signature of ICG-(99m)Tc-nanocolloid. Intraoperatively, 43 SLNs could be localized and excised with combined radio- and fluorescence guidance. Additionally, in four patients, an SLN located close to the primary injection site (in three patients this SLN was located in level I) could only be intraoperatively localized using fluorescence imaging. Pathological analysis of the SLNs revealed a metastasis in one patient. CONCLUSION Combined preoperative SLN identification and intraoperative radio- and fluorescence guidance during SLN biopsies for oral cavity cancer proved feasible using ICG-(99m)Tc-nanocolloid. The addition of fluorescence imaging was shown to be of particular value when SLNs were located in close proximity to the primary tumour.
Collapse
|
42
|
|
43
|
Gurney BAS, Schilling C, Putcha V, Alkureishi LW, Alvarez AJ, Bakholdt V, Barbier Herrero L, Barzan L, Bilde A, Bloemena E, Salces CC, Dalla Palma P, de Bree R, Dequanter D, Dolivet G, Donner D, Flach GB, Fresno M, Grandi C, Haerle S, Huber GF, Hunter K, Lawson G, Leroux A, Lothaire PH, Mamelle G, Silini EM, Mastronicola R, Odell EW, O'Doherty MJ, Poli T, Rahimi S, Ross GL, Zuazua JS, Santini S, Sebbesen L, Shoaib T, Sloan P, Sorensen JA, Soutar DS, Therkildsen MH, Vigili MG, Villarreal PM, von Buchwald C, Werner JA, Wiegand S, McGurk M. Implications of a positive sentinel node in oral squamous cell carcinoma. Head Neck 2012; 34:1580-5. [PMID: 22290737 DOI: 10.1002/hed.21973] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 08/29/2011] [Accepted: 09/07/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The role of sentinel node biopsy in head and neck cancer is currently being explored. Patients with positive sentinel nodes were investigated to establish if additional metastases were present in the neck, their distribution, and their impact on outcome. METHODS In all, 109 patients (n = 109) from 15 European centers, with cT1/2,N0 tumors, and a positive sentinel lymph node were identified. Kaplan-Meier and univariate and multivariate logistic regression analysis were used to identify variables that predicted for additional positive nodes and their position within the neck. RESULTS A total of 122 neck dissections were performed in 109 patients. Additional positive nodes were found in 34.4% of cases (42/122: 18 same, 21 adjacent, and 3 nonadjacent neck level). Additional nodes, especially if outside the sentinel node basin, had an impact on outcome. CONCLUSIONS The results are preliminary but suggest that both the number and the position of positive sentinel nodes may identify different prognostic groups that may allow further tailoring of management plans.
Collapse
Affiliation(s)
- Benjamin A S Gurney
- Department of Oral and Maxillofacial Surgery, Department of Oncology, Guy's King's and St Thomas's Hospital, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Van Abel KM, Moore EJ. Focus issue: neck dissection for oropharyngeal squamous cell carcinoma. ISRN SURGERY 2012; 2012:547017. [PMID: 22586518 PMCID: PMC3265121 DOI: 10.5402/2012/547017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 11/21/2011] [Indexed: 11/23/2022]
Abstract
The staging and prognosis of oropharyngeal squamous cell carcinoma is intimately tied to the status of the cervical lymph nodes. Due to the high risk for occult nodal disease, most clinicians recommend treating the neck for these primary tumors. While there are many modalities available, surgical resection of nodal disease offers both a therapeutic and a diagnostic intervention. We review the relevant anatomy, nodal drainage patterns, clinical workup, surgical management and common complications associated with neck dissection for oropharyngeal squamous cell carcinoma.
Collapse
Affiliation(s)
- Kathryn M. Van Abel
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Eric J. Moore
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
45
|
Comparison of animal studies between interstitial magnetic resonance lymphography and radiocolloid SPECT/CT lymphoscintigraphy in the head and neck region. Ann Nucl Med 2012; 26:281-5. [PMID: 22237675 DOI: 10.1007/s12149-011-0565-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 12/15/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To comparatively assess two techniques, radiocolloid SPECT/CT lymphoscintigraphy and interstitial MR lymphography using SPIO and gadoxetate disodium, in animal models. MATERIALS AND METHODS We used twenty one 8-week-old male nude mice of strain BALB/c Slc-nu/nu, weighing 23-27 g. The 4.7-T MRI equipment was used to detect the SNs. T2*WI of gradient-echo sequences was acquired sequentially up to 24 h after administering SPIO, ferucarbotran. T1WI was acquired sequentially up to 80 min after administering gadoxetate disodium. (99m)Tc-phytate SPECT/CT lymphoscintigraphy was taken at 30 min after the injection to detect the SNs using animal-dedicated whole-body SPECT/CT hybrid scanner. The injection was submucosally performed in the right tongue margin of each mouse. Reading performances concerning SN visualization and its quality on interstitial MR lymphogram and SPECT/CT lymphoscintigram were performed by 3 radiologists. RESULTS The SN intensities were 0.43 for the right, 0.61 for the left at 30 min after ferucarbotran injection, with gradual decrease in intensity, and 1.43 for the right, 1.33 for the left at 10 min after gadoxetate disodium injection with a fast decrease in intensity. The base value of 1.0 was at pre-examination. The mean numbers of lymph nodes visualized were 4.00 nodes for on SPECT/CT lymphoscintigram and 2.0 for interstitial MR lymphogram. There was a statistically significant difference in the mean scores between SPECT/CT lymphoscintigraphy and interstitial MR lymphography (two factor mixed design with repeated measures on one factor: p < 0.0002). CONCLUSIONS In our comparative study using mice, the results of radiocolloid SPECT/CT lymphoscintigraphy were superior to those of interstitial MR lymphography, while both SPIO and gadoxetate disodium have a potential of being employed for sentinel node navigation surgery by interstitial MR lymphography in the head and neck region.
Collapse
|
46
|
Sentinel Lymph Node in Nonmelanoma Skin Cancer. ACTAS DERMO-SIFILIOGRAFICAS 2011. [DOI: 10.1016/j.adengl.2011.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
47
|
An exploration of the surgical modality of sentinel lymph node biopsy in patients with cN0 tongue carcinoma: An animal study. ACTA ACUST UNITED AC 2011; 112:439-45. [DOI: 10.1016/j.tripleo.2010.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 11/03/2010] [Accepted: 11/08/2010] [Indexed: 11/17/2022]
|
48
|
Salguero-Fernández I, Rios-Buceta L, Jaén-Olasolo P. Ganglio centinela en cáncer de piel no melanoma. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:589-98. [DOI: 10.1016/j.ad.2011.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 04/28/2011] [Accepted: 05/26/2011] [Indexed: 12/12/2022] Open
|
49
|
Down regulation of E-Cadherin (ECAD) - a predictor for occult metastatic disease in sentinel node biopsy of early squamous cell carcinomas of the oral cavity and oropharynx. BMC Cancer 2011; 11:217:1-8. [PMID: 21639893 PMCID: PMC3128007 DOI: 10.1186/1471-2407-11-217] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Accepted: 06/03/2011] [Indexed: 11/29/2022] Open
Abstract
Background Prognostic factors in predicting occult lymph node metastasis in patients with head and neck squamous-cell carcinoma (HNSCC) are necessary to improve the results of the sentinel lymph node procedure in this tumour type. The E-Cadherin glycoprotein is an intercellular adhesion molecule in epithelial cells, which plays an important role in establishing and maintaining intercellular connections. Objectives To determine the value of the molecular marker E-Cadherin in predicting regional metastatic disease. Methods E-Cadherin expression in tumour tissue of 120 patients with HNSCC of the oral cavity and oropharynx were evaluated using the tissue microarray technique. 110 tumours were located in the oral cavity (91.7%; mostly tongue), 10 tumours in the oropharynx (8.3%). Intensity of E-Cadherin expression was quantified by the Intensity Reactivity Score (IRS). These results were correlated with the lymph node status of biopsied sentinel lymph nodes. Univariate and multivariate analysis was used to determine statistical significance. Results pT-stage, gender, tumour side and location did not correlate with lymph node metastasis. Differentiation grade (p = 0.018) and down regulation of E-Cadherin expression significantly correlate with positive lymph node status (p = 0.005) in univariate and multivariate analysis. Conclusion These data suggest that loss of E-cadherin expression is associated with increased lymhogeneous metastasis of HNSCC. E-cadherin immunohistochemistry may be used as a predictor for lymph node metastasis in squamous cell carcinoma of the oral cavity and oropharynx. Level of evidence: 2b
Collapse
|
50
|
Pattani KM, Califano J. Long-Term Experience in Sentinel Node Biopsy for Early Oral and Oropharyngeal Squamous Cell Carcinoma. Ann Surg Oncol 2011; 18:2709-10. [DOI: 10.1245/s10434-011-1785-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Indexed: 11/18/2022]
|