1
|
Krabbe CA, Pruim J, Scholtens AM, Roodenburg JLN, Brouwers AH, Phan TTH, Agool A, Dijkstra PU. 18F-FDG PET in squamous cell carcinoma of the oral cavity and oropharynx: a study on inter- and intraobserver agreement. J Oral Maxillofac Surg 2010; 68:21-7. [PMID: 20006150 DOI: 10.1016/j.joms.2009.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 04/14/2009] [Accepted: 07/25/2009] [Indexed: 11/15/2022]
Abstract
PURPOSE Good observer agreement is mandatory for an effective imaging technique. However, little is known about the observer agreement of fluorine-18 fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) in head and neck squamous cell carcinoma. The aim of the present study was to evaluate the inter- and intraobserver agreement of interpretations of (18)F-FDG PET in head and neck SCC and to assess the influence of observer experience, tumor localizing, and tumor size on the agreement. PATIENTS AND METHODS (18)F-FDG PET scans of 80 patients with oral and oropharyngeal SCC were reassessed twice by 2 experienced nuclear medicine physicians and 2 residents in nuclear medicine. The absolute agreement and Cohen's kappa were calculated by comparing the results of the 4 observers for the primary tumor, cervical metastases, and distant metastases/second primary tumor. To analyze the sensitivity and specificity, the results were compared with the findings from the histologic specimens or the follow-up data. RESULTS The interobserver agreement of the nuclear medicine physicians revealed an absolute agreement and kappa of 0.91 and 0.58 for detecting the primary tumor, 0.94 and 0.83 for detecting cervical metastases, and 0.85 and 0.53 for detecting distant metastases/second primary tumors, respectively. The intraobserver agreement was greater overall than the interobserver agreement. Compared with the nuclear medicine physicians, the residents scored lower in interobserver agreement. The interobserver agreement decreased when localizing the malignancy more precisely. The agreement and sensitivity increased with tumor size. However, for small metastases, a high observer agreement was found owing to the nondetection of these malignancies. CONCLUSIONS Good inter- and intraobserver agreement in SCC in the oral cavity or oropharynx with (18)F-FDG PET was found. Observer experience had limited influence on observer agreement. However, the agreement level decreased when a more precise anatomic tumor localization was required.
Collapse
Affiliation(s)
- Christiaan A Krabbe
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
2
|
Straetmans JMJAA, Olthof N, Mooren JJ, de Jong J, Speel EJM, Kremer B. Human papillomavirus reduces the prognostic value of nodal involvement in tonsillar squamous cell carcinomas. Laryngoscope 2009; 119:1951-7. [DOI: 10.1002/lary.20593] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
3
|
van den Brekel MWM, Castelijns JA. What the clinician wants to know: surgical perspective and ultrasound for lymph node imaging of the neck. Cancer Imaging 2005; 5 Spec No A:S41-9. [PMID: 16361135 PMCID: PMC1665300 DOI: 10.1102/1470-7330.2005.0028] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Imaging of lymph node metastases in the neck can have two major indications: (1) prognosis and assisting with choice of treatment; (2) staging and detection of clinically occult metastases in different levels of the neck. Both indications are discussed. The role and limitations of US and US-guided fine-needle aspiration cytology are also reviewed.
Collapse
Affiliation(s)
- Michiel W M van den Brekel
- Department of Otolaryngology, Head and Neck Surgery, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
| | | |
Collapse
|
4
|
Sticht C, Hofele C, Flechtenmacher C, Bosch FX, Freier K, Lichter P, Joos S. Amplification of Cyclin L1 is associated with lymph node metastases in head and neck squamous cell carcinoma (HNSCC). Br J Cancer 2005; 92:770-4. [PMID: 15700036 PMCID: PMC2361871 DOI: 10.1038/sj.bjc.6602400] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Overrepresentation of chromosomal bands 3q25–q29 has been associated with shortened disease-specific survival in head and neck squamous cell carcinoma (HNSCC). To assess the prevalence of copy number gains (>4 signals per cell) and high-level amplifications (>8 signals per cell) from putative oncogenes in this chromosomal region (CCNL1, SNO, PIK3CA, TP73L), tissue microarray analysis was applied on 280 HNSCCs by fluorescence in situ hybridization. Overall frequency of additional copy numbers was 34.3% for CCNL1, 31.8% for SNO, 39.0% for PIK3CA and 38.3% for TP73L, respectively. In general, gains were more frequently detected in stage IV compared to stage I–III tumours. Performing multivariate logistic regression analysis, a significant association of CCNL1 gains and the presence of lymph node metastases was found, which was independent of anatomical site and T-stage of the primary tumour (P=0.049). Site-specific subgroup analysis further showed that copy number gains of CCNL1 and SNO occurred more frequently in oral carcinomas in advanced clinical stages as compared to N0 oral lesions (CCNL1: P=0.03; SNO: P=0.03). Finally, Kaplan–Meier analysis revealed that high-level amplifications of CCNL1 correlated with shorter overall survival of the patients. Our results indicate that CCNL1 plays a critical role in the loco-regional progression of HNSCC and may serve as an indicator for occult advanced tumour stages.
Collapse
Affiliation(s)
- C Sticht
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Heidelberg, Heidelberg, Germany
- Deutsches Krebsforschungszentrum Abteilung Molekulare Genetik (B060), Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany
| | - C Hofele
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - C Flechtenmacher
- Pathologisches Institut Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - F X Bosch
- Molekularbiologisches Labor der Klinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - K Freier
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Heidelberg, Heidelberg, Germany
- Deutsches Krebsforschungszentrum Abteilung Molekulare Genetik (B060), Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany
| | - P Lichter
- Deutsches Krebsforschungszentrum Abteilung Molekulare Genetik (B060), Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany
| | - S Joos
- Deutsches Krebsforschungszentrum Abteilung Molekulare Genetik (B060), Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany
- Deutsches Krebsforschungszentrum Abteilung Molekulare Genetik (B060), Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany. E-mail:
| |
Collapse
|
5
|
Takes RP. Staging of the neck in patients with head and neck squamous cell cancer: Imaging techniques and biomarkers. Oral Oncol 2004; 40:656-67. [PMID: 15172634 DOI: 10.1016/j.oraloncology.2003.11.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2003] [Accepted: 11/10/2003] [Indexed: 10/26/2022]
Abstract
Regional metastasis is an important factor in the treatment and prognosis of head and neck cancer patients. Current treatment strategies rely on staging based on the still limited accuracy of imaging techniques to detect regional metastases. If more certainty about the nodal status could be attained, treatment strategies concerning the neck could be better adjusted to the individual patient. The continuing improvement of established imaging techniques and the introduction of new imaging modalities will add to better staging. Moreover, the additional use of biomarkers studied on a protein, RNA or DNA level may provide even better information about the chance of occult nodal metastasis in head and neck cancer patients.
Collapse
Affiliation(s)
- Robert P Takes
- Department of Otolaryngology/Head and Neck Surgery, University Medical Center Nijmegen, P.O. Box 9101, 6500 HB, The Netherlands.
| |
Collapse
|
6
|
Hall TB, Barton DPJ, Trott PA, Nasiri N, Shepherd JH, Thomas JM, Moskovic EC. The role of ultrasound-guided cytology of groin lymph nodes in the management of squamous cell carcinoma of the vulva: 5-year experience in 44 patients. Clin Radiol 2003; 58:367-71. [PMID: 12727164 DOI: 10.1016/s0009-9260(02)00575-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM To assess the accuracy of ultrasound combined with fine-needle aspiration cytology (FNAC) in the detection of lymph node metastasis in patients with squamous cell carcinoma of the vulva. MATERIALS AND METHODS The groin nodes of 44 consecutive patients with primary squamous cell carcinoma of the vulva undergoing groin node dissection were assessed with ultrasound and FNAC. The results were compared with histology from subsequent inguinofemoral lymph node dissection. Twenty-nine patients underwent bilateral groin node dissections and 15 unilateral providing comparable data for 73 groins. RESULTS Histology demonstrated metastatic disease in 28 groins and no evidence of metastatic disease in 45. Ultrasound agreed with the histology in 67 of the 73 groins (92%), with two false-positives, four false-negatives and two indeterminate appearances. Cytology agreed with the histology in 65 of 72 FNAC samples obtained (90%), with six false-negatives, and one indeterminate result. No false-positive cytology results were seen. Ultrasound and FNAC together failed to detect metastatic disease in four groins, one with an indeterminate ultrasound appearance, another with indeterminate cytology, the two others each having a single positive inguinal node despite a negative ultrasound and FNAC. CONCLUSION The combination of ultrasound and FNAC provides a sensitive and specific tool for pre-operative assessment and may prevent unnecessary groin dissection and the attendant morbidity in selected patients with vulval cancer.
Collapse
Affiliation(s)
- T B Hall
- Department of Diagnostic Radiology, Royal Marsden Hospital, London, UK
| | | | | | | | | | | | | |
Collapse
|
7
|
Takes RP, Baatenburg de Jong RJ, van Blommestein R, Hermans J, van Krieken HHJM, Cornelisse CJ. DNA ploidy status as a prognostic marker and predictor of lymph node metastasis in laryngeal carcinoma. Ann Otol Rhinol Laryngol 2002; 111:1015-20. [PMID: 12450177 DOI: 10.1177/000348940211101112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In patients with laryngeal carcinoma, nodal metastasis, recurrence after radiotherapy, and prognosis are important factors in clinical decision-making. Parameters such as tumor stage are considered insufficient for predicting these important items. The DNA ploidy status of the tumor may be a useful additional marker. The DNA ploidy status of 38 laryngeal cancers was determined by flow cytometry. Correlations were studied with TNM stage, differentiation, survival rate, relapse risk, recurrence after radiotherapy, and nodal metastasis. A positive correlation of DNA ploidy status with the development of lymph node metastases was found for diploid and peridiploid versus aneuploid tumors (DNA index, <1.4 versus > or = 1.4; p = .007). No correlation was found between ploidy status and recurrence after radiotherapy. The overall survival rate (p = .01), but not the disease-specific survival rate or the relapse risk, showed a correlation with the ploidy status. The DNA ploidy status may be a useful marker for metastatic behavior in head and neck squamous cell carcinoma and may therefore be helpful in decision-making concerning elective treatment of the neck.
Collapse
Affiliation(s)
- Robert P Takes
- Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | | |
Collapse
|
8
|
Shintani S, Yoshihama Y, Ueyama Y, Terakado N, Kamei S, Fijimoto Y, Hasegawa Y, Matsuura H, Matsumura T. The usefulness of intraoral ultrasonography in the evaluation of oral cancer. Int J Oral Maxillofac Surg 2001; 30:139-43. [PMID: 11405449 DOI: 10.1054/ijom.2000.0035] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Many studies focused on the tumour thickness in oral squamous cell carcinomas, suggesting a relationship with the occurrence of cervical metastasis. Accurate preoperative assessment of the tumour thickness of oral cancer would provide useful information for targeting those patients who need elective treatment of the neck. Some useful diagnostic aids to evaluate oral cancer are computed tomography (CT), magnetic resonance imaging (MRI), and intraoral ultrasonography. The purpose of the present study is to compare intraoral ultrasonography with CT and MRI in delineating the disease extent and in measuring the tumour thickness of oral carcinoma. Thirty-nine patients with oral cancer were preoperatively evaluated with intraoral ultrasonography, and CT, and in 26 of them MRI was carried out. High-quality ultrasonographic images were obtained and the tumour thickness was measured within 1 mm. However, in most tumours less than 5.0 mm in thickness, CT and MRI could not detect a sufficient density difference from the normal tissue to accurately delineate the extent of the tumour. There was a significant correlation between measurements by intraoral ultrasonography and the histological sections. The present study shows that ultrasonography is superior to CT and MRI in assessment of the primary lesion of oral carcinoma.
Collapse
Affiliation(s)
- S Shintani
- Department of Oral and Maxillofacial Surgery II, Okayama University Dental School, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Sato T, Yamaguchi K, Morita Y, Noikura T, Sugihara K, Matsune S. Lymphoscintigraphy for interpretation of changes of cervical lymph node function in patients with oral malignant tumors: comparison of Tc-99m-Re and Tc-99m-HSA-D. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 90:525-37. [PMID: 11027392 DOI: 10.1067/moe.2000.109190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study is to compare the usefulness of technetium-99m-rhenium colloid (Tc-99m-Re) and technetium-99m-human serum albumin diethylene-triamine-pentaacetic acid (Tc-99m-HSA-D) as lymphoscintigraphic agents and to discuss the significance of lymphoscintigraphy in comparison with computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US). STUDY DESIGN Dynamic and static lymphoscintigraphies were performed with Tc-99m-Re and Tc-99m-HSA-D. The usefulness of the 2 agents was evaluated statistically in comparison with pathologic findings and palpation. The significance of lymphoscintigraphy is discussed in comparison with CT, MRI, and US (by the literature of CT, MRI, and US). RESULTS Lymphoscintigraphy was superior to palpation, and Tc-99m-Re was superior to Tc-99m-HSA-D in accuracy, specificity, and the incidence of true-positive and false-positive. Statistical significance was shown between the static lymphoscintigraphy with Tc-99m-Re and palpation. The reliability of lymphoscintigraphy seemed to be slightly inferior to CT and MRI in specificity and accuracy. However, lymphoscintigraphy had some advantages that CT and MRI lacked; for example, it showed very high sensitivity (100%) and no false-negative (0%). It also showed changes of lymph node function, showed all levels of neck nodes at one time, and showed a possibility of detecting small lymph node metastases. CONCLUSION Lymphoscintigraphy was more useful than palpation in detecting lymph node metastases, and Tc-99m-Re was superior to Tc-99m-HSA-D as an agent. Lymphoscintigraphy is significant when it is performed as a preliminary examination before CT or MRI.
Collapse
Affiliation(s)
- T Sato
- Kagoshima University Dental School and Medical School, Department of Dental Radiology, Japan.
| | | | | | | | | | | |
Collapse
|
10
|
Cerilli LA, Wick MR. Fine Needle Aspiration Biopsies of the Head and Neck: The Surgical Pathologist's Perspective. Int J Surg Pathol 2000; 8:17-28. [PMID: 11493961 DOI: 10.1177/106689690000800107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Masses of the head and neck comprise a variety of benign and malignant tumors and tumor-like conditions, which may present diagnostic challenges to the surgical pathologist and surgeon. Fine needle aspiration cytology is an increasingly popular technique in the initial evaluation of such lesions. The high diagnostic accuracy of this technique makes it generally preferable to traditional surgical biopsy. It is particularly useful in the sampling of histologically uniform neoplasms of the salivary glands, identification of classical papillary carcinoma and medullary carcinoma of the thyroid, separation of colloid goiter from follicular neoplasms, and confirmation of clinically suspicious lymph node metastases in cases with already documented malignant diseases. Despite its usefulness, aspiration cytology of head and neck lesions has certain inherent pitfalls, and these are briefly examined in this review. Int J Surg Pathol 8(1):17-28, 2000
Collapse
Affiliation(s)
- Lisa A. Cerilli
- Robert E. Fechner Laboratory of Surgical Pathology, University of Virginia Medical Center, Charlottesville, Virginia
| | | |
Collapse
|
11
|
Affiliation(s)
- M W van den Brekel
- Department of Otorhinolaryngology/Head & Neck Surgery, Free University Hospital, Amsterdam, The Netherlands
| | | |
Collapse
|
12
|
Robinson IA, Cozens NJ. Does a joint ultrasound guided cytology clinic optimize the cytological evaluation of head and neck masses? Clin Radiol 1999; 54:312-6. [PMID: 10362238 DOI: 10.1016/s0009-9260(99)90561-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIM To compare the results of fine-needle aspiration (FNA) of head and neck masses performed in an ultrasound-guided cytology clinic (USGCC) staffed by a radiologist and pathologist to those obtained with specimens sent from other sources. METHODS Comparison of broad-category FNA diagnoses (malignant, uncertain, benign or inadequate) with the patient's ultimate clinical or pathological outcome. Because FNA outcomes are semi-quantitative, accuracy of the procedure (the proportion of all tests resulting in a true- positive or negative fine-needle aspirate) is a better measure than sensitivity or specificity. Specimens (n = 292) from the first 2 years of the USGCC are compared with 600 specimens received from other sources over the previous 4 years. RESULTS Accuracy was 23.4% better for specimens from the USGCC compared with those obtained by clinician guided aspiration (83.9%, 95% CI 79.7-88.1%, vs 60.5%, 95% CI 56.6-64.4%). There was an 84% reduction in inadequate specimens (from 21.5% to 3.4%). The proportion resulting in an uncertain result did not alter; 12.0% for USGCC and 11.9% for clinician-derived specimens. Improvement in accurate identification of salivary gland, lymph node, soft tissue and thyroid pathology was 27.0%, 21.2%, 18.3% and 15.8% respectively. CONCLUSIONS The common practice of FNA performed by clinicians produces sub-optimal results in head and neck masses. A combined approach of ultrasound-guided fine-needle aspiration of head and neck masses, with immediate assessment of the material by a pathologist, is more accurate than with specimens obtained in other ways. If the results of FNA are to be incorporated into clinical decision making, the samples are best obtained using the USGCC model.
Collapse
Affiliation(s)
- I A Robinson
- Department of Histopathology, Derbyshire Royal Infirmary, Derby, UK
| | | |
Collapse
|
13
|
Pfister DG, Ruchlin HS, Elkin EB. Health services research in head and neck cancer. Cancer Treat Res 1998; 97:159-75. [PMID: 9711416 DOI: 10.1007/978-0-585-30498-4_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- D G Pfister
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | | |
Collapse
|
14
|
Atula TS, Varpula MJ, Kurki TJ, Klemi PJ, Grénman R. Assessment of cervical lymph node status in head and neck cancer patients: palpation, computed tomography and low field magnetic resonance imaging compared with ultrasound-guided fine-needle aspiration cytology. Eur J Radiol 1997; 25:152-61. [PMID: 9283844 DOI: 10.1016/s0720-048x(96)01071-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Since the assessment of lymph node metastases in head and neck cancer patients remains a major problem, the findings of different imaging methods and the role of these methods in the clinical management are compared. MATERIAL AND METHODS Palpation, computed tomography (CT) and low field magnetic resonance imaging (MRI; 0.1 T) are evaluated and compared with ultrasound-guided fine-needle aspiration cytology (US-guided FNAC) prospectively in 105 consecutive patients with a primary cancer in the head and neck region. RESULTS In the subgroup of 86 patients with palpable normal necks, CT showed lymph nodes fulfilling the radiologic criteria for malignancy in 27% (23/86), MRI in 17% (10/60) and US in 14% (12/86) of the patients US guided FNAC usually showed malignancy in necks containing lymph nodes with central necrosis on CT, but the enlarged lymph nodes that were also common on the contralateral side were often benign on cytology. In 5 patients, FNAC under US-guidance showed malignancy although none of them had lymph nodes fulfilling the radiologic criteria for malignancy. In the other subgroup of 19 patients with palpable metastatic necks, 2 patients had bilateral metastases detected by all imaging methods but not by palpation. CONCLUSION CT is superior to low field MRI in depicting small pathologic lymph nodes. Unlike lymph node structure, lymph node size is not a highly reliable criterion for malignancy. The findings must be correlated in relation to the primary disease. Since FNAC under US-guidance offers additional information about enlarged lymph nodes and since it can show malignancy in small lymph nodes not found by other methods, it can be recommended for most head and neck cancer patients irrespective of the use of CT or MRI.
Collapse
Affiliation(s)
- T S Atula
- Department of Otorhinolaryngology, Turku University Central Hospital, Finland
| | | | | | | | | |
Collapse
|
15
|
Maremonti P, Califano L, Longo F, Zupi A, Ciccarelli R, Vallone G. Detection of latero-cervical metastases from oral cancer. J Craniomaxillofac Surg 1997; 25:149-52. [PMID: 9234094 DOI: 10.1016/s1010-5182(97)80006-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
In squamous cell carcinoma of the oral cavity, the presence of nodal metastases greatly influences prognosis. The evaluation of regional lymph nodal involvement is crucial in the correct management of these neoplasms. The records of 45 patients with oral cancer were reviewed retrospectively to evaluate the accuracy and prognostic value of the techniques used to detect lymph node metastasis in the neck (clinical examination, echo-colour-Doppler, computed tomography and magnetic resonance imaging). Echo-colour-Doppler was the most accurate procedure with a predictive positive value of 95.6% and the lowest false-negative rate. Therefore, a diagnostic preoperative study must include echo-colour-Doppler preferably associated with computed tomography to achieve the greatest diagnostic accuracy.
Collapse
Affiliation(s)
- P Maremonti
- Department of Maxillofacial Surgery, School of Medicine and Surgery, Federico II University of Naples, Italy
| | | | | | | | | | | |
Collapse
|
16
|
Fukano H, Matsuura H, Hasegawa Y, Nakamura S. Depth of invasion as a predictive factor for cervical lymph node metastasis in tongue carcinoma. Head Neck 1997; 19:205-10. [PMID: 9142520 DOI: 10.1002/(sici)1097-0347(199705)19:3<205::aid-hed7>3.0.co;2-6] [Citation(s) in RCA: 248] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Many histopathologic parameters in head and neck squamous cell carcinoma have been identified as predictive factors for cervical metastasis. Several studies focused on tumor thickness, and the depth of invasion was suggested to have a relationship to the occurrence of cervical metastasis. Nonetheless, the criterium for elective neck therapy in terms of tumor depth is still inconclusive. Therefore, a retrospective study was undertaken to substantiate the differing results in the literature with our own findings concerning the interrelationship between tumor thickness and clinically suspicious neck, as well as occult neck disease. In addition, the study attempted to identify further predictive factors for cervical metastasis in squamous cell carcinoma of the tongue. METHODS The medical records of 34 primary tongue carcinomas operated without any preoperative therapy between 1980 and 1991 were reviewed. Each patient's tumor type, tumor location, tumor size, invasion mode, depth of invasion, intralymphatic tumor emboli, and perineural invasion were evaluated. Chi-square contingency tables were used to correlate clinical or histopathologic parameters with metastasis in the neck. RESULTS The overall cervical metastatic rate was 35.3% (n = 12/34). In univariate analysis, invasion mode and depth of invasion were statistically significant predictors of regional metastasis at p = 0.0019 and p = 0.0003, respectively. In the group in which tumor depth exceeded 5 mm, the metastatic rate was 64.7% (11/17). In contrast, when the depth of invasion was less than 5 mm, the incidence of cervical metastasis was 5.9% (1/17). Clinically negative necks turned out pathologically positive in 30.0% (n = 9/30). The tumor depth exceeded 5 mm in 43.4% (13/30) of the N0 necks. In the conversion (N0-->N1) group, tumor depth exceeding 5 mm was noted in 88.9% (n = 8/9). CONCLUSIONS We suggest that there is a discerning point at 5 mm of tumor depth at which cervical metastasis is probable. Electric neck therapy (surgery or irradiation) is strongly indicated for tumors exceeding 5 mm invasion. Tumor invasion mode and tumor size also bear an impact on the indication for therapy.
Collapse
Affiliation(s)
- H Fukano
- Department of Head and Neck Surgery, Aichi Cancer Center, Nagoya, Japan
| | | | | | | |
Collapse
|
17
|
Atula T, Silvoniemi P, Kurki T, Varpula M, Grénman R. The evaluation and treatment of the neck in carcinoma of the oral cavity. ACTA OTO-LARYNGOLOGICA. SUPPLEMENTUM 1997; 529:223-5. [PMID: 9288316 DOI: 10.3109/00016489709124128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Locoregional recurrence is the most common cause of failure in the treatment of carcinoma in the oral cavity. The extent of the disease can be evaluated by inspection, endoscopy, palpation, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US). The treatment consists of surgery, radiation, and their combination. The purpose of this study was to evaluate the effect of imaging and active treatment of the neck in patients with oral cancer. Altogether 31 consecutive patients with 32 squamous cell carcinomas in the oral cavity were included. Of the tumors, 5 were T1, 18 were T2, 5 were T3 and 4 were T4. According to CT and US findings, 19 of the patients had a normal lymph node status, whereas 12 patients had enlarged or rim-like enhanced lymph nodes in the neck. Preoperative radiotherapy to the primary site and the neck was given to all except 3 patients. Surgery was carried out in all except 4 patients. A neck dissection was performed in N-positive cases (n = 9) and electively in patients with a high risk of metastases (n = 10). The median follow-up time was 31 months, with the minimum of 11 months, or until death. Seventeen (55%) of the patients experienced a recurrence. In only 1 patient the recurrence appeared initially in the neck, whereas all others had a local recurrence. Later, a distant metastasis was found in 3 patients. The meticulous imaging and active treatment of the neck were successful since only one patient's disease recurred primarily in the neck. The high number of recurrencies at the primary site show the need for intensified therapy.
Collapse
Affiliation(s)
- T Atula
- Department of Otorhinolaryngology, Turku University Central Hospital, Finland
| | | | | | | | | |
Collapse
|
18
|
Atula TS, Grénman R, Varpula MJ, Kurki TJ, Klemi PJ. Palpation, ultrasound, and ultrasound-guided fine-needle aspiration cytology in the assessment of cervical lymph node status in head and neck cancer patients. Head Neck 1996; 18:545-51. [PMID: 8902568 DOI: 10.1002/(sici)1097-0347(199611/12)18:6<545::aid-hed9>3.0.co;2-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Lymph node status of the neck is the most important prognostic factor in head and neck cancer patients. Assessment of the lymph nodes status is still often based on palpation only, although the low accuracy of palpation is known. METHODS Altogether 105 consecutive head and neck cancer patients were examined using ultrasound (US) and ultrasound-guided fine-needle aspiration cytology (FNAC) to evaluate the additional information obtained by these methods. RESULTS Of the 86 patients with palpable normal necks, FNAC taken under US-guidance showed malignancy in 13. The US size criteria for malignancy were fulfilled in 7 of these patients, whereas the lymph nodes were of normal size in 6 of them. In the whole patient material, US-guided FNAC showed bilateral metastasis in 3 patients although only unilateral or no metastasis was found by palpation. CONCLUSION US combined with US-guided FNAC can be recommended as a method for evaluating for regional metastases in head and neck cancer patients, both for those with and those without palpable metastasis.
Collapse
Affiliation(s)
- T S Atula
- Department of Otorhinolaryngology, Turku University Central Hospital, Finland
| | | | | | | | | |
Collapse
|
19
|
Abstract
BACKGROUND Elective treatment of the NO neck in patients with laryngeal cancer remains a controversial issue. We reviewed our experience with patients who had neck dissection for NO laryngeal carcinoma with occult metastases in order to compare elective lymphadenectomy results with those achieved with therapeutic neck dissection performed subsequently when occult disease became clinically evident. METHODS We retrospectively analyzed 150 NO laryngeal cancer patients who after a neck dissection had histologically positive lymph nodes and 5-year minimum follow-up. This population was divided in two subsets, including: 54 NO patients with occult neck metastases who had an elective neck surgery (ED); 96 initially NO patients who had a subsequent therapeutic neck dissection when nodal involvement became clinically detectable (STD). The two groups were compared with respect to the pattern of nodal metastasis and sites of treatment failures and also in terms of absolute, determinate, and actuarial survival. RESULTS Overall absolute survival was 72.2% in the elective dissected (ED) group, compared with 54.1% in the group of subsequent therapeutic dissected (STD) patients (p = 0.075). Determinate survival was 74.0% after ED and 59.3% after STD (p = 0.17). Actuarial curves by the Kaplan-Meier method did not show any statistically significant differences among the two groups analyzed (logrank test, p = 0.54). Accordingly, Cox multivariate analysis confirmed that neck treatment policy had no prognostic impact on survival in our NO laryngeal cancer patients. However, a higher proportion of STD patients died of metastases at distant sites compared with ED patients (21.9% vs 7.4%, respectively) (p = 0.02). CONCLUSIONS Elective lymphadenectomy does not significantly improve survival in NO laryngeal cancer patients with occult disease compared with those undergoing a therapeutic neck dissection when metastases subsequently appear.
Collapse
Affiliation(s)
- O Gallo
- Institute of Otorhinolaryngology Head & Neck Surgery, University of Florence, Italy
| | | | | | | | | |
Collapse
|
20
|
|
21
|
Wennerberg J. Pre versus post-operative radiotherapy of resectable squamous cell carcinoma of the head and neck. Acta Otolaryngol 1995; 115:465-74. [PMID: 7572119 DOI: 10.3109/00016489509139350] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The literature on pre-operative radiotherapy (RT) vs. post-operative RT in patients with advanced, resectable squamous cell carcinoma of the head and neck is reviewed and the theoretical arguments for and against the two different modalities discussed. It was possible to identify eleven reports published during the last four decades (1965-91) evaluating different aspects of pre- vs. post-operative RT given at comparable dose levels. Two reports were of prospective, randomised clinical studies and nine of retrospective comparisons. Together, the eleven studies comprised 1,358 patients (326 in prospective studies). The bulk of the evidence clearly suggests post-operative loco-regional control to be superior to pre-operative RT. However, this seems to be offset by the subsequent development of distant metastases or metachronous tumours.
Collapse
Affiliation(s)
- J Wennerberg
- Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital, Lund, Sweden
| |
Collapse
|
22
|
Gallo O, Boddi V, Bottai GV, Franchi A, Storchi OF. Prognostic significance of clinically false positive cervical lymph nodes in patients with laryngeal carcinoma. Cancer 1995; 75:1077-83. [PMID: 7850704 DOI: 10.1002/1097-0142(19950301)75:5<1077::aid-cncr2820750505>3.0.co;2-a] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND A significant proportion of clinically positive palpable cervical lymph nodes in patients with head and neck cancer are histologically benign. The biologic and prognostic significance of this reactive lymph node enlargement has not been fully clarified. METHODS In this study, the incidence of clinically positive microscopically negative cervical lymph nodes in a series of 902 patients who had neck procedures as a part of their primary treatment for N0-2 laryngeal cancer was analyzed and survival rates of 342 patients with true negative lymph nodes (N0- necks) were compared with those of 106 patients with clinically false positive lymph nodes (N1-2b- necks). In 86 patients with false positive lymph nodes, a histopathologic analysis was performed to determine the histomorphologic pattern of the enlarged lymph nodes and to evaluate which parameters, if any, correlated with 5-year patient survival. RESULTS Overall actuarial survival did not differ significantly in the two groups. However, the actuarial survival curves in the false positive group were clearly better compared with those of the true negative group with more advanced laryngeal cancers, particularly T4 lesions (P < 0.05). Interestingly, the analysis of pattern of recurrence showed a higher incidence of distant metastases in false positive patients with advanced stage laryngeal cancer than in true negative subjects. In addition, the histologic examination of 375 enlarged hyperplastic cervical lymph nodes from 86 neck specimens showed the prevalence of sinus histiocytosis in the false positive group and its favorable prognostic significance. No statistically significant differences with regard to the number and size of enlarged lymph nodes were found. On the contrary, lymph node location seems to have a prognostic impact on survival and the reactive benign enlargement of a digastric lymph node is a possible poor prognostic factor. CONCLUSIONS Survival of patients with clinically false positive, histologically benign hyperplastic cervical lymph nodes who have more advanced laryngeal carcinoma is higher than clinically negative patients, suggesting that the presence of palpable benign nodes may be a sign of the host's immune activation, with favorable prognostic significance.
Collapse
Affiliation(s)
- O Gallo
- Institute of Otolaryngology Head and Neck Surgery, Florence, Italy
| | | | | | | | | |
Collapse
|
23
|
van den Brekel MW, Bartelink H, Snow GB. The value of staging of neck nodes in patients treated with radiotherapy. Radiother Oncol 1994; 32:193-6. [PMID: 7816937 DOI: 10.1016/0167-8140(94)90017-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- M W van den Brekel
- Department of Otorhinolaryngology and Head and Neck Surgery, Free University Hospital, Amsterdam, The Netherlands
| | | | | |
Collapse
|