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Liokatis P, Liokati I, Obermeier K, Smolka W, Ersan F, Dewenter I, Otto S, Philipp P, Siegmund B, Walz C, Braunschweig T, Klauschen F, Mock A. Prognostic role of lymph node micrometastasis in oral and oropharyngeal cancer: A systematic review. Oral Oncol 2024; 154:106808. [PMID: 38823172 DOI: 10.1016/j.oraloncology.2024.106808] [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: 02/06/2024] [Revised: 04/02/2024] [Accepted: 04/10/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND An estimated 20% of patients with oral and oropharyngeal squamous cell carcinoma (OOSCC) have micrometastases (Mi) or isolated tumor cells (ITC) in the cervical lymph nodes that evade detection by standard histological evaluation of lymph node sections. Lymph node Mi and ITC could be one reason for regional recurrence after neck dissection. The aim of this study was to review the existing data regarding the impact of Mi on the survival of patients with OOSCC. METHODS PubMed and the Cochrane Library were searched for articles reporting the impact of Mi and ITC on patient survival. Two authors independently assessed the methodological quality of retrieved studies using the Downs and Black index. Data were also extracted on study type, number of included patients, mode of histological analysis, statistical analysis, and prognostic impact. RESULTS Sixteen articles with a total of 2064 patients were included in the review. Among the 16 included studies, eight revealed a statistically significant impact of Mi on at least one endpoint in the Kaplan-Meier and/or multivariate analysis. Three studies regarded Mi as Ma, while five studies found no impact of Mi on survival. Only one study demonstrated an impact of ITC on patient's prognosis in the univariate but not in the multivariate analysis. CONCLUSION The majority of cases included in the review were patients with oral cancer. The findings provide low-certainty evidence that Mi negatively impacts survival. Data on ITC were scarcer, so no conclusions can be drawn about their effect on survival. The lower threshold to discriminate between Mi and ITC should be defined for OOSCC since the existing thresholds are based on data from different tumors. The histological, immunohistological, and anatomical characteristics of Mi and ITC in OOSCC as well as the effect of radiotherapy on Mi should be further investigated separately for oral and oropharyngeal carcinomas.
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Affiliation(s)
- Paris Liokatis
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany.
| | - Ioanna Liokati
- Department of Otorhinolaryngology, General Hospital Georgios Gennimatas, Athens, Greece.
| | - Katharina Obermeier
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany.
| | - Wenko Smolka
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany.
| | - Fatma Ersan
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany.
| | - Ina Dewenter
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany.
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany.
| | - Poxleitner Philipp
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany.
| | - Birte Siegmund
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany.
| | - Christoph Walz
- Institute of Pathology, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.
| | - Till Braunschweig
- Institute of Pathology, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.
| | - Frederick Klauschen
- Institute of Pathology, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.
| | - Andreas Mock
- Institute of Pathology, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.
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Couto EV, Lau F, Gazmenga FP, Texeira D, Bertuzzo CS, Chone CT. A pilot study of quantitative real-time polymerase chain reaction metastases detection on sentinel lymph nodes of oral cancer and literature review. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e2024S126. [PMID: 38865545 PMCID: PMC11164285 DOI: 10.1590/1806-9282.2024s126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 06/14/2024]
Affiliation(s)
- Eduardo Vieira Couto
- Universidade Estadual de Campinas, Department of Otolaryngology Head and Neck Surgery – São Paulo (SP), Brazil
| | - Fabio Lau
- Universidade Estadual de Campinas, Department of Otolaryngology Head and Neck Surgery – São Paulo (SP), Brazil
| | - Fabio Portella Gazmenga
- Universidade Estadual de Campinas, Department of Otolaryngology Head and Neck Surgery – São Paulo (SP), Brazil
| | - Daniel Texeira
- Universidade Estadual de Campinas, Department of Otolaryngology Head and Neck Surgery – São Paulo (SP), Brazil
| | - Carmen Sílvia Bertuzzo
- Universidade Estadual de Campinas, Medical Sciences College, Department of Medical Genetics – São Paulo (SP), Brazil
| | - Carlos Takahiro Chone
- Universidade Estadual de Campinas, Department of Otolaryngology Head and Neck Surgery – São Paulo (SP), Brazil
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3
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Stenz NA, Morand GB, Schoch M, Werner J, Rajan GP. Use of Indocyanine Green Near-Infrared Imaging for Sentinel Lymph Node Biopsy in Early Oral Squamous Cell Carcinoma: A Pilot Study. Mol Imaging Biol 2024; 26:264-271. [PMID: 38441862 DOI: 10.1007/s11307-024-01903-3] [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: 12/05/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE The current established technique for sentinel lymph node (SLN) biopsy is preoperative injection of 99mtechnetium-labeled nanosized colloids (99mTc) followed by single photon emission computed tomography and standard computed tomography (SPECT/CT) with subsequent intraoperative gamma probe-guided excision of the SLN. It is however time and resource consuming, causes radiation exposure and morbidity for the patient as the injection is done in the awake patient. Recently near-infrared imaging with indocyanine green (ICG) gained importance in SLN biopsy as a faster and more convenient technique. The objective of our study was to investigate the feasibility of SLN biopsy using ICG-imaging in early oral squamous cell carcinoma (OSCC). METHODS Single-centre pilot study of five patients with early-stage OSCC. For all patients, both techniques (99mTc and ICG) were performed. We injected 99mTc preoperatively in the awake patient, followed by SPECT/CT imaging. Intraoperatively ICG was injected around the primary tumor. Then the neck incision was performed according to the SPECT/CT images and SLN were detected by using a gamma probe and near-infrared fluorescence imaging of the ICG-marked lymph nodes intraoperatively. The excised lymph nodes were sent to histopathological examination according to the SLN dissection protocol. RESULTS In all five patients sentinel lymph nodes were identified. A total of 7 SLN were identified after injection of 99mTc, imaging with SPECT/CT and intraoperative use of a gamma probe. All these SLN were fluorescent and visible with the ICG technique. In two patients, we could identify additional lymph nodes using the ICG technique. Pathological analysis demonstrated occult metastasis in two of the cases. CONCLUSIONS Our study shows that ICG-guided SLN biopsy is a feasible technique, especially in combination with conventional radioisotope method and may help for intraoperative localization of SLN. Validation studies with bigger patient cohorts are needed to prove our results.
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Affiliation(s)
- Nadja A Stenz
- Department of Otorhinolaryngology - Head and Neck Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.
| | - Gregoire B Morand
- Department of Otorhinolaryngology - Head and Neck Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Manuel Schoch
- Department of Otorhinolaryngology - Head and Neck Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jonas Werner
- Department of Otorhinolaryngology - Head and Neck Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Gunesh P Rajan
- Department of Otorhinolaryngology - Head and Neck Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- Otolaryngology, Head & Neck Surgery, Medical School, University of Western Australia, Perth, Australia
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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4
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Hingsammer L, Schönegg D, Gander T, Lanzer M. Radioactive nanosized colloids and indocyanine green identify the same sentinel lymph nodes in oral squamous cell carcinoma. J Cancer Res Clin Oncol 2023; 149:17223-17229. [PMID: 37801136 PMCID: PMC10657288 DOI: 10.1007/s00432-023-05427-1] [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: 07/25/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Near-infrared fluorescence imaging using indocyanine green (ICG) combined with radioactive markers has the potential to improve sentinel lymph-node (SLN) mapping in oral squamous cell carcinoma (OSCC). This study aimed to evaluate the ability of 99mTc and ICG in identifying the sentinel lymph nodes in patients with early stage OSCC. METHODS Data were collected prospectively, and a retrospective analysis of 15 patients with early stage OSCC and a cN0 neck was performed. All patients received peritumoral injection of 99mTc the day before surgery and ICG was administered intraoperatively. Intentionally, the application of the two different tracers were done by two different physicians with varying degrees of experience. The number of identified lymph nodes positive for 99mTc and ICG, the overlap or possible discrepancies of both methods, and the time until fluorescence signals of ICG were detected were noted. RESULTS In all patients, a 100% agreement in sentinel lymph-node identification was achieved, regardless of both the exact location of the peritumoral injection and the experience of the injecting surgeon. Time until ICG accumulation in the sentinel lymph node was consistently found to be between 1 and 3 min. CONCLUSION ICG constitutes a viable and useful addition to 99mTc for intraoperative sentinel lymph-node detection in this study.
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Affiliation(s)
- Lukas Hingsammer
- Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
- Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Daphne Schönegg
- Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Thomas Gander
- Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Martin Lanzer
- Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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5
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Patel HN, Bowe C, Garg M, Tighe D, Gulati A, Norris P, Kerawala C, McGurk M, Bisase B, Thavaraj S, Schilling C. Centralised pathology service for sentinel node biopsy in oral cavity cancer: The Southeast England Consortium experience. J Oral Pathol Med 2022; 51:315-321. [PMID: 35218247 DOI: 10.1111/jop.13291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/07/2022] [Accepted: 02/22/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy is an increasingly recognised option for accurate staging and subsequent management of the clinically negative neck in early stage oral cavity squamous cell carcinoma. However, the technique is currently underused due to several logistic constraints including increased burden on pathology services. Here, we describe the feasibility of an outsourced centralised pathology processing and reporting service for sentinel lymph node biopsies in oral cavity squamous cell carcinoma. PATIENTS AND METHODS The Southeast England Consortium comprises four surgical centres utilising a central pathology service. Consecutive cases between January 2016 and February 2020 were retrospectively evaluated for survival outcomes and laboratory turnaround times. RESULTS Twenty-eight per cent from a cohort of 139 patients had positive sentinel nodes. There was a trend towards greater overall, disease-free and disease-specific survival (OS, DFS and DSS, respectively) in sentinel node negative compared to sentinel node positive patients, but these differences were not statistically significant. The sensitivity, negative predictive value and false negative rate were 92.8%, 97.0% and 6.8%, respectively. The mean and mode laboratory TAT were 5 and 4 working days, respectively. CONCLUSION An outsourced centralised pathology service is a feasible option to widen the availability of sentinel node biopsy in oral cavity squamous cell carcinoma.
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Affiliation(s)
- Helina N Patel
- Head and Neck Academic Centre, University College London, London, UK
| | - Conor Bowe
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Montey Garg
- Department of Oral & Maxillofacial Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David Tighe
- Department of Oral & Maxillofacial Surgery, East Kent Hospitals NHS Foundation Trust, Kent, UK
| | - Aakshay Gulati
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Paul Norris
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Cyrus Kerawala
- Head and Neck Unit, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Mark McGurk
- Head and Neck Academic Centre, University College London, London, UK.,Head & Neck Surgery, University College London Hospital, London, UK
| | - Brian Bisase
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Selvam Thavaraj
- Faculty of Dentistry, Oral & Craniofacial Science, King's College London, London, UK.,Head and Neck Pathology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Clare Schilling
- Head and Neck Academic Centre, University College London, London, UK.,Head & Neck Surgery, University College London Hospital, London, UK
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6
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Alkulaibi MM, Suleiman AM. A Proposed Method for Cervical Lymph Node Evaluation in Head and Neck Cancer Patients: A Radiological Study. J Maxillofac Oral Surg 2022; 21:156-162. [PMID: 35400901 PMCID: PMC8934800 DOI: 10.1007/s12663-020-01341-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 02/20/2020] [Indexed: 12/16/2022] Open
Abstract
Objectives To present a new method to assess the cervical lymph nodes status in head and neck cancer patients. Methods Twenty-five oral and maxillofacial cancer patients underwent preoperative CT imaging. The cervical lymph node features on CT scan were examined. Each parameter was given a score, and the total scores in each case was calculated and referred to as metastatic score (MS). Then, patients underwent neck dissection, and all dissected lymph nodes were sent for histopathology. Results All cases with MS ≥ 6 were histopathologically positive, and all cases with MS ≤ 3 were histopathologically negative. All cases of nodal sizes > 3 cm were histopathologically positive, 82% of cases of nodal sizes between 2.1 and 3 cm were histopathologically positive, 40% of cases of nodal sizes between 1 and 2 cm were histopathologically positive, and all cases of lymph nodes sizes < 1 cm were histopathologically negative. Seventy-seven percent of cases which had a group of lymph nodes ≥ 3 nodes/region were histopathologically positive, while 79% of cases with rounded nodes were histopathologically positive, and all cases with necrotic lymph nodes were positive for malignancy. Conclusion The proposed formula is a good assessment tool for cervical lymph nodes evaluation using helical CT scan in head and neck cancer patients.
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Affiliation(s)
- Mohammed Musid Alkulaibi
- grid.9763.b0000 0001 0674 6207Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan ,grid.412413.10000 0001 2299 4112Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Sana’a University, Sana’a, Yemen
| | - Ahmed Mohamed Suleiman
- grid.9763.b0000 0001 0674 6207Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
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7
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Hirakawa H, Matsuzuka T, Uemura H, Yoshimoto S, Miura K, Shiotani A, Sugasawa M, Homma A, Yokoyama J, Tsukahara K, Yoshizaki T, Hanai N, Suzuki H, Suzuki M, Hasegawa Y. Distribution pattern and pathologic analysis of metastatic sentinel and non-sentinel lymph nodes in lymphatic basin dissection for clinical T2/T3 oral cancer with clinical N0 status. Auris Nasus Larynx 2021; 49:680-689. [PMID: 34895941 DOI: 10.1016/j.anl.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/09/2021] [Accepted: 11/17/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The localization pattern of metastatic sentinel lymph node (SN) and non-SNs and pathologic analysis of metastatic lymph nodes in SN lymphatic basin dissection (SLBD) were investigated in patients with cT2/T3cN0 oral squamous cell carcinoma (OSCC). METHODS This prospective multicenter trial involved 10 institutions nationwide in Japan. A total of 57 patients were enrolled. The lateral neck was divided into 5 lymphatic basins. The lymphatic basin containing SNs was defined as the SN lymphatic basin. All patients underwent SLBD with backup selective neck dissection (I-III) combined with primary tumor removal. When SNs were found outside of levels I-III, including in the contralateral neck, SLBD was performed by removing the compartments containing SNs separately. SN metastasis was classified as isolated tumor cells (ITCs), micrometastasis, or macrometastasis. ITCs are defined as a lesion no larger than 0.2 mm in largest dimension and are classified as pN0. RESULTS SN metastasis was observed in 22 cases. All metastatic lymph nodes, including false-negative cases, were detected in the SN lymphatic basin. Isolated tumor cells in the SNs did not affect prognosis, whereas micrometastasis tended to have poor prognosis. After adjusting for other risk factors, a positive SN remained a significant predictor of poor 5-year overall survival in pT2-4 OSCC. CONCLUSION SLBD for intraoperative SN biopsy is a sufficient therapeutic procedure and is valuable for determining pathologic nodal stage in OSCC. SN positivity was demonstrated to be an independent predictor of poor prognosis in patients with pT2-4 disease undergoing SLBD with backup selective neck dissection (I-III).
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Affiliation(s)
- Hitoshi Hirakawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan.
| | - Takashi Matsuzuka
- Department of Otorhinolaryngology, Head and Neck Surgery, Asahi University Hospital, Mizuho, Gifu, Japan
| | - Hirokazu Uemura
- Department of Otolaryngology, Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Kouki Miura
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, Minato-ku, Tokyo, Japan
| | - Akihiro Shiotani
- Department of Otolaryngology, Head and Neck Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masashi Sugasawa
- Department of Head and Neck Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, Japan
| | - Akihiro Homma
- Department of Otolaryngology, Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Junkichi Yokoyama
- Department of Otolaryngology, Head and Neck Surgery, Nadogaya Hospital, Kashiwa, Chiba, Japan
| | - Kiyoaki Tsukahara
- Department of Otolaryngology, Head and Neck Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tomokazu Yoshizaki
- Division of Otolaryngology, Head and Neck Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Hidenori Suzuki
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Mikio Suzuki
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Yasuhisa Hasegawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Asahi University Hospital, Mizuho, Gifu, Japan
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8
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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.
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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
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9
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Boeve K, Mastik MF, Slagter-Menkema L, van Dijk BAC, Roodenburg JLN, van der Laan BFAM, Witjes MJH, van der Vegt B, Schuuring E. Cortactin expression assessment improves patient selection for a watchful waiting strategy in pT1cN0-staged oral squamous cell carcinomas with a tumor infiltration depth below 4 mm. Head Neck 2021; 43:2688-2697. [PMID: 34008248 PMCID: PMC8453862 DOI: 10.1002/hed.26746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/21/2021] [Accepted: 05/04/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In this feasibility study we aimed to evaluate the value of previously reported molecular tumor biomarkers associated with lymph node metastasis in oral squamous cell carcinoma (OSCC) to optimize neck strategy selection criteria. METHODS The association between expression of cortactin, cyclin D1, FADD, RAB25, and S100A9 and sentinel lymph node status was evaluated in a series of 87 (cT1-2N0) patients with OSCC treated with primary resection and SLNB procedure. RESULTS Tumor infiltration depth and tumor pattern of invasion were independent prognostic markers for SLN status, while none of the tumor makers showed a better prognostic value to replace SLNB as neck staging technique in the total cohort. However, in the subgroup of patients with pT1N0 OSCC, cortactin expression (OR 16.0, 95%CI 2.0-127.9) was associated with SLN classification. CONCLUSIONS Expression of cortactin is a promising immunohistochemical tumor marker to identify patients at low risk that may not benefit from SLNB or END.
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Affiliation(s)
- Koos Boeve
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Department of Pathology & Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Mirjam F Mastik
- Department of Pathology & Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Lorian Slagter-Menkema
- Department of Pathology & Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Department of Otorhinolaryngology - Head & Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Boukje A C van Dijk
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - Jan L N Roodenburg
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology - Head & Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bert van der Vegt
- Department of Pathology & Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ed Schuuring
- Department of Pathology & Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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10
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Hasegawa Y, Tsukahara K, Yoshimoto S, Miura K, Yokoyama J, Hirano S, Uemura H, Sugasawa M, Yoshizaki T, Homma A, Chikamatsu K, Suzuki M, Shiotani A, Matsuzuka T, Kohno N, Miyazaki M, Oze I, Matsuo K, Kosuda S, Yatabe Y. Neck Dissections Based on Sentinel Lymph Node Navigation Versus Elective Neck Dissections in Early Oral Cancers: A Randomized, Multicenter, and Noninferiority Trial. J Clin Oncol 2021; 39:2025-2036. [PMID: 33877855 DOI: 10.1200/jco.20.03637] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE This study aimed to compare patients with early oral cavity squamous cell carcinoma (OCSCC) (tumor category [T] 1-2, node-negative, and no distant metastasis) treated with traditional elective neck dissection (ND) with those managed by sentinel lymph node biopsy (SLNB) using survival and neck function and complications as end points. METHODS Sixteen institutions in Japan participated in the study (trial registration number: UMIN000006510). Patients of age ≥ 18 years with histologically confirmed, previously untreated OCSCC (Union for International Cancer Control TNM Classification of Malignant Tumors 7th edition T1-2, node-negative no distant metastasis), with ≥ 4 mm (T1) depth of invasion, were randomly assigned to undergo standard selective ND (ND group; n = 137) or SLNB-navigated ND (SLNB group; n = 134). The primary end point was the 3-year overall survival rate, with a 12% noninferiority margin; secondary end points included postoperative neck functionality and complications and 3-year disease-free survival. Sentinel lymph nodes underwent intraoperative multislice frozen section analyses for the diagnosis. Patients with positive sentinel lymph nodes underwent either one-stage or second-look ND. RESULTS Pathologic metastasis-positive nodes were observed in 24.8% (34 of 137) and 33.6% (46 of 134) of patients in the ND and SLNB groups, respectively (P = .190). The 3-year overall survival in the SLNB group (87.9%; lower limit of one-sided 95% CI, 82.4) was noninferior to that in the ND group (86.6%; lower limit 95% CI, 80.9; P for noninferiority < .001). The 3-year disease-free survival rate was 78.7% (lower limit 95% CI, 72.1) and 81.3% (75.0) in the SLNB and ND groups, respectively (P for noninferiority < .001). The scores of neck functionality in the SLNB group were significantly better than those in the ND group. CONCLUSION SLNB-navigated ND may replace elective ND without a survival disadvantage and reduce postoperative neck disability in patients with early-stage OCSCC.
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Affiliation(s)
| | | | | | - Kouki Miura
- International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | | | | | | | - Masashi Sugasawa
- Saitama Medical University International Medical Center, Hidaka, Japan
| | - Tomokazu Yoshizaki
- Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Akihiro Homma
- Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | | | - Mikio Suzuki
- University of the Ryukyus Faculty of Medicine, Okinawa, Japan
| | | | - Takashi Matsuzuka
- Asahi University Hospital, Gifu, Japan.,Fukushima Medical University, Fukushima, Japan
| | | | | | - Isao Oze
- Aichi Cancer Center Research Institute, Nagoya, Japan
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11
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Diagnostic yield of sentinel lymph node biopsy in oral squamous cell carcinoma T1/T2-N0: systematic review and meta-analysis. Int J Oral Maxillofac Surg 2021; 50:1271-1279. [PMID: 33602650 DOI: 10.1016/j.ijom.2021.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 01/24/2021] [Accepted: 01/27/2021] [Indexed: 12/24/2022]
Abstract
The objective of this study was to conduct a systematic review and meta-analysis on the efficacy of sentinel lymph node biopsy (SLNB) in T1/T2-N0 oral squamous cell carcinoma (OSCC). A systematic review of the literature on SLNB until March 2019 was conducted. The review was organized according to the PRISMA protocol, considering the following PICO (population, intervention, comparison, outcome) question: What is the sensitivity of sentinel lymph node biopsy in OSCC? 'P' was patients with head and neck squamous cell carcinoma T1/2-N0; 'I' was SLNB; 'C' was neck treated with elective neck dissection and haematoxylin-eosin histopathology; 'O' was sensitivity and specificity. A meta-analysis and meta-regression were performed on the selected studies. The sensitivity of SLNB was up to 88% (95% confidence interval (CI) 72-96%) and specificity was up to 99% (95% CI 96-100%). The area under the summary receiver operating characteristic curve was 0.99 (95% CI 0.98-1.00). In the four studies where immunohistochemistry was performed, both the sensitivity and specificity were higher than in the studies without immunohistochemistry: 93% (95% CI 88-97%) and 98% (95% CI 96-100%), respectively. In conclusion, SLNB is an effective technique for treating patients with some types of stage T1/2-N0 OSCC. Some parameters such as immunohistochemistry could determine the level of diagnostic accuracy.
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12
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Morand GB, Broglie MA, Schumann P, Huellner MW, Rupp NJ. Histometabolic Tumor Imaging of Hypoxia in Oral Cancer: Clinicopathological Correlation for Prediction of an Aggressive Phenotype. Front Oncol 2020; 10:1670. [PMID: 32984043 PMCID: PMC7481376 DOI: 10.3389/fonc.2020.01670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/28/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction Fluorodeoxyglucose-positron emission tomography (FDG-PET) is a widely used imaging tool for oral squamous cell carcinoma (OSCC). Preliminary studies indicate that quantification of tumor metabolic uptake may correlate with tumor hypoxia and aggressive phenotypes. Methods Retrospective review of a consecutive cohort of OSCC (n = 98) with available pretherapeutic FDG-PET/CT, treated at the University Hospital Zurich. Clinico-pathologico-radiological correlation between maximum standard uptake value (SUVmax) of the primary tumor, immunohistochemical staining for hypoxia-related proteins glucose transporter 1 (GLUT1) and hypoxia-inducible factor 1-alpha (HIF1a), depth of invasion (DOI), lymph node metastasis, and outcome was examined. Results Positive staining for GLUT1 and HIF1a on immunohistopathological analysis correlated with increased SUVmax on pretherapeutic imaging and with increased DOI (Kruskal–Wallis, P = 0.037, and P = 0.008, respectively). SUVmax and DOI showed a strong positive correlation (Spearman Rho, correlation coefficient = 0.451, P = 0.0003). An increase in SUVmax predicted nodal metastasis (Kruskal–Wallis, P = 0.017) and poor local control (log rank, P = 0.047). Conclusion In OSCC, FDG-PET-derived metabolic tumor parameter SUVmax serves as a surrogate marker for hypoxia and can be used to predict tumor aggressiveness, with more invasive phenotypes and poorer local control.
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Affiliation(s)
- Grégoire B Morand
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Martina A Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Paul Schumann
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Martin W Huellner
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Niels J Rupp
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
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13
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Head and neck robotic surgery combined with sentinel lymph node biopsy. Fascinating, but feasible? Oral Oncol 2020; 111:104939. [PMID: 32745899 DOI: 10.1016/j.oraloncology.2020.104939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/08/2020] [Accepted: 07/27/2020] [Indexed: 02/05/2023]
Abstract
Robotic approaches and sentinel lymph node (SLN) biopsy are both strategies that evolved driven by the need to reduce impact of head and neck oncological surgery in terms of operative timing, morbidity, hospitalization time, and aesthetic results. A comprehensive review of the scientific literature was performed on PubMed, Embase, ResearchGate, Cochrane, and CENTRAL electronic databases with the aim to discuss the role that these two approaches can play together in the management of head and neck cancers (HNCs) of various sites. Dedicated publications on the combined robotics and SLN biopsy approaches resulted, up to now very limited, while their separated application in non-shared fields is gaining strength. However, the possibility to implement and combine technologies to minimize sequelae of head and neck surgery is an interesting and evolving topic.
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14
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de Veij Mestdagh PD, Walraven I, Vogel WV, Schreuder WH, van Werkhoven E, Carbaat C, Donswijk ML, van den Brekel MW, Al-Mamgani A. SPECT/CT-guided elective nodal irradiation for head and neck cancer is oncologically safe and less toxic: A potentially practice-changing approach. Radiother Oncol 2020; 147:56-63. [DOI: 10.1016/j.radonc.2020.03.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/19/2020] [Accepted: 03/06/2020] [Indexed: 01/16/2023]
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15
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Peigné L, Godey F, Le Gallo M, Le Gall F, Fautrel A, Morcet J, Jégoux F. One-step nucleic acid amplification for detecting lymph node metastasis of head and neck squamous cell carcinoma. Oral Oncol 2020; 102:104553. [PMID: 32004908 DOI: 10.1016/j.oraloncology.2019.104553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/21/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND In head and neck squamous cell carcinoma (HNSCC) 30% of cN0 patients have occult metastasis. LN invasion is a major prognostic factor. Sentinel lymph node (SLN) is an option for cN0 neck management. One-step nucleic acid amplification (OSNA) used to analyze SLN in breast cancer is also a candidate to get more reliable intraoperative HNSCC lymph node (LN) staging. OBJECTIVE To compare OSNA analysis to pathological analysis in cN0 HNSCC. MATERIALS AND METHODS 157 LN from 26 cN0 HNSCC patients were prospectively analyzed (6.3LN/patient). Exclusion criteria were previous surgery or radiotherapy. Each node was cut into 4 equal pieces alternatively sent to pathological analysis and OSNA technique. IHC CK19 was performed on the primary tumor biopsy and RT-qPCR of CK19, PVA and EPCAM on the LN lysate of discordant cases. RESULTS OSNA was able to provide intraoperative result in all patients. OSNA detected 21 metastases. There were 139 concordant LN (88.5%). There were 18 initial discordant LN (11.5%), 13 (8.3%) were OSNA positive/pathological analysis negative, 5 (3.2%) were OSNA negative/pathological analysis positive. After elimination of allocation bias, false negative rate was 1.3%, sensitivity and specificity were 90% and 95.6%, PPV and NPV were 75% and 98.5%. CONCLUSION Our results suggest that OSNA should be considered to improve SNB analysis both for increasing micro metastasis diagnosis and offer extemporaneous results. Study registered under clinicaltrials.gov database number NCT02852343.
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Affiliation(s)
- Lucie Peigné
- Head Neck Surgery Department, University Hospital, Rennes, France
| | - Florence Godey
- Department of Biology, Eugène Marquis Comprehensive Cancer Center, CS 44 229, Av. De Bataille Flandres Dunkerques, 35042 Rennes Cedex, France
| | - Mathieu Le Gallo
- Chemistry, Oncogenesis, Stress, Signaling COSS, INSERM 1242, Rennes 1 University, CLCC Eugene Marquis, Rue de la bataille Flandres Dunkerques, Rennes, France
| | - François Le Gall
- Pathology Department, University Hospital, Rennes, France; Head Neck Surgery Department, University Hospital, Rennes, France
| | - Alain Fautrel
- H2P2, Histopathological Platform, University of Rennes, 35000 Rennes, France
| | - Jeff Morcet
- Clinical Investigation Center, CIC INSERM 1414, University Hospital of Rennes, France
| | - Franck Jégoux
- Head Neck Surgery Department, University Hospital, Rennes, France; Chemistry, Oncogenesis, Stress, Signaling COSS, INSERM 1242, Rennes 1 University, CLCC Eugene Marquis, Rue de la bataille Flandres Dunkerques, Rennes, France.
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16
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Myofascial pain, widespread pressure hypersensitivity, and hyperalgesia in the face, neck, and shoulder regions, in survivors of head and neck cancer. Support Care Cancer 2019; 28:2891-2898. [PMID: 31754834 DOI: 10.1007/s00520-019-05173-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/05/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Medical treatment for head and neck cancer may induce the presence of inflammation, pain, and dysfunction. The purpose of the current study was to assess the presence of myofascial trigger points (TrPs) and their relationship with widespread pressure hypersensitivity and hyperalgesia in survivors of head and neck cancer (sHNC). METHODS TrPs and pressure-pain thresholds (PPTs) were quantified in different muscles/joints in the head and neck of 30 sHNC (59.45 ± 13.13 years) and 28 age- and sex-matched controls (58.11 ± 12.67 years). RESULTS The sHNC had more TrPs in all muscles on the affected side (p < 0.05) than did the healthy controls, and in the temporalis, masseter, and suboccipitalis muscles on the unaffected side (p < 0.05). They also had lower PPTs in all places (p < 0.05) except for the temporalis muscle (p = 0.114) and C5-C6 joint (p = 0.977). The intensity of cervical pain correlated positively with the presence of upper trapezius TrPs. CONCLUSIONS sHNC suffering cervical and/or temporomandibular joint pain have multiple active TrPs and experience widespread pressure hypersensitivity and hyperalgesia, suggestive of peripheral and central sensitization.
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17
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Araki K, Tomifuji M, Shiotani A, Hirano S, Yokoyama J, Tsukahara K, Homma A, Yoshimoto S, Hasegawa Y. Minimally invasive surgery for laryngopharyngeal cancer: Multicenter feasibility study of a combination strategy involving transoral surgery and real‐time indocyanine green fluorescence‐navigated sentinel node navigation surgery. Head Neck 2019; 42:254-261. [DOI: 10.1002/hed.25993] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/03/2019] [Accepted: 10/09/2019] [Indexed: 02/05/2023] Open
Affiliation(s)
- Koji Araki
- Department of Otolaryngology—Head and Neck SurgeryNational Defense Medical College Tokorozawa Japan
| | - Masayuki Tomifuji
- Department of Otolaryngology—Head and Neck SurgeryNational Defense Medical College Tokorozawa Japan
| | - Akihiro Shiotani
- Department of Otolaryngology—Head and Neck SurgeryNational Defense Medical College Tokorozawa Japan
| | - Shigeru Hirano
- Department of Otolaryngology—Head and Neck SurgeryKyoto Prefectural University of Medicine Kyoto Japan
| | - Junkichi Yokoyama
- Department of Otolaryngology—Head and Neck SurgeryEdogawa Hospital Tokyo Japan
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology—Head and Neck SurgeryTokyo Medical University Tokyo Japan
| | - Akihiro Homma
- Department of Otolaryngology—Head and Neck Surgery, Faculty of Medicine and Graduate School of MedicineHokkaido University Sapporo Japan
| | - Seichi Yoshimoto
- Department of Head and Neck SurgeryNational Cancer Center Hospital Tokyo Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery and OtolaryngologyAsahi University Hospital Gifu Japan
- Department of Head and Neck SurgeryAichi Cancer Center Hospital Nagoya Japan
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18
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Evaluation of SHP1-P2 methylation as a biomarker of lymph node metastasis in patients with squamous cell carcinoma of the head and neck. ASIAN BIOMED 2019. [DOI: 10.1515/abm-2019-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Hypermethylation of Src homology region 2 domain-containing protein-tyrosine phosphatase 1 promoter 2 (SHP1-P2) has been proven as an epithelial-specific marker. This marker has been used for the detection of lymph node metastasis in patients with lung cancer or colon cancer.
Objectives
To investigate SHP1-P2 methylation in patients with squamous cell carcinoma of the head and neck (HNSCC) and determine its potential for micrometastasis detection in the lymph nodes of patients with HNSCC.
Methods
SHP1-P2 methylation levels were analyzed by combined methylation-specific primer TaqMan real-time PCR in 5 sample groups: normal tonsils (n = 10), microdissected squamous cell carcinoma epithelia (n = 9), nonmetastatic head and neck cancer lymph nodes (LN N0, n = 15), metastatic HNSCC histologically negative for tumor cells (LN–, n = 18), and matched cases histologically positive for tumor cells (LN+, n = 18).
Results
SHP1-P2 methylation of 10.27 ± 4.05% was found in normal tonsils as a lymphoid tissue baseline, whereas it was 61.31 ± 17.00% in microdissected cancer cell controls. In the 3 lymph node groups, the SHP1-P2 methylation levels were 9.99 ± 6.61% for LN N0, 14.49 ± 10.03% for LN- Nx, and 41.01 ± 24.51% for LN+ Nx. The methylation levels for LN- Nx and LN+ Nx were significantly different (P
= 0.0002). Receiver operating characteristic curve analysis of SHP1-P2 methylation demonstrated an area under the curve of 0.637 in distinguishing LN N0 from LN– Nx.
Conclusions
SHP1-P2 methylation was high in HNSCC, and low in lymphoid tissues. This methylation difference is concordant with lymph node metastasis.
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19
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Garau LM, Muccioli S, Caponi L, Maccauro M, Manca G. Sentinel lymph node biopsy in oral–oropharyngeal squamous cell carcinoma: standards, new technical procedures, and clinical advances. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00338-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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20
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Chakrabarti S, Singhavi HR, Bal M, Mair M, Malik A, Mahuvakar A, Singh A, Mathur R, Joshi P, Nair S, Nair D, Chaturvedi P. Intraoperative frozen section for detection of occult metastasis in clinically N0 neck does not improve outcome in oral cavity carcinomas. Eur Arch Otorhinolaryngol 2019; 276:2325-2330. [PMID: 31147769 DOI: 10.1007/s00405-019-05484-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/20/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the utility of frozen section (FS) in detecting occult nodal metastasis in cN0 OSCC and its impact on regional failure and survival. MATERIALS AND METHODS Clinical records of patients of OSCC operated from January 2013 to December 2014 were retrospectively reviewed. These patients were divided into two groups-Group A comprised of patients who underwent selective neck dissection (SND) (level III/IV) and FS based completion (level IV ± V); Group B included patients who underwent SND I-III/IV without FS. The sensitivity and specificity of FS in detecting occult metastasis was calculated. The regional failure rates and overall survival (OS) between the two groups were compared. RESULTS The sensitivity, specificity, PPV (positive predictive value) and NPV (negative predictive value) of FS in detecting occult metastasis were 64.06%, 100%, 100%, and 92.15%, respectively. There was no significant difference in regional failure rates (p = 0.219) and OS (p = 0.08) between the two groups. CONCLUSION FS has a poor sensitivity in detecting occult nodal metastasis. FS-guided neck dissection does not have a significant impact in reducing regional failure or improving OS in clinically node-negative neck in oral cavity carcinomas.
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Affiliation(s)
- Swagnik Chakrabarti
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | | | - Munita Bal
- Department of Head and Neck Pathology, Tata Memorial Centre, Mumbai, India
| | - Manish Mair
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Akshat Malik
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Ankit Mahuvakar
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Arjun Singh
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Rachit Mathur
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Poonam Joshi
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Deepa Nair
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India.
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21
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Koyfman SA, Ismaila N, Crook D, D'Cruz A, Rodriguez CP, Sher DJ, Silbermins D, Sturgis EM, Tsue TT, Weiss J, Yom SS, Holsinger FC. Management of the Neck in Squamous Cell Carcinoma of the Oral Cavity and Oropharynx: ASCO Clinical Practice Guideline. J Clin Oncol 2019; 37:1753-1774. [PMID: 30811281 DOI: 10.1200/jco.18.01921] [Citation(s) in RCA: 191] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The aim of the current work is to provide evidence-based recommendations to practicing physicians and others on the management of the neck in patients with squamous cell carcinoma of the oral cavity and oropharynx. METHODS ASCO convened an Expert Panel of medical oncology, surgery, radiation oncology, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 1990 through 2018. Outcomes of interest included survival, regional disease control, neck recurrence, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 124 relevant studies to inform the evidence base for this guideline. Six clinical scenarios were devised; three for oral cavity cancer and three for oropharynx cancer, and recommendations were generated for each one. RECOMMENDATIONS For oral cavity cancers, clinical scenarios focused on the indications for and the hallmarks of a high-quality neck dissection, indications for postoperative radiotherapy or chemoradiotherapy, and whether radiotherapy alone is sufficient elective treatment of an undissected neck compared with high-quality neck dissection. For oropharynx cancers, clinical scenarios focused on hallmarks of a high-quality neck dissection, factors that would favor operative versus nonoperative primary management, and clarifying criteria for an incomplete response to definitive chemoradiation for which salvage neck dissection would be recommended. Consensus was reached and recommendations were made for all six clinical scenarios. Additional information is available at www.asco.org/head-neck-cancer-guidelines .
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Affiliation(s)
| | | | - Doug Crook
- 3 Patient representative, Indianapolis, IN
| | | | | | | | | | | | | | - Jared Weiss
- 10 University of North Carolina, Chapel Hill, NC
| | - Sue S Yom
- 11 University of California, San Francisco, San Francisco, CA
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22
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Romer CAE, Broglie Daeppen MA, Mueller M, Huber GF, Guesewell S, Stoeckli SJ. Long-term speech and swallowing function after primary resection and sentinel node biopsy for early oral squamous cell carcinoma. Oral Oncol 2019; 89:127-132. [PMID: 30732950 DOI: 10.1016/j.oraloncology.2018.12.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 12/16/2018] [Accepted: 12/25/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Analysis of long-term speech and swallowing function and subjective quality of life (QOL) after primary resection and sentinel node biopsy (SNB) in patients with early stage (cT1/T2) oral squamous cell carcinomas (OSCC). MATERIAL AND METHODS Eighty-one consecutive patients treated primarily by transoral resection without flap reconstruction and SNB for a cT1/T2 OSCC were included. Completion neck dissection (CND) was indicated in case of occult disease in the sentinel nodes. Adjuvant radiation (aRT) was administered according to the ultimate lymph node status. All patients showed no evidence of disease at time of analysis. Speech and swallowing function were assessed using standardized clinical examinations (11-item, articulation test) and validated questionnaires on subjective QOL (MDADI, FIGS). Median follow-up was 60 months (range 13-159 months) after initial treatment. RESULTS In all assessments for speech and swallowing, the entire study cohort achieved very high scores, with mean values located in the highest 10% of the scales. Neither tumor size nor site, age, pN-category, CND, and aRT had significant impact on functional outcomes and subjective QOL with the exception of lower scores in the global and physical scores of MDADI after CND or aRT, and articulation in the population over 60 years of age. CONCLUSION Transoral resection without reconstruction and SNB for early OSCC achieves excellent outcome with regard to speech, swallowing and subjective QOL.
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Affiliation(s)
- C A E Romer
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, Switzerland.
| | - M A Broglie Daeppen
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, Switzerland; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Switzerland
| | - M Mueller
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, Switzerland
| | - G F Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, Switzerland; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Switzerland
| | - S Guesewell
- Clinical Trials Unit, Kantonsspital St. Gallen, Switzerland
| | - S J Stoeckli
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, Switzerland
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23
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Hingsammer L, Seier T, Zweifel D, Huber G, Rücker M, Bredell M, Lanzer M. Sentinel lymph node biopsy for early stage tongue cancer-a 14-year single-centre experience. Int J Oral Maxillofac Surg 2018; 48:437-442. [PMID: 30389112 DOI: 10.1016/j.ijom.2018.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 02/05/2023]
Abstract
This study was performed to report the usage of sentinel lymph node biopsy (SLNB) in clinical stage I or II tongue cancer patients with cN0 necks seen over a 14-year period. Data were collected prospectively, and a retrospective analysis was performed of 41 patients with early stage oral squamous cell carcinoma of the tongue and a cN0 neck. Sentinel lymph node (SLN)-positive patients underwent elective neck dissection, whereas SLN-negative patients were kept under careful observation. Seven of the 41 (17%) patients enrolled in the study were found to have occult metastases. The patients were followed up for a mean duration of 92 months (range 60-144 months). The neck recurrence rate for SLN-positive patients was 0% and for SLN-negative patients was 3%. The authors recommend the routine use of SLNB in patients with early stage oral squamous cell carcinoma of the tongue and a cN0 neck. Furthermore, special focus should be placed on isolated tumour cells, as their presence is of high clinical relevance.
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Affiliation(s)
- L Hingsammer
- Department of Oral and Maxillofacial Surgery, University Clinic of Zurich, Zurich, Switzerland.
| | - T Seier
- Department of Oral and Maxillofacial Surgery, University Clinic of Zurich, Zurich, Switzerland
| | - D Zweifel
- Department of Oral and Maxillofacial Surgery, University Clinic of Zurich, Zurich, Switzerland
| | - G Huber
- Department of Ear, Nose and Throat, University Clinic of Zurich, Zurich, Switzerland
| | - M Rücker
- Department of Oral and Maxillofacial Surgery, University Clinic of Zurich, Zurich, Switzerland
| | - M Bredell
- Department of Oral and Maxillofacial Surgery, University Clinic of Zurich, Zurich, Switzerland
| | - M Lanzer
- Department of Oral and Maxillofacial Surgery, University Clinic of Zurich, Zurich, Switzerland
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Abstract
Management of oral cavity squamous cell carcinoma has become increasingly driven by emerging evidence as a result of the improved quality of clinical research associating clinicopathologic risk factors with oncologic and survival outcomes. Multiple significant recent changes to treatment guidelines and staging algorithms for oral cavity squamous cell carcinoma reflect evolving understanding of tumor biology and the need for adequately extensive treatment of aggressive disease. This article provides clinicians with a synopsis of the most contemporary management strategies for oral cavity squamous cell carcinoma, framed within the context of historical treatment philosophies.
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Affiliation(s)
- Kyle S Ettinger
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Section of Head and Neck Oncologic Surgery and Reconstruction, Mayo Clinic, Mayo College of Medicine, Mail Code: ro_ma_12_12econ, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Oral and Maxillofacial Surgery, Division of Head and Neck Surgery, University of Florida College of Medicine - Jacksonville, 653-1 West 8th Street 2nd FL/LRC, Jacksonville, FL 32209, USA
| | - Laurent Ganry
- Department of Oral and Maxillofacial Surgery, Division of Head and Neck Surgery, University of Florida College of Medicine - Jacksonville, 653-1 West 8th Street 2nd FL/LRC, Jacksonville, FL 32209, USA; Department of Maxillo-facial, Plastic, Reconstructive and Aesthetic Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
| | - Rui P Fernandes
- Division of Head and Neck Surgery, Head and Neck Oncologic Surgery and Microvascular Reconstruction Fellowship, Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine - Jacksonville, University of Florida - Jacksonville, 653-1 West 8th Street 2nd FL/LRC, Jacksonville, FL 32209, USA.
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Riese C, Karstadt JA, Schramm A, Güleryüz S, Dressel G, Lorenz K, Klemenz B, Sailer A, Seitz S, Wilde F. Validity of sentinel node biopsy in early oral and oropharyngeal carcinoma. J Craniomaxillofac Surg 2018; 46:1748-1752. [DOI: 10.1016/j.jcms.2018.07.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/05/2018] [Accepted: 07/27/2018] [Indexed: 02/05/2023] Open
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Abstract
Imaging studies are essential components of tumor diagnosis, staging, assessing tumor response to neoadjuvant and adjuvant therapies, and postoperative surveillance on completion of definitive treatment. Treatment of early stage clinically node negative oral cavity squamous cell carcinoma is controversial. Approximately 3% of all head and neck tumors arise within the parotid gland and most often within the superficial lobe, lateral to the facial nerve; about 80% are benign and most are pleomorphic adenoma. In patients with dry eyes failing multiple other treatment modalities and facing ongoing pain and loss of vision, microvascular transplant of the submandibular gland is a viable option.
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Affiliation(s)
- Kyle S Ettinger
- Department of Surgery, Division of Oral & Maxillofacial Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Jacob G Yetzer
- Private Practice, Head and Neck Surgery, Nebraska Oral and Facial Surgery, 2600 S. 56th Street, Suite A, Lincoln, NE 68506, USA; Assistant Professor, Department of Surgery, Creighton University School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA.
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27
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Sensitivity and specificity of sentinel lymph node biopsy in patients with oral squamous cell carcinomas using indocyanine green fluorescence imaging. J Craniomaxillofac Surg 2018; 46:1379-1384. [PMID: 29907432 DOI: 10.1016/j.jcms.2018.05.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/11/2018] [Accepted: 05/17/2018] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The purpose of this clinical study was to evaluate the sensitivity and specificity of cervical sentinel lymph node biopsy after mapping with indocyanine green fluorescence (ICG) for imaging early-stage oral cancer. PATIENTS AND METHODS A sentinel lymph node biopsy (SLNB) was performed during a selective neck dissection (SND) in 20 patients with oral squamous cell carcinoma (OSCC, cT1 or cT2, N0 status). The sentinel lymph nodes (SLN) were identified using an infrared video camera after ICG injection. Lymph nodes were examined histologically. The endpoint of this study was to investigate the rate of false-negative results in SLNB. RESULTS Sentinel lymph nodes could be detected after 8.1 min (range 1-22 min). In eight out of 20 cases, lymph node metastases were found during histopathological evaluation of the neck dissection specimen. In four cases a metastasis could be found in the detected SLN (sensitivity 50%). In the other four cases metastases were found in different lymph nodes. Specificity was 100%, positive predictive value 100%, and negative predictive value 75%. CONCLUSION In this study, reliability of sentinel lymph node biopsy after ICG imaging could not be verified, as there were false-negative results in 50% of the cases. Therefore, SND can still be recommended as for patients with cT1 or cT2 OSCC, and a N0 neck status.
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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
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29
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Moncayo VM, Alazraki AL, Alazraki NP, Aarsvold JN. Sentinel Lymph Node Biopsy Procedures. Semin Nucl Med 2017; 47:595-617. [DOI: 10.1053/j.semnuclmed.2017.06.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Kale H, Rath TJ. Chapter 3 The Role of PET/CT in Squamous Cell Carcinoma of the Head and Neck. Semin Ultrasound CT MR 2017; 38:479-494. [PMID: 29031365 DOI: 10.1053/j.sult.2017.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Head and neck squamous cell carcinoma is an important cause of cancer morbidity worldwide and has been stratified into human papillomavirus-related and human papillomavirus-unrelated subgroups that affect prognosis and now staging. Conventional anatomical imaging methods are suboptimal for the detection of regional and distant metastases that are important prognosticators associated with poor outcomes. Functional imaging with (F18)-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) is a useful tool in the management of head and neck squamous cell carcinoma, providing complementary physiological and anatomical information. In this article, optimal PET/CT technique will be reviewed and the pretreatment and posttreatment applications of PET/CT will be described. A simplified approach to imaging interpretation, including review of pearls and pitfalls will be discussed. An initial framework for follow-up evaluation will be provided.
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Affiliation(s)
- Hrishikesh Kale
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Tanya J Rath
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
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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.
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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
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Abdul-Razak M, Chung H, Wong E, Palme C, Veness M, Farlow D, Coleman H, Morgan G. Sentinel lymph node biopsy for early oral cancers: Westmead Hospital experience. ANZ J Surg 2016; 87:65-69. [PMID: 27878928 DOI: 10.1111/ans.13853] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/23/2016] [Accepted: 10/18/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) has become an alternative option to elective neck dissection (END) for early oral cavity squamous cell carcinoma (OCSCC) outside of Australia. We sought to assess the technical feasibility of SLNB and validate its accuracy against that of END in an Australian setting. METHODS We performed a prospective cohort study consisting of 30 consecutive patients with cT1-2 N0 OCSCC referred to the Head and Neck Cancer Service, Westmead Hospital, Sydney, between 2011 and 2014. All patients underwent SLNB followed by immediate selective neck dissection (levels I-III). RESULTS A total of 30 patients were diagnosed with an early clinically node-negative OCSCC (seven cT1 and 23 cT2), with the majority located on the oral tongue. A median of three (range: 1-14) sentinel nodes were identified on lymphoscintigraphy, and all sentinel nodes were successfully retrieved, with 50% having a pathologically positive sentinel node. No false-negative sentinel nodes were identified using selective neck dissection as the gold standard. The negative predictive value (NPV) of SLNB was 100%, with 40% having a sentinel node identified outside the field of planned neck dissection on lymphoscintigraphy. Of these, one patient had a positive sentinel node outside of the ipsilateral supraomohyoid neck dissection template. CONCLUSION SLNB for early OCSCC is technically feasible in an Australian setting. It has a high NPV and can potentially identify at-risk lymphatic basins outside the traditional selective neck dissection levels even in well-lateralized lesions.
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Affiliation(s)
- Muzib Abdul-Razak
- Head and Neck Cancer Service, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Hsiang Chung
- Head and Neck Cancer Service, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia
| | - Eva Wong
- Head and Neck Cancer Service, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia
| | - Carsten Palme
- Head and Neck Cancer Service, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia.,Sydney Head and Neck Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Michael Veness
- Head and Neck Cancer Service, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - David Farlow
- Department of Nuclear Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Hedley Coleman
- Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia
| | - Gary Morgan
- Head and Neck Cancer Service, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
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Sohn B, Koh YW, Kang WJ, Lee JH, Shin NY, Kim J. Is there an additive value of 18 F-FDG PET-CT to CT/MRI for detecting nodal metastasis in oropharyngeal squamous cell carcinoma patients with palpably negative neck? Acta Radiol 2016; 57:1352-1359. [PMID: 26013025 DOI: 10.1177/0284185115587544] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Cervical node metastasis is one of the most significant prognostic factors in patients with oropharyngeal squamous cell carcinoma (SCC). There is little information regarding the comparison of histopathologic analysis following neck dissection with imaging results in oropharyngeal SCC. Purpose To investigate the clinical utility of PET-CT compared with computed tomography (CT) or magnetic resonance imaging (MRI) for detecting nodal metastasis in oropharyngeal SCC patients with palpably negative neck and to investigate whether pretreatment imaging modalities support the rationale for elective neck treatment. Material and Methods A total of 49 oropharyngeal SCC patients with palpably negative neck (42 men, 7 women; average age, 59.1 years) underwent primary tumor resection and neck dissection as a primary treatment. All patients were preoperatively evaluated with PET-CT and CT/MRI, and the diagnostic accuracy of each imaging modality was assessed by comparison with histopathologic results of the surgical specimen. Results Twenty-five (51.0%) of our 49 patients had neck metastases. On a level-by-level analysis, the sensitivity of PET-CT, CT/MRI, and a combination of PET-CT and CT/MRI was 54.6%, 54.6%, and 60.6%, respectively, at all neck levels. The area under the ROC showed that the diagnostic performance of the combined interpretation was not significantly different from that of CT/MRI alone (0.780 vs. 0.750, respectively; P = 0.158) and PET-CT alone (0.780 vs. 0.765, respectively; P = 0.501). Conclusion Addition of PET-CT to CT/MRI did not provide better diagnostic accuracy for detecting nodal metastasis in preoperative evaluation of oropharyngeal SCC patients with palpably negative neck, suggesting that current imaging studies might not replace elective neck dissection.
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Affiliation(s)
- Beomseok Sohn
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Jun Kang
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hoon Lee
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Na-Young Shin
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinna Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Flach GB, Verdonck-de Leeuw IM, Witte BI, Klop WMC, van Es RJ, Schepman KP, de Bree R. Patients' perspective on the impact of sentinel node biopsy in oral cancer treatment. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:279-86. [DOI: 10.1016/j.oooo.2016.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/09/2016] [Accepted: 03/21/2016] [Indexed: 02/06/2023]
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Den Toom IJ, Bloemena E, van Weert S, Karagozoglu KH, Hoekstra OS, de Bree R. Additional non-sentinel lymph node metastases in early oral cancer patients with positive sentinel lymph nodes. Eur Arch Otorhinolaryngol 2016; 274:961-968. [PMID: 27561671 PMCID: PMC5281672 DOI: 10.1007/s00405-016-4280-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/19/2016] [Indexed: 12/17/2022]
Abstract
To determine risk factors for additional non-sentinel lymph node metastases in neck dissection specimens of patients with early stage oral cancer and a positive sentinel lymph node biopsy (SLNB). A retrospective analysis of 36 previously untreated SLNB positive patients in our institution and investigation of currently available literature of positive SLNB patients in early stage oral cancer was done. Degree of metastatic involvement [classified as isolated tumor cells (ITC), micro- and macrometastasis] of the sentinel lymph node (SLN), the status of other SLNs, and additional non-SLN metastases in neck dissection specimens were analyzed. Of 27 studies, comprising 511 patients with positive SLNs, the pooled prevalence of non-SLN metastasis in patients with positive SLNs was 31 %. Non-SLN metastases were detected (available from 9 studies) in 13, 20, and 40 % of patients with ITC, micro-, and macrometastasis in the SLN, respectively. The probability of non-SLN metastasis seems to be higher in the case of more than one positive SLN (29 vs. 24 %), the absence of negative SLNs (40 vs. 19 %), and a positive SLN ratio of more than 50 % (38 vs. 19 %). Additional non-SLN metastases were found in 31 % of neck dissections following positive SLNB. The presence of multiple positive SLNs, the absence of negative SLNs, and a positive SLN ratio of more than 50 % may be predictive factors for non-SLN metastases. Classification of SLNs into ITC, micro-, and macrometastasis in the future SLNB studies is important to answer the question if treatment of the neck is always needed after positive SLNB.
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Affiliation(s)
- Inne J Den Toom
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Elisabeth Bloemena
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry (ACTA) Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Pathology, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Stijn van Weert
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - K Hakki Karagozoglu
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry (ACTA) Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Otto S Hoekstra
- Department of Radiology and Nuclear Medicine, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Remco de Bree
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
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Hernando J, Villarreal P, Álvarez-Marcos F, García-Consuegra L, Gallego L, Junquera L. Sentinel node biopsy versus elective neck dissection. Which is more cost-effective? A prospective observational study. J Craniomaxillofac Surg 2016; 44:550-6. [DOI: 10.1016/j.jcms.2016.01.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/14/2016] [Accepted: 01/26/2016] [Indexed: 02/05/2023] Open
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Stoeckli SJ, Huebner T, Huber GF, Broglie MA. Technique for reliable sentinel node biopsy in squamous cell carcinomas of the floor of mouth. Head Neck 2016; 38:1367-72. [PMID: 27027415 DOI: 10.1002/hed.24440] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/22/2015] [Accepted: 02/02/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Applicability of sentinel node biopsy (SNB) for tumors of the floor of mouth (FOM) is controversial. METHODS Prospective evaluation of the accuracy of gamma-probe-guided superselective neck dissection of the preglandular triangle of level I for SNB in FOM squamous cell carcinoma (SCC) after preoperative lymphoscintigraphy and single photon emission CT (SPECT)/CT. RESULTS In total, 22 sentinel lymph nodes were harvested in level I. Eight of 22 (36%) were seen on lymphoscintigraphy and 11 (50%) on SPECT/CT. Eleven sentinel lymph nodes (50%) were only detected intraoperatively. In unilateral tumors, 20% were contralateral, and, in midline tumors, 93% showed bilateral level I sentinel lymph nodes. The false-negative rate was 8.3%, the negative predictive value was 96.4%, and the false-omission rate was 3.6%. The ultimate neck control rate, including salvage treatment, was 100%. CONCLUSION SNB in FOM can be reliably performed using the presented surgical technique. Level I exploration, bilaterally in midline tumors, is mandatory irrespective of the visualization of sentinel lymph nodes in other levels. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1367-1372, 2016.
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Affiliation(s)
- Sandro J Stoeckli
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Thomas Huebner
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Gerhard F Huber
- Department of Otorhinolaryngology, Head and Neck Surgery University Hospital Zurich, Zurich, Switzerland
| | - Martina A Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Gupta T, Nair S, Chaturvedi P, Kannan S. Sentinel lymph node biopsy for the diagnosis of lymph node involvement in oral/oropharyngeal squamous cell carcinoma. Hippokratia 2016. [DOI: 10.1002/14651858.cd010275.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tejpal Gupta
- Advanced Centre for Treatment Research & Education in Cancer (ACTREC), Tata Memorial Centre; Radiation Oncology; Kharghar Navi Mumbai India 410210
| | - Sudhir Nair
- Advanced Centre for Treatment Research & Education in Cancer (ACTREC), Tata Memorial Centre; Surgical Oncology; Kharghar Navi Mumbai India 410210
| | - Pankaj Chaturvedi
- Tata Memorial Hospital; Surgical Oncology; Parel Mumbai India 400012
| | - Sadhana Kannan
- Advanced Centre for Treatment Research & Education in Cancer (ACTREC), Tata Memorial Centre; Clinical Research Secretariat/Epidemiology & Clinical Trial Unit; Kharghar Navi Mumbai India 410210
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Cost–utility of sentinel lymph node biopsy in cT1–T2N0 oral cancer. Oral Oncol 2016; 53:20-6. [DOI: 10.1016/j.oraloncology.2015.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/01/2015] [Accepted: 11/11/2015] [Indexed: 02/05/2023]
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Green B, Bisase B, Godden D, Mitchell DA, Brennan PA. Current surgical management of metastases in the neck from mucosal squamous cell carcinoma of the head and neck. Br J Oral Maxillofac Surg 2016; 54:135-40. [DOI: 10.1016/j.bjoms.2015.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 06/30/2015] [Indexed: 01/17/2023]
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Mes SW, Leemans CR, Brakenhoff RH. Applications of molecular diagnostics for personalized treatment of head and neck cancer: state of the art. Expert Rev Mol Diagn 2016; 16:205-21. [PMID: 26620464 DOI: 10.1586/14737159.2016.1126512] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Squamous cell carcinomas of the head and neck are the sixth most frequent tumors worldwide. Risk factors are carcinogenic exposure, infection with the human papillomavirus (HPV) and genetic predisposition. Lymph node metastasis in the neck and HPV status are major prognostic factors. There are several important clinical challenges that determine the research agenda in head and neck cancer. The first is more accurate staging, particularly of occult metastatic lymph nodes in the neck. A second challenge is the lack of biomarkers for personalized therapy. There are a number of treatment modalities that can be employed both single and in combination, but at present only site and stage of the tumor are used for treatment planning. Provided here is an overview of the successes and failures of molecular diagnostic approaches that have been and are being evaluated to address these clinical challenges.
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Affiliation(s)
- Steven W Mes
- a Department of Otolaryngology-Head and Neck Surgery , VU University Medical Center , Amsterdam , The Netherlands
| | - C René Leemans
- a Department of Otolaryngology-Head and Neck Surgery , VU University Medical Center , Amsterdam , The Netherlands
| | - Ruud H Brakenhoff
- a Department of Otolaryngology-Head and Neck Surgery , VU University Medical Center , Amsterdam , The Netherlands
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Wakisaka N, Hasegawa Y, Yoshimoto S, Miura K, Shiotani A, Yokoyama J, Sugasawa M, Moriyama-Kita M, Endo K, Yoshizaki T. Primary Tumor-Secreted Lymphangiogenic Factors Induce Pre-Metastatic Lymphvascular Niche Formation at Sentinel Lymph Nodes in Oral Squamous Cell Carcinoma. PLoS One 2015; 10:e0144056. [PMID: 26630663 PMCID: PMC4668078 DOI: 10.1371/journal.pone.0144056] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 11/12/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The objectives of this study were to evaluate the formation of lymphvascular niches in lymph nodes of patients with oral squamous cell carcinoma (OSCC), and investigate the roles of lymphangiogenic and angiogenic factors, such as vascular endothelial growth factor (VEGF)-A, VEGF-C, and VEGF-D, expressed in the primary tumors. MATERIALS AND METHODS Forty-four patients with previously untreated clinically late T2 or T3 OSCC of cN0 were evaluated for primary tumors and 166 sentinel lymph nodes (SLNs). Primary tumors were immunohistochemically analyzed for expressions of VEGFs. Densities of lymphatic vessels (LVDpodoplanin) and high endothelial venules (HEVD) in the SLNs were also calculated using antibodies for each marker, podoplanin and MECA-79, respectively. RESULTS In 25 patients, all lymph nodes were metastasis-negative, whereas, in 19 patients, metastasis was positive for at least one lymph node (either at SLN, non-SLN, or nodal recurrence). From the analyses of 140 SLNs without metastasis, LVDpodoplanin in 50 SLNs of metastasis-positive cases was significantly higher than that in 90 SLNs of metastasis-negative cases (p = 0.0025). HEVD was not associated with lymph node metastasis. The patients with VEGF-A-High or VEGF-D-High tumors had significantly higher LVDpodoplanin than patients with their Low counterparts (p = 0.0233 and p = 0.0209, respectively). In cases with lymph node metastasis, the VEGF-D-expression score was significantly higher than in those without lymph node metastasis (p = 0.0006). CONCLUSIONS These results suggest that lymph node lymphangiogenesis occurs before metastasis in OSCC. VEGF-A and VEGF-D play critical roles in this process. VEGF-D is a potential predictive marker of positive lymph node metastasis in cN0 patients.
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Affiliation(s)
- Naohiro Wakisaka
- Division of Otolaryngology, and Head & Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
- * E-mail:
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery, Aichi Cancer Center, Nagoya, Aichi, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Kouki Miura
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo, Japan
| | - Akihiro Shiotani
- Department of Otolaryngology-Head & Neck Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Junkichi Yokoyama
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Masashi Sugasawa
- Department of Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Makiko Moriyama-Kita
- Division of Otolaryngology, and Head & Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Kazuhira Endo
- Division of Otolaryngology, and Head & Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tomokazu Yoshizaki
- Division of Otolaryngology, and Head & Neck Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
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Schilling C, Stoeckli SJ, Haerle SK, Broglie MA, Huber GF, Sorensen JA, Bakholdt V, Krogdahl A, von Buchwald C, Bilde A, Sebbesen LR, Odell E, Gurney B, O'Doherty M, de Bree R, Bloemena E, Flach GB, Villarreal PM, Fresno Forcelledo MF, Junquera Gutiérrez LM, Amézaga JA, Barbier L, Santamaría-Zuazua J, Moreira A, Jacome M, Vigili MG, Rahimi S, Tartaglione G, Lawson G, Nollevaux MC, Grandi C, Donner D, Bragantini E, Dequanter D, Lothaire P, Poli T, Silini EM, Sesenna E, Dolivet G, Mastronicola R, Leroux A, Sassoon I, Sloan P, McGurk M. Sentinel European Node Trial (SENT): 3-year results of sentinel node biopsy in oral cancer. Eur J Cancer 2015; 51:2777-84. [PMID: 26597442 DOI: 10.1016/j.ejca.2015.08.023] [Citation(s) in RCA: 230] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/22/2015] [Accepted: 08/23/2015] [Indexed: 01/18/2023]
Abstract
PURPOSE Optimum management of the N0 neck is unresolved in oral cancer. Sentinel node biopsy (SNB) can reliably detect microscopic lymph node metastasis. The object of this study was to establish whether the technique was both reliable in staging the N0 neck and a safe oncological procedure in patients with early-stage oral squamous cell carcinoma. METHODS An European Organisation for Research and Treatment of Cancer-approved prospective, observational study commenced in 2005. Fourteen European centres recruited 415 patients with radiologically staged T1-T2N0 squamous cell carcinoma. SNB was undertaken with an average of 3.2 nodes removed per patient. Patients were excluded if the sentinel node (SN) could not be identified. A positive SN led to a neck dissection within 3 weeks. Analysis was performed at 3-year follow-up. RESULTS An SN was found in 99.5% of cases. Positive SNs were found in 23% (94 in 415). A false-negative result occurred in 14% (15 in 109) of patients, of whom eight were subsequently rescued by salvage therapy. Recurrence after a positive SNB and subsequent neck dissection occurred in 22 patients, of which 16 (73%) were in the neck and just six patients were rescued. Only minor complications (3%) were reported following SNB. Disease-specific survival was 94%. The sensitivity of SNB was 86% and the negative predictive value 95%. CONCLUSION These data show that SNB is a reliable and safe oncological technique for staging the clinically N0 neck in patients with T1 and T2 oral cancer. EORTC Protocol 24021: Sentinel Node Biopsy in the Management of Oral and Oropharyngeal Squamous Cell Carcinoma.
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Affiliation(s)
- Clare Schilling
- Department of Head and Neck Surgery, Guys and St Thomas NHS Trust, London, UK
| | - Sandro J Stoeckli
- Department of Otorhinolaryngology, Head and Neck Surgery Kantonsspital St Gallen, Switzerland
| | - Stephan K Haerle
- Department of Head and Neck Surgery, University of Basel, Switzerland
| | - Martina A Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery Kantonsspital St Gallen, Switzerland
| | - Gerhard F Huber
- Department of Otolaryngology University Hospital Zurich, Switzerland
| | - Jens Ahm Sorensen
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Denmark
| | - Vivi Bakholdt
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Denmark
| | | | - Christian von Buchwald
- Department of Otolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Anders Bilde
- Department of Otolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Lars R Sebbesen
- Department of Otolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Edward Odell
- Head and Neck/Oral Pathology, King's College London, Guys and St Thomas NHS Trust, London, UK
| | - Benjamin Gurney
- Department of Head and Neck Surgery, Guys and St Thomas NHS Trust, London, UK
| | - Michael O'Doherty
- Department of Nuclear Medicine, Guys and St Thomas NHS Trust, London, UK
| | - Remco de Bree
- Department of Otolaryngology Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Elisabeth Bloemena
- Department of Pathology, VU University Medical Centre and Academic Centre of Dentistry Amsterdam, The Netherlands
| | - Geke B Flach
- Department of Otolaryngology Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Pedro M Villarreal
- Department of Maxillofacial Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Julio Alvarez Amézaga
- Department of Maxillofacial Surgery, BioCruces, Hospital Universitario De Cruces, Universidad del Pais Vasco (UPV/EHU), Bilbao, Spain
| | - Luis Barbier
- Department of Maxillofacial Surgery, BioCruces, Hospital Universitario De Cruces, Universidad del Pais Vasco (UPV/EHU), Bilbao, Spain
| | - Joseba Santamaría-Zuazua
- Department of Maxillofacial Surgery, BioCruces, Hospital Universitario De Cruces, Universidad del Pais Vasco (UPV/EHU), Bilbao, Spain
| | - Augusto Moreira
- Department of Head and Neck Surgery, Instituto Portugues de Oncologia do Porto, Portugal
| | - Manuel Jacome
- Department of Head and Neck Surgery, Instituto Portugues de Oncologia do Porto, Portugal
| | | | - Siavash Rahimi
- Department of Histopathology, San Carlo Hospital Rome, Italy
| | | | - Georges Lawson
- Department of Head and Neck Surgery, CHU Dinant Godinne, Université Catholique de Louvain, Belgium
| | - Marie-Cecile Nollevaux
- Department of Head and Neck Surgery, CHU Dinant Godinne, Université Catholique de Louvain, Belgium
| | - Cesare Grandi
- Department of Otolaryngology, Ospedale S. Chiara, Trento, Italy
| | - Davide Donner
- Department of Nuclear Medicine, Ospedale S. Chiara, Trento, Italy
| | - Emma Bragantini
- Department of Surgical Pathology, Ospedale S. Chiara, Trento, Italy
| | - Didier Dequanter
- Department of Maxillofacial Surgery CHU de Charleroi Belgium, Belgium
| | - Philippe Lothaire
- Department of Maxillofacial Surgery CHU de Charleroi Belgium, Belgium
| | - Tito Poli
- Department of Maxillofacial Surgery, Azienda Ospedaliera, Universitaria of Parma, Italy
| | - Enrico M Silini
- Department of Pathology Azienda Ospedaliera Universitaria of Parma, Italy
| | - Erinco Sesenna
- Department of Maxillofacial Surgery, Azienda Ospedaliera, Universitaria of Parma, Italy
| | - Giles Dolivet
- Department of Head and Neck Surgery Centre Alexis Vautrin, Vandoeuvre Les Nancy, France
| | - Romina Mastronicola
- Department of Head and Neck Surgery Centre Alexis Vautrin, Vandoeuvre Les Nancy, France
| | - Agnes Leroux
- Department of Pathology Centre Alexis Vautrin, Vandoeuvre Les Nancy, France
| | | | - Philip Sloan
- Department of Cellular Pathology, Newcastle University Hospital, UK
| | - Mark McGurk
- Department of Head and Neck Surgery, Guys and St Thomas NHS Trust, London, UK.
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Chung MK, Lee GJ, Choi N, Cho JK, Jeong HS, Baek CH. Comparative study of sentinel lymph node biopsy in clinically N0 oral tongue squamous cell carcinoma: Long-term oncologic outcomes between validation and application phases. Oral Oncol 2015; 51:914-20. [PMID: 26231920 DOI: 10.1016/j.oraloncology.2015.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/14/2015] [Accepted: 07/17/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study tested the long-term outcomes of sentinel lymph node biopsy (SLNB) for oral tongue squamous cell carcinoma (SCC) during the transition from validation to application phase. MATERIALS AND METHODS Sensitivity, negative predictive value (NPV), neck control rate, disease-specific survival (DSS), disease-free survival (DFS), and overall survival (OS) were compared in cN0 oral tongue SCC patients from different phases. RESULTS A total of 133 SLNs from 61 patients (21 in the validation phase, 40 in the application phase) were harvested. Fourteen SLNs of 12 patients (6 in each phase) were positive for metastasis (occult metastasis rate, 19.6%). Regional recurrences developed from 5 negative SLNs (one in the validation phase, 4 in the application phase), of whom 3 patients were successfully salvaged. Sensitivity and NPV of the validation phase were both 100%, with 60.0% and 88.2% in the application phase. False omission rates were 6.6% (1/15) in the validation group, and 11.7% (4/34) in the application group, respectively. The neck control rate was 95.2% in the validation phase and 97.5% in the application phase (p=0.52). No differences were evident in DSS, DFS, and OS between the two phases (DSS: 92.5% vs 95.2%, p=0.69; DFS: 85.0% vs 90.4%, p=0.40; OS: 90% vs 85.5%, p=0.62). Subgroup analyses between negative- and positive-SLNs within each phase revealed no significant differences in all endpoints. CONCLUSION Given higher false negative cases in the application phase, stringent strategy of follow-up and salvage treatment is mandatory to maintain acceptable outcomes.
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Affiliation(s)
- Man Ki Chung
- Department of Otorhinolaryngology -Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Gil Joon Lee
- Department of Otorhinolaryngology -Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Nayeon Choi
- Department of Otorhinolaryngology -Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University Yansan Hospital, Puasn National University, Busan, South Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology -Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Chung-Hwan Baek
- Department of Otorhinolaryngology -Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea.
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Chen Y, Cao W, Gao X, Ong H, Ji T. Predicting postoperative complications of head and neck squamous cell carcinoma in elderly patients using random forest algorithm model. BMC Med Inform Decis Mak 2015; 15:44. [PMID: 26054335 PMCID: PMC4459053 DOI: 10.1186/s12911-015-0165-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 05/22/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Head and Neck Squamous Cell Carcinoma (HNSCC) has a high incidence in elderly patients. The postoperative complications present great challenges within treatment and they're hard for early warning. METHODS Data from 525 patients diagnosed with HNSCC including a training set (n = 513) and an external testing set (n = 12) in our institution between 2006 and 2011 was collected. Variables involved are general demographic characteristics, complications, disease and treatment given. Five data mining algorithms were firstly exploited to construct predictive models in the training set. Subsequently, cross-validation was used to compare the different performance of these models and the best data mining algorithm model was then selected to perform the prediction in an external testing set. RESULTS Data from 513 patients (age > 60 y) with HNSCC in a training set was included while 44 variables were selected (P < 0.05). Five predictive models were constructed; the model with 44 variables based on the Random Forest algorithm demonstrated the best accuracy (89.084%) and the best AUC value (0.949). In an external testing set, the accuracy (83.333%) and the AUC value (0.781) were obtained by using the random forest algorithm model. CONCLUSIONS Data mining should be a promising approach used for elderly patients with HNSCC to predict the probability of postoperative complications. Our results highlighted the potential of computational prediction of postoperative complications in elderly patients with HNSCC by using the random forest algorithm model.
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Affiliation(s)
- YiMing Chen
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhizaoju Road, Shanghai, 200011 China
| | - Wei Cao
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhizaoju Road, Shanghai, 200011 China
| | - XianChao Gao
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhizaoju Road, Shanghai, 200011 China
| | - HuiShan Ong
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhizaoju Road, Shanghai, 200011 China
| | - Tong Ji
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhizaoju Road, Shanghai, 200011 China
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Coskun HH, Medina JE, Robbins KT, Silver CE, Strojan P, Teymoortash A, Pellitteri PK, Rodrigo JP, Stoeckli SJ, Shaha AR, Suçrez C, Hartl DM, de Bree R, Takes RP, Hamoir M, Pitman KT, Rinaldo A, Ferlito A. Current philosophy in the surgical management of neck metastases for head and neck squamous cell carcinoma. Head Neck 2015; 37:915-26. [PMID: 24623715 PMCID: PMC4991629 DOI: 10.1002/hed.23689] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 01/03/2014] [Accepted: 03/08/2014] [Indexed: 12/11/2022] Open
Abstract
Neck dissection is an important treatment for metastases from upper aerodigestive carcinoma; an event that markedly reduces survival. Since its inception, the philosophy of the procedure has undergone significant change from one of radicalism to the current conservative approach. Furthermore, nonsurgical modalities have been introduced, and, in many situations, have supplanted neck surgery. The refinements of imaging the neck based on the concept of neck level involvement has encouraged new philosophies to evolve that seem to benefit patient outcomes particularly as this relates to diminished morbidity. The purpose of this review was to highlight the new paradigms for surgical removal of neck metastases using an evidence-based approach.
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Affiliation(s)
- H. Hakan Coskun
- Department of Otolaryngology–Head and Neck Surgery, Uludag University School of Medicine, Bursa, Turkey
| | - Jesus E. Medina
- Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - K. Thomas Robbins
- Division of Otolaryngology–Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Carl E. Silver
- Departments of Surgery and Otolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Afshin Teymoortash
- Department of Otolaryngology–Head and Neck Surgery, University of Marburg, Marburg, Germany
| | - Phillip K. Pellitteri
- Department of Otolaryngology–Head and Neck Surgery, Guthrie Health System, Sayre, Pennsylvania
| | - Juan P. Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto Universitario de Oncologıa del Principado de Asturias, Oviedo, Spain
| | - Sandro J. Stoeckli
- Department of Otorhinolaryngology–Head and Neck Surgery, Kantonsspital, St. Gallen, Switzerland
| | - Ashok R. Shaha
- Head and Neck Service, Memorial Sloan–Kettering Cancer Center, New York, New York
| | - Carlos Suçrez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto Universitario de Oncologıa del Principado de Asturias, Oviedo, Spain
| | - Dana M. Hartl
- Department of Otolaryngology–Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France
- Laboratoire de Phonétique et de Phonologie, Sorbonne Nouvelle, Paris, France
| | - Remco de Bree
- Department of Otolaryngology–Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Robert P. Takes
- Department of Otolaryngology–Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marc Hamoir
- Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital and Cancer Center, Brussels, Belgium
| | - Karen T. Pitman
- Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, Arizona
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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.
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49
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Heuveling DA, van Weert S, Karagozoglu KH, de Bree R. Evaluation of the use of freehand SPECT for sentinel node biopsy in early stage oral carcinoma. Oral Oncol 2015; 51:287-90. [DOI: 10.1016/j.oraloncology.2014.12.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 11/28/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023]
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50
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Head and neck cancer: towards a new paradigm with sentinel node localization. Clin Transl Imaging 2014. [DOI: 10.1007/s40336-014-0096-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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