Selective neck dissection in the management of squamous cell carcinoma of the upper digestive tract

Selective neck dissection has been used clinically in elective treatment of carcinoma, although many surgeons continue to advocate modified radical or radical neck dissection for therapeutic management of the neck. In a retrospective study 167 previously untreated patients were reviewed following curative laser microsurgical resections of oral or pharyngeal primary tumors and a unior bilateral selective neck dissection. In all, 221 (54 bilateral) neck dissections were performed. In patients with oral primary disease lymph nodes of levels I-III were removed, while nodes in levels II and III were removed in patients with pharyngeal tumors. Level IV was dissected when several metastases were suspected during operation. The posterior triangle was not dissected. Lymph nodes were histopathologically negative in 73 patients and positive in 94 patients. Twenty-five of these latter cases had pN1 disease, 55 had pN2b disease and 10 had bilateral lymph node metastases. Twenty patients in the pN0 group and 63 patients in the pN+ group received postoperative radiotherapy (to 56.7 Gy to the primary site and 52.5 Gy to the neck). With a median follow-up interval of 34 months, recurrence in the dissected neck occurred in 3 of 73 patients (4.1%) with pN0 disease and 6 of 90 patients (6.6%) with pN+ necks. Four patients with pN+ necks had simultaneous recurrences at the primary site. The addition of adjuvant radiotherapy seemed to improve disease control in the neck and improve overall survival in patients with an unfavorable prognosis due to multiple metastases or metastases with extracapsular spread.

Detection of nodal micrometastases in head and neck cancer by serial sectioning and immunostaining

We investigated the incidence of micrometastases from squamous cell carcinomas of the head and neck in neck dissection specimens originally staged as pNO. A total of 76 dissection specimens from 60 patients were evaluated using serial microscopic sectioning in 10-microns intervals, H & E staining, and immunostaining with an antibody to pan-cytokeratin. Examination of 1,020 lymph nodes from 76 neck dissection specimens revealed 8 micrometastases (7.9%) in 6 specimens from 6 patients with oral and pharyngeal primaries, resulting in upstaging. Six micrometastases were located in lymph nodes 3 to 6 mm in diameter. The surgeon should be aware of the relatively high incidence of micrometastases from oral and pharyngeal carcinomas, which are undetectable preoperatively or by routine histopathologic examination. Primary tumor site (oral cavity and pharynx) and certain features of the primary can delineate a group of patients with a higher risk of harboring occult metastases who may benefit from elective treatment of the neck.

Micrometastases in carcinoma of the upper aerodigestive tract: detection, risk of metastasizing, and prognostic value of depth of invasion

BACKGROUND

The purpose of this study was to investigate the incidence of micrometastases from squamous cell carcinomas of the upper aerodigestive tract in neck dissection specimens, and to determine whether features of the primary tumor might be of prognostic value for metastasizing.

METHODS

Seventy-six originally pNO staged neck dissection specimens from 60 patients were evaluated using serial sectioning in 10-micrometer intervals, H&E staining and immunostaining with an antibody to pan-cytokeratin. The influence of the variables pT-category, cytologic grade, and maximum depth of invasion of the primary tumor on the nodal status was analyzed in 128 patients.

RESULTS

The examination of 1020 lymph nodes from 76 neck dissection specimens revealed 8 micrometastases in 6 specimens (7.9%) from 6 patients with oral and pharyngeal primaries, resulting in upstaging. Six micrometastases were located in lymph nodes of 3-6 mm in diameter. Depth of invasion was the only significant risk factor for metastasizing selected in logistic regression.

CONCLUSION

The surgeon should be aware of a relatively high incidence of micrometastases from oral and pharyngeal carcinomas, which are neither detectable preoperatively nor histopathologically by a reasonable effort. The measurement of the maximum depth of invasion of the primary can delineate a group of patients who should be treated by elective neck dissection.

[Special aspects of histopathologic diagnosis in laser microsurgery of cancers of the upper aerodigestive tract]

Histological examination of CO2 laser-resected specimens reveals a thin layer of carbonisation, beneath which the cellular architecture is preserved, permitting adequate assessment. With early staged laryngeal, oral and pharyngeal carcinomas, it is usually possible to remove the tumour as a single block, and the margins can be studied by parallel histologic sections. Advanced tumours, regardless of their localisation, demand resection in several blocks. Each tissue block is carefully orientated and the deep surface of every specimen is stained. Accurate mapping of every block is essential to enable the surgeon to identify the precise location of each specimen in the patient. The specimens are vertically sectioned after paraffin wax embedding. Grading, depth of invasion, lateral and basal margins are examined. Like in conventional surgery, it is technically impossible to examine all margins of a large specimen. With vertical sections only limited information can be obtained about lateral and basal margins. If deep tumour infiltration reaches cartilage or bony structures, clear microscopic margins are difficult to prove after laser resection. Finally it must be possible for the surgeon to recreate a complete, 3-dimensional mosaic of the entire lesion to achieve accurate pT-staging.

[Medical ENT endoscopic studies in the iron and steel industry]

461 chromium- and nickel-exposed steelworkers were otolaryngologically examined by endoscopy. Besides chronic inflammatory diseases of the ear, nose and paranasal sinuses, the clinical diagnosis of leukoplakia and hyperplastic laryngitis was made for 30 workers. In no case a lesion suspicious of cancer was found. Office staff showing no such occupational risk factors served as the control group. It was found that in both groups smoking has to be assumed as the decisive factor for the development of chronic inflammation and precancerous changes in the oral cavity and the larynx.

[Pseudotumor of the hypopharynx and other primary diseases in the head and neck region in HIV infections. A case report and review of the literature]

The present article describes a pseudotumor of the hypopharynx, and deteriorating breathing and swallowing in a 72-year-old man. The pseudotumor was due to advanced HIV-infection and is the first such case to be described. Additionally, the article reviews the literature concerning otorhinolaryngeal diseases as primary manifestations of HIV infection.

[Current aspects of evaluating wood dust-induced adenocarcinomas of the nose and paranasal sinuses]

The evaluation of 40 patients with adenocarcinoma of the nasal cavity shows that these patients had been exposed to oak and beech dusts proving the causal connection between this type of wood dust and adenocarcinoma of the nose. In view of this knowledge, compensation in accordance with section 551 (2) RVO (Reichsversicherungsordnung: social insurance statute) can be recommended in individual cases after intensive occupational exposure to oak or beech dust over many years.

[Prevention of occupational cancer in the asbestos cement industry (preliminary report)]

In a cohort study on 324 asbestos cement workers an increased risk of lung cancer was observed in comparison to cement workers (O/E = 1.7, p less than 0.05). 10 out of 17 deaths from lung cancer occurred after age 65, stressing the need for screening after retirement. In a pilot study on 198 asbestos cement workers we tried to adjust the screening intensity to individual risk (esp. for respiratory and gastrointestinal diseases) by use of history (exposure, smoking, etc.) and results of earlier examination. We found relations between smoking and respiratory symptoms, smoking and parameters of flow-volume-curves, smoking and radiological signs of early pneumoconiosis. Possibilities for early detection and intervention are discussed.

[Pulmonary function tests in a population with endemic pleural plaques and environmental asbestos exposure]

The prevalence of pleural plaques in a sample of a community subjected to environmental asbestos exposure from natural deposits was 10%. Spirogram, flow-volume curves and pulmonary resistance of persons with plaques were not significantly different from controls. The larger, age-dependent decrease in lung function parameters in our sample as compared with various reference values may be explained by accelerated "aging" of the bronchial tree related to exposure to the noxious inhalant or by underrepresentation of the higher age groups in the reference studies.

[Effect of BCG vaccination of the newborn infant on the incidence and course of juvenile leukemias]

As a retrospective study the clinical data of 613 leukaemic children were collected. 269 of them were born in Austria, fell sick between 1967 and 1976 and were not older than 5 years at the onset of disease. BCG-vaccination, which is performed in Austria within the first three days after birth, was checked by means of hospital reports, birth protocols and central BCG record. All data were stored and evaluated by electronic data processing. Besides a significant decrease of mortality, which we could demonstrate in earlier studies, the following correlations between BCG-vaccination of newborn and leukaemia were found: Reduction of morbidity, decrease of case fatality, increase of 5 years survival rate, increase of mean survival time, delayed onset of disease, decrease of frequency of myeloic and chronic leukaemia. With the exception of the slight reduction of morbidity all correlations are significant.