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Wilkie MD, Emmett MS, Santosh S, Lightbody KA, Lane S, Goodyear PW, Sheard JD, Boyd MT, Pritchard-Jones RO, Jones TM. Relative expression of vascular endothelial growth factor isoforms in squamous cell carcinoma of the head and neck. Head Neck 2015; 38:775-81. [DOI: 10.1002/hed.23959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 10/02/2014] [Accepted: 12/12/2014] [Indexed: 11/06/2022] Open
Affiliation(s)
- Mark D. Wilkie
- Department of Molecular and Clinical Cancer Medicine; Liverpool Cancer Research Centre, University of Liverpool; Liverpool United Kingdom
- Department of Otorhinolaryngology - Head and Neck Surgery; University Hospital Aintree; Liverpool United Kingdom
| | - Maxine S. Emmett
- Department of Molecular and Clinical Cancer Medicine; Liverpool Cancer Research Centre, University of Liverpool; Liverpool United Kingdom
| | - Shilpa Santosh
- Department of Pathology; University Hospital Aintree; Liverpool United Kingdom
| | - Kathryn A. Lightbody
- Department of Otorhinolaryngology - Head and Neck Surgery; University Hospital Aintree; Liverpool United Kingdom
| | - Steven Lane
- Department of Biostatistics; University of Liverpool; Liverpool United Kingdom
| | - Paul W. Goodyear
- Department of Otorhinolaryngology - Head and Neck Surgery; University Hospital Aintree; Liverpool United Kingdom
| | - Jon D. Sheard
- Department of Pathology; University Hospital Aintree; Liverpool United Kingdom
| | - Mark T. Boyd
- Department of Molecular and Clinical Cancer Medicine; Liverpool Cancer Research Centre, University of Liverpool; Liverpool United Kingdom
| | - Rowan O. Pritchard-Jones
- Department of Molecular and Clinical Cancer Medicine; Liverpool Cancer Research Centre, University of Liverpool; Liverpool United Kingdom
| | - Terence M. Jones
- Department of Molecular and Clinical Cancer Medicine; Liverpool Cancer Research Centre, University of Liverpool; Liverpool United Kingdom
- Department of Otorhinolaryngology - Head and Neck Surgery; University Hospital Aintree; Liverpool United Kingdom
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Zohdi I, El Sharkawy LS, El Bestar MF, Abdel Tawab HM, Hamela MA, Hareedy AA. Selective Neck Dissection (IIa, III): A Rational Replacement for Extended Supraomohyoid Neck Dissection in Patients with N0 Supraglottic and Glottic Squamous Cell Carcinoma. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2015; 8:1-6. [PMID: 25733946 PMCID: PMC4327406 DOI: 10.4137/cment.s19874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 11/23/2014] [Accepted: 11/24/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of selective neck dissection of sublevel IIa and level III in cases of glottis and supraglottic laryngeal carcinoma in the absence of lymph node metastasis and to show if there is value in dissecting the sublevel IIb or level IV in these cases. PATIENTS AND METHODS Twenty-five patients with N0 glottic or supraglottic cancer were subjected to unilateral or bilateral selective neck dissection according to the site and the extent of the tumor, and the specimens were histopathologically examined for metastasis. RESULTS Twenty-five patients (23 males and 2 females) with mean age of 55.72 years were included in the study. Lymph node metastasis to sublevel IIa and level III was found in 6/25 (24%) cases with glottic or supraglottic carcinoma, while to sublevel IIb and level IV was found in 1/25 (4%) with P-value of 0.05, which is statistically significant. CONCLUSION Selective neck dissection of level IIb is not required in cases of the supraglottic laryngeal cancer. Dissection of sublevel IIa and level III takes less time and is effective. Dissection of level IV is not needed in the case of supraglottic cancer.
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Affiliation(s)
- Ismail Zohdi
- Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Egypt
| | - Louay S El Sharkawy
- Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Egypt
| | - Mahmoud F El Bestar
- Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Egypt
| | - Hazem M Abdel Tawab
- Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Egypt
| | - Mo'men Aa Hamela
- Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Egypt
| | - Amal A Hareedy
- Department of Pathology, Faculty of Medicine, Cairo University, Egypt
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Matsuzuka T, Suzuki M, Saijo S, Matsui T, Nomoto Y, Ikeda M, Tada Y, Nomoto M, Omori K. Usefulness of sentinel node navigation surgery in the management of early tongue cancer. Auris Nasus Larynx 2014; 41:475-8. [PMID: 24913730 DOI: 10.1016/j.anl.2014.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 04/30/2014] [Accepted: 05/02/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the validity of sentinel node navigation surgery (SNNS) in early stage tongue cancer, the occurrence rate of postoperative cervical metastasis (POCM) after lead plate technique (LPT) introduction and survival rates in patients who underwent SNNS were analyzed. METHODS SNNS was performed in 29 patients (stage I: 14, stage II: 15) from 2000 to 2007. Tc-labeled phytate was prepared as a radiotracer a day before SNNS. The sentinel node (SN) was then examined pathologically during surgery. For cases where metastasis in SN was positive, neck dissection was performed. Occurrence of POCM after LPT introduction was compared with that before LPT introduction. 'Wait and see' policy was performed in 52 patients (stage I: 27, stage II: 25) from 1987 to 1999 as a historical control. The observation period of SNNS cases and 'wait and see' policy cases ranged from 10 months to 165 months (median: 91 months) and from 7 months to 268 months (median: 87 months), respectively. RESULTS Six of the 29 SNNS cases (21%) were proven metastatic SNs. Before LPT introduction, POCM occurred in 2 of the 15 cases, while we had no occurrences after LPT introduction. The 5-year overall survival rate of the 29 patients who underwent SNNS and the 52 patients with 'wait and see' policy were 96% and 84%, respectively, and there was statistical significance in the two groups (p<0.05). CONCLUSIONS As the survival rate of the patients with the SNNS tended to be better than that with the 'wait and see' policy in our cases, SNNS could avoid unnecessary neck dissection. SNNS provides useful information regarding decision-making for neck dissection in early stage tongue cancer.
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Affiliation(s)
- Takashi Matsuzuka
- Department of Otolarynogology, Fukushima Medical University School of Medicine, Japan
| | - Masahiro Suzuki
- Department of Otolarynogology, Fukushima Medical University School of Medicine, Japan
| | - Satoshi Saijo
- Department of Otolarynogology, Fukushima Medical University School of Medicine, Japan
| | - Takamichi Matsui
- Department of Otolarynogology, Fukushima Medical University School of Medicine, Japan
| | - Yukio Nomoto
- Department of Otolarynogology, Fukushima Medical University School of Medicine, Japan
| | - Masakazu Ikeda
- Department of Otolarynogology, Fukushima Medical University School of Medicine, Japan
| | - Yasuhiro Tada
- Department of Otolarynogology, Fukushima Medical University School of Medicine, Japan
| | - Mika Nomoto
- Department of Otolarynogology, Fukushima Medical University School of Medicine, Japan
| | - Koichi Omori
- Department of Otolarynogology, Fukushima Medical University School of Medicine, Japan.
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Immunohistochemistry, a valuable tool in detection of cervical lymph node micrometastases in head and neck squamous cell carcinoma: a prospective study. Indian J Otolaryngol Head Neck Surg 2012; 65:89-94. [PMID: 24427623 DOI: 10.1007/s12070-012-0551-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 03/14/2012] [Indexed: 10/28/2022] Open
Abstract
The regional failure after comprehensive clearance of neck metastasis and consequent pathological report of N0 disease has been reported fairly frequently. The role of recurrence of disease in the neck in the cases has been variously reported by different authors. The light microscopy does not detect the micrometastasis and the specimen is reported negative for metastasis. The presence of micrometastasis (the reason for neck failure) has been reported by many studies as 5-58 % (mean 19.6 %). These figures are significantly high. The present study was done to ascertain the micrometastasis after comprehensive neck clearance (pN0 report). Two groups of patients were included in this study. (1) Group I included patients with N0 necks (80 patients). (2) Group II included Patients with N+ necks (107 patients). We found that 20 % case were reported N0 (Group I) in light microscopy but on immunohistochemistry these were positive for disease. 15 % upstaging was reported in N+ cases (Group 2). Immunohistochemistry has been more sensitive for cancer detection and has significantly changed the tumor staging and its consequent management.
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Preliminary study of indirect CT lymphography-guided sentinel lymph node biopsy in a tongue VX2 carcinoma model. Int J Oral Maxillofac Surg 2009; 38:1268-72. [DOI: 10.1016/j.ijom.2009.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 04/24/2009] [Accepted: 07/13/2009] [Indexed: 11/21/2022]
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Santaolalla >F, Sanchez J, Ereño C, Gonzalez A, Rodriguez M, Sanchez A, Martinez A. Non-sentinel node tumor invasion in oropharyngeal and oral cancer: risk of misdiagnosis of metastasis. Acta Otolaryngol 2008; 128:1159-64. [PMID: 18607950 DOI: 10.1080/00016480801891710] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONCLUSION The existence of patients with positive non-sentinel node indicates a risk of misdiagnosis of metastasis in oropharyngeal and oral cancer. OBJECTIVES We attempted to confirm the usefulness of sentinel lymph node biopsy (SLNB) in oropharyngeal and oral cavity cancer to detect clinically occult metastases. PATIENTS AND METHODS Twenty-two patients with a mean age of 57 (SD=13) years were studied prospectively. All presented T1-T3 squamous cell carcinoma (SCC) of the oropharynx or oral cavity, and were cN0 on palpation and CT. A preoperative (24 h) lymphoscintigraphy was performed with 99mTc-labelled sulfur colloid injected around the primary tumor. Subsequently, we proceeded with tumor exeresis and detection of SLN following the procedures described in a previous paper. RESULTS We detected a total of 32 SLNs in 21 of 22 patients. Ipsilateral neck node location was observed in 18 patients and bilateral in 3. We observed 10 patients with true positive SLNs (3 patients had micrometastases), indicating occult metastases. We harvested a total of 454 nodes in our selective neck dissections, 19 of which presented metastatic invasion. We identified four patients with positive non-sentinel nodes.
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Detection of lymph node micrometastases in patients with squamous carcinoma of the head and neck. Eur Arch Otorhinolaryngol 2008; 265:1147-53. [PMID: 18523794 DOI: 10.1007/s00405-008-0715-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2008] [Accepted: 05/16/2008] [Indexed: 10/22/2022]
Abstract
While the significance of large cervical node metastases in patients with head and neck squamous carcinomas is well established, the import of a finding of regional nodal micrometastases (where a micrometastasis is defined as a metastatic deposit greater than 0.2 mm and not greater than 2.0 mm in greatest dimension) or isolated tumor cells in those patients is less clearly understood. Some earlier investigators have suggested that finding micrometastases does not have an impact on prognosis; some later investigators, however, have taken issue with this position, arguing that finding either micrometastases or isolated tumor cells might portend a poorer prognosis for head and neck cancer patients. At this juncture, it is difficult to advance a single recommendation for handling a finding of micrometastases or isolated tumor cells. It would be helpful if two courses of action were followed: first, while the detection of micrometastases and isolated tumor cells remains an investigatory practice, data should be collected and analyzed with an eye to discerning whether such findings are indeed of significance to the individual head and neck cancer patient. Second, rigorous definitions of micrometastases and isolated tumor cells (such as the definitions suggested here) should be developed and widely employed so as to permit ready comparison between the results as they are reported by different investigators.
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Goudakos JK, Markou K, Nikolaou A, Themelis C, Vital V. Management of the clinically negative neck (N0) of supraglottic laryngeal carcinoma: a systematic review. Eur J Surg Oncol 2008; 35:223-9. [PMID: 18468836 DOI: 10.1016/j.ejso.2008.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 04/01/2008] [Indexed: 10/22/2022] Open
Abstract
AIM The most effective therapeutic approach for patients with supraglottic laryngeal carcinoma (SGLC) and clinically negative neck (cN0) remains a subject of much debate. The purpose of this systematic review was to answer the following question: among patients with SGLC and cN0 neck, are the survival and occurrence of neck metastases significantly different between patients that received neck dissection and those that had another therapeutic treatment (radiotherapy, combined therapy, 'wait and see' policy)? MATERIALS AND METHODS An electronic literature search was performed in MEDLINE, EMBASE, Cochrane Library and CENTRAL databases, followed by extensive hand-searching for the identification of relevant studies. The following inclusion criteria were established: the study should (a) include a comparison of neck dissection with one of the other therapeutic procedures for cN0 of SGLC; (b) report the therapy for the initial supraglottic cancer; and (c) use time-to-event analysis of its results. Six studies were eventually identified and systematically reviewed. RESULTS All studies included in the systematic review were retrospective (n=792 patients). The survival (overall, disease-specific and neck disease-free) and the site of neck recurrence of the patients with N0 supraglottic cancer were not significantly different between patients in the neck dissection treatment group and those of the rest of the therapeutic strategies examined (neck radiotherapy, combined therapy and 'wait and see' policy). CONCLUSIONS The present systematic review highlights the need for further well-designed prospective studies that will provide more reliable answers to the debatable issue of the management of cN0 of SGLC. Currently, based on the best available evidence, it seems that neck dissection is not superior to radiotherapy or combined therapy or a 'wait and see' policy in terms of survival and control of neck disease.
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Affiliation(s)
- J K Goudakos
- 1(st) Department of Otorhinolaryngology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
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Need for intensive histopathologic analysis to determine lymph node metastases when using sentinel node biopsy in oral cancer. Laryngoscope 2008; 118:408-14. [PMID: 18043487 DOI: 10.1097/mlg.0b013e31815d8e15] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To determine the predictive value of sentinel node biopsy (SNB)-assisted neck dissection in patients with oral squamous cell carcinoma (SCC) stage T1 to 2N0M0 and to determine the incidence of subclinical metastases. STUDY DESIGN Prospective cohort study. METHODS Fifty-one patients with clinically N0 neck underwent SNB-assisted neck dissection. The localization of the sentinel node (SN) was determined using dynamic and planar lymphoscintigraphy and single photon emission computed tomography-computed tomography. Histopathologic examination of the harvested SN was performed using step-serial sectioning with hematoxylin-eosin (H&E) and immunohistochemistry on formalin-fixed, paraffin-embedded tissue. RESULTS A total of 181 SNs were excised with a median of 3 (range 1-7) SNs per patient. Four percent (2 of 51) of patients with subclinical (occult) lymph node metastasis would have been identified using routine H&E staining, whereas the 18% (9 of 49) were upstaged as a result of additional histopathology when the H&E evaluation was negative. Overall, the incidence of subclinical metastases was 22% (11 of 51). CONCLUSION In this study, SNB-assisted neck dissection proved to be technically feasible in identifying subclinical metastasis, thus accurately staging the neck with a high degree of sensitivity in patients with oral SCC T1 to 2N0M0 when additional histopathology was performed. The vast majority of patients in this study would have been spared selective neck dissection had reliance on SNB been used and selective neck dissection performed only in the case of a positive SN. Future studies should focus on determining whether SNB alone reduces patient morbidity and whether this is as equally effective in the treatment of cervical nodal metastases as compared with selective neck dissection in patients with oral SCC.
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Xu Y, Zhao X, Guan M, Li B, Zhou Y, Zhou F. Determination of lymph node micrometastases in patients with supraglottic carcinoma. Acta Otolaryngol 2007; 127:1188-95. [PMID: 17851895 DOI: 10.1080/00016480701200327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONCLUSIONS The frequency of loss of heterozygosity (LOH) at D9S 171 microsatellite locus on 9p21 may serve as an available method to evaluate occult micrometastases in laryngeal squamous cell carcinoma. High frequency of LOH was associated with a decreased probability of survival time. OBJECTIVE To explore an available and sensitive method to detect cervical lymph node micrometastases in patients with laryngeal squamous cell carcinoma, the frequency of LOH at D9S171 microsatellite locus on 9p21 was studied. PATIENTS AND METHODS Twenty samples from supraglottic cancer and 182 lymph nodes from neck dissections were examined by LOH comparing immunohistochemical (IHC) staining using cytokeratin 19 (CK19), and hematoxylin and eosin (H&E) staining. The frequency of lymph node metastasis and the clinical relevance were analysed. RESULTS The frequency of LOH was 37.4% of lymph nodes and all of the primary tumors. Occult micrometastases were present in 9 of 20 cases; 23.6% of lymph nodes were positive for CK19 by IHC; 16.5% of lymph nodes were positive by H&E. There was a highly significant difference among the three methods. The highest rate of positive lymph nodes was at level II of the neck. There was a highly significant difference between overall survival time and lymph node metastasis with LOH and CK19 analysis.
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Affiliation(s)
- Yaping Xu
- Department of Otorhinolaryngology, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88# Jie Fang Road, Hangzhou, 310009, Zhejiang, China.
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Zbären P, Nuyens M, Caversaccio M, Stauffer E. Elective neck dissection for carcinomas of the oral cavity: occult metastases, neck recurrences, and adjuvant treatment of pathologically positive necks. Am J Surg 2006; 191:756-60. [PMID: 16720144 DOI: 10.1016/j.amjsurg.2006.01.052] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Revised: 01/08/2006] [Accepted: 01/08/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Supraomohyoid neck dissection (SOHND) is currently performed in patients with carcinoma of the oral cavity with clinically negative neck. Most investigators consider SOHND as a staging procedure. METHODS Records of 100 patients with cancer of the oral cavity and clinically negative neck undergoing SOHND were reviewed. The rate and significance of occult metastases are evaluated, the neck recurrences are analyzed and the indication of adjuvant radiation of pN+ necks is discussed. RESULTS In 34 of 1814 of analyzed lymph nodes, metastatic disease was detected as follows: 30 macrometastases and 4 micrometastases. In 13 of 34 metastases (38%), extracapsular spread was observed. Twenty of 100 patients (20%) had to be upstaged. In 9 of 87 (10%) patients without local recurrence and with a minimal follow-up of 24 months, 5 ipsilateral (4 within the dissection field) and 5 contralateral neck recurrences were observed. Regional recurrence developed in 4% and 35% of patients with pN0 and pN+ necks, respectively. CONCLUSIONS In 20% of patients with oral cavity tumors and pN0 neck, occult metastases were disclosed. Neck recurrences developed significantly more often in patients with pN+ than in those with pN0 necks. To evaluate the exact indication for an adjuvant treatment of patients with cN0/pN+ necks, prospective studies should be performed.
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Affiliation(s)
- Peter Zbären
- Department of Otolaryngology, Head and Neck Surgery, University of Bern, Inselspital CH-3010 Bern, Switzerland.
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Ferlito A, Rinaldo A, Silver CE, Gourin CG, Shah JP, Clayman GL, Kowalski LP, Shaha AR, Robbins KT, Suárez C, Leemans CR, Ambrosch P, Medina JE, Weber RS, Genden EM, Pellitteri PK, Werner JA, Myers EN. Elective and therapeutic selective neck dissection. Oral Oncol 2006; 42:14-25. [PMID: 15979381 DOI: 10.1016/j.oraloncology.2005.03.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Accepted: 03/20/2005] [Indexed: 11/22/2022]
Abstract
Selective neck dissection is a modification of the more comprehensive modified radical or radical neck dissection that is designed to remove only those nodal levels considered to be at risk for harboring nodal metastases. The role of selective neck dissection continues to evolve: while initially designed as a staging and diagnostic procedure for patients without clinical evidence of nodal disease, a growing body of literature suggests that selective neck dissection has a therapeutic role in patients with clinical and histologic evidence of nodal metastases. The rationale behind selective neck dissection, its application in the clinically negative but histologically node-positive neck and the extended application of selective neck dissection in patients with clinical evidence of nodal disease are discussed.
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Affiliation(s)
- Alfio Ferlito
- Department of Surgical Sciences, ENT Clinic, University of Udine, Policlinico Universitario, Piazzale S. Maria della Misericordia, 33100 Udine, Italy.
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Ferlito A, Rinaldo A. Neck dissection: historical and current concepts. Am J Otolaryngol 2005; 26:289-95. [PMID: 16137525 DOI: 10.1016/j.amjoto.2005.01.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2004] [Indexed: 10/25/2022]
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Ross GL, Soutar DS, Gordon MacDonald D, Shoaib T, Camilleri I, Roberton AG, Sorensen JA, Thomsen J, Grupe P, Alvarez J, Barbier L, Santamaria J, Poli T, Massarelli O, Sesenna E, Kovács AF, Grünwald F, Barzan L, Sulfaro S, Alberti F. Sentinel Node Biopsy in Head and Neck Cancer: Preliminary Results of a Multicenter Trial. Ann Surg Oncol 2004; 11:690-6. [PMID: 15197011 DOI: 10.1245/aso.2004.09.001] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim was to determine the reliability and reproducibility of sentinel node biopsy (SNB) as a staging tool in head and neck squamous cell carcinoma (HNSCC) for T1/2 clinically N0 patients by means of a standardized technique. METHODS Between June 1998 and June 2002, 227 SNB procedures have been performed in HNSCC cases at six centers. One hundred thirty-four T1/2 tumors of the oral cavity/oropharynx in clinically N0 patients were investigated with preoperative lymphoscintigraphy (LSG), intraoperative use of blue dye/gamma probe, and pathological evaluation with step serial sectioning and immunohistochemistry, with a follow-up of at least 12 months. In 79 cases SNB alone was used to stage the neck carcinoma, and in 55 cases SNB was used in combination with an elective neck dissection (END). RESULTS In 125/134 cases (93%) a sentinel node was identified. Of 59 positive nodes, 57 were identified with the intraoperative gamma probe and 44 with blue dye. Upstaging of disease occurred in 42/125 cases (34%): with hematoxylin-eosin in 32/125 (26%) and with additional pathological staging in 10/93 (11%). The sensitivity of the technique with a mean follow-up of 24 months was 42/45 (93%). The identification of SNB for floor of mouth (FOM) tumors was 37/43 (86%), compared with 88/91 (97%) for other tumors. The sensitivity for FOM tumors was 12/15 (80%), compared with 30/30 (100%) for other tumor groups. CONCLUSION SNB can be successfully applied to early T1/2 tumors of the oral cavity/oropharynx in a standardized fashion by centers worldwide. For the majority of these tumors the SNB technique can be used alone as a staging tool.
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Affiliation(s)
- Gary L Ross
- Plastic Surgery Unit, Canniesburn Hospital, Bearsden, Glasgow, UK.
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Ross G. Rationale for Sentinel Node Biopsy to Stage N0 Head and Neck Squamous-Cell Carcinoma. Cancer Biother Radiopharm 2004; 19:273-84. [PMID: 15285874 DOI: 10.1089/1084978041424963] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Sentinel node biopsy is an evolving staging tool in the management of patients with squamous-cell carcinoma of the head and neck. This tool provides a more detailed understanding of the lymphatic pathways within the head and neck and the role of these pathways regarding tumor spreading. By targeting nodes that are most likely to harbor disease, a more detailed pathological evaluation of sentinel nodes is possible-thus improving staging by the identification of micrometastases. The rationale behind the use of sentinel node biopsy to stage the N0 neck are discussed within this paper.
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Affiliation(s)
- Gary Ross
- Plastic Surgery Unit, Canniesburn Hospital, Bearsden, Glasgow, Scotland, United Kingdom.
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Rinaldo A, Devaney KO, Ferlito A. Immunohistochemical Studies in the Identification of Lymph Node Micrometastases in Patients with Squamous Cell Carcinoma of the Head and Neck. ORL J Otorhinolaryngol Relat Spec 2004; 66:38-41. [PMID: 15103200 DOI: 10.1159/000077232] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2003] [Accepted: 01/09/2004] [Indexed: 11/19/2022]
Abstract
In the prediction of likely disease-free and overall survival intervals in patients with squamous carcinomas of the head and neck, cervical lymph node status assumes a prime role, and patients with cervical node metastases have diminished survivals, as a group, compared with patients whose cervical nodes are reported as negative for metastatic carcinoma. Conventional means of pathologic examination of cervical node biopsy specimens include examination of a single section through each individual node identified on gross examination, a process which, of necessity, leaves a significant portion of the node unexamined by microscopy. Recently, it has become apparent that more exhaustive pathologic sampling techniques, such as examining multiple sections of each lymph node, or staining each lymph node with antibodies to keratin via immunohistochemistry, will reliably yield a greater incidence of positive cervical lymph nodes ("micrometastases") than do conventional pathologic techniques. This suggests that the next line of inquiry should answer this question: just because micrometastases can be detected, should they be? Does the identification of (otherwise likely to be overlooked) tiny microscopic foci of spread of tumor in regional nodes by more sophisticated techniques yield additional data of real import to the patients, or is such information of lesser value? Should a role be defined in the care of head and neck cancer patients for the use of such advanced inquiries in the structuring of therapies, then the best approach to finding such elusive micrometastases (intraoperative immunohistochemistry? immunohistochemistry using routinely fixed tissues? polymerase chain reaction?) may subsequently be established.
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Affiliation(s)
- Alessandra Rinaldo
- Department of Surgical Sciences, ENT Clinic, University of Udine, Policlinico Universitario, Piazzale S. Maria della Misericordia, IT-33100 Udine, Italy
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Rinaldo A, Ferlito A, Devaney KO. Can the surgeon consistently differentiate intraoperatively benign from malignant lymph nodes? Oral Oncol 2004; 40:361-3. [PMID: 14969814 DOI: 10.1016/j.oraloncology.2003.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2003] [Accepted: 08/11/2003] [Indexed: 11/30/2022]
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Ferlito A, Rinaldo A, Robbins KT, Leemans CR, Shah JP, Shaha AR, Andersen PE, Kowalski LP, Pellitteri PK, Clayman GL, Rogers SN, Medina JE, Byers RM. Changing concepts in the surgical management of the cervical node metastasis. Oral Oncol 2003; 39:429-35. [PMID: 12747966 DOI: 10.1016/s1368-8375(03)00010-1] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Alfio Ferlito
- Department of Otolaryngology-Head and Neck Surgery, University of Udine, Policlinico Universitario, Piazzale S. Maria della Misericordia, I-33100, Udine, Italy.
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19
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Pitman KT, Ferlito A, Devaney KO, Shaha AR, Rinaldo A. Sentinel lymph node biopsy in head and neck cancer. Oral Oncol 2003; 39:343-9. [PMID: 12676253 DOI: 10.1016/s1368-8375(02)00086-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In the past decade, the technique of sentinel lymph node biopsy (SLNB) has been applied to a vast array of primary neoplasms, ranging from head and neck melanoma to vulvar carcinoma. At present, experience with SLNB is greatest in patients with melanoma and breast cancer. In view of the well known complications associated with cervical node dissection, it has been suspected for some time that cervical SLNB, if successful, might reduce the morbidity associated with the definitive care of patients with head and neck cancers. This report assesses the current status of SLNB in the treatment of head and neck cancers; while formal investigations of the efficacy of this technique are recommended, SLNB has not yet been demonstrated to possess the same level of utility seen in SLNB in melanoma and breast cancer patients. As a consequence, the application of SLNB to head and neck cancers remains an experimental technique--one which has not yet acquired the status of the standard of patient care.
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Affiliation(s)
- Karen T Pitman
- Department of Otolaryngology, University of Mississippi Medical Center, Jackson, MS, USA
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20
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MacLennan K, Jose J, Ferlito A, Devaney KO, Robbins KT, Moor J, Rinaldo A. Cervical soft tissue metastases in head and neck cancer. Acta Otolaryngol 2003; 123:336-9. [PMID: 12737287 DOI: 10.1080/00016480310001402] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Kohno N, Ohno Y, Kihara K, Kitahara S, Tamura E, Tanabe T, Kosuda S. Feasibility of sentinel lymph node radiolocalization in neck node-negative oral squamous cell carcinoma patients. ORL J Otorhinolaryngol Relat Spec 2003; 65:66-70. [PMID: 12624511 DOI: 10.1159/000068655] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2002] [Indexed: 11/19/2022]
Abstract
We examined the reliability of the use of lymphoscintigraphy (LS) and a hand-held gamma probe (GP) to identify the sentinel lymph node (SLN), and sequentially determined the feasibility of SLN radiolocalization in clinical neck node-negative oral squamous cell carcinoma (SCC) patients. A radiolabel with the unfiltered (99m)Tc tin colloid was injected submucosally around the primary site followed by LS at 2-hour intervals. Preoperative localization was performed with GP. After en bloc removal of the regional lymphatics, histopathologic results for the nodes were compared with the SLN radiolocalization. The LS and GP counts were well correlated, and there was concordance between SLN and neck node status in 7 of 8 cases (87.5%). We thus considered that our concept in this study was valid in determining the necessity for neck dissection for those node-negative oral SCC patients.
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Affiliation(s)
- Naoyuki Kohno
- Department of Otolaryngology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
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22
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Mira E, Benazzo M, Rossi V, Zanoletti E. Efficacy of selective lymph node dissection in clinically negative neck. Otolaryngol Head Neck Surg 2002; 127:279-83. [PMID: 12402005 DOI: 10.1067/mhn.2002.128601] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy of selective neck dissection (SND) for elective treatment of the clinically negative neck in head and neck squamous cell carcinoma (SCC). METHODS A retrospective review was undertaken on 91 previously untreated patients with T1-4 SCC of oral cavity (23), oropharynx (5), hypopharynx (7), larynx (56), and clinically negative neck (N0), undergoing 126 SND from January 1990 to March 1999 at a single institution. Twenty-five patients received postoperative radiation therapy on the basis of histologic evidence of >2 positive nodes, extracapsular spread (ECS), and/or the presence of advanced primary lesion. RESULTS On pathologic examination the average number of lymph nodes was 20.5 per neck, occult disease was detected in 14 (11.11%) of 126 necks; of necks with positive nodes, 6 (42.85%) of 14 had ECS. The median follow-up was 36 months. Overall recurrence rate (local, regional, and distant) was 12.8% (11 of 91). Recurrent disease developed in the neck of one patient, outside the dissected field. There was no difference in recurrence rate between pN0 and pN+ patients, as well as between pN+ with or without ECS. Overall survival rate was 84% (77 of 91), with a statistically significant difference between pN0 and pN+ necks. CONCLUSION SND seems to be a pragmatic approach that is as effective as comprehensive procedures for staging and treating the clinically negative neck.
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Affiliation(s)
- Eugenio Mira
- Department of Otorhinolaryngology, University of Pavia, and IRCCS Policlinico S Matteo, Italy.
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23
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von Buchwald C, Bilde A, Shoaib T, Ross G. Sentinel node biopsy: the technique and the feasibility in head and neck cancer. ORL J Otorhinolaryngol Relat Spec 2002; 64:268-74. [PMID: 12232473 DOI: 10.1159/000064143] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Management of the clinically N(0) neck in head and neck squamous cell carcinoma is still under debate. Tumour spread to the neck is the most important prognostic factor in head and neck cancer patients. The sentinel node technique comprises the identification of the sentinel node by means of dye or isotope or a combination, and surgical removal followed by histological examination. We have reviewed the preliminary reports indicating that sentinel node identification is technically feasible in head and neck cancer surgery, i.e. in solitary and unilaterally oral and pharyngeal cancer stages T1 and T2 with clinical N(0). However, the existing reports enrole observational studies, thus randomised trials should be considered to gain maximum valid data to prove that sentinel node biopsy has an effect on parameters such as loco-regional control and survival.
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Affiliation(s)
- Christian von Buchwald
- Department of Otolaryngology, Head and Neck Surgery, Rigshospitalet, Copenhagen, Denmark.
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24
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Ferlito A, Robbins KT, Shaha AR, Pellitteri PK, Kowalski LP, Gavilan J, Silver CE, Rinaldo A, Medina JE, Pitman KT, Byers RM. Current considerations in neck dissection. Acta Otolaryngol 2002; 122:323-9. [PMID: 12030584 DOI: 10.1080/000164802753648259] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Alfio Ferlito
- Department of Otolaryngology--Head and Neck Surgery, University of Udine, Italy.
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25
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Ferlito A, Shaha AR, Rinaldo A. The incidence of lymph node micrometastases in patients pathologically staged N0 in cancer of oral cavity and oropharynx. Oral Oncol 2002; 38:3-5. [PMID: 11755814 DOI: 10.1016/s1368-8375(01)00037-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The presence of nodal metastasis in head and neck cancer is an important prognostic factor and crucial in making critical decisions regarding postoperative radiation treatment and follow up. The final documentation of nodal metastasis is still based on routine histopathological evaluation of the lymph nodes in the neck. The newer technologies including immunohistochemistry, molecular analysis and subserial sectioning may increase the detection of lymph node micrometastases in patients pathologically staged N0 in cancer of oral cavity and oropharynx.
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Affiliation(s)
- A Ferlito
- Department of Otolaryngology-Head and Neck Surgery, University of Udine, Policlinico Universitario, Piazzale S. Maria della Misericordia, 33100 Udine, Italy.
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26
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Mamede RC, Figueiredo DL, Mamede FV. Blindness after laryngectomy and bilateral neck dissection in a diabetic patient: case report. SAO PAULO MED J 2001; 119:181-3. [PMID: 11723529 DOI: 10.1590/s1516-31802001000500006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
CONTEXT Neck dissection that accompanies resection of the primary lesion in malignant tumors of the upper aerodigestive tracts may cause complications inherent to the procedure or to prolongation of surgical time, increasing the risks for the patient. Among the complications that might occur is blindness, a rare complication with only 10 cases reported in the literature thus far. OBJECTIVE To present the case of a diabetic patient submitted to total laryngectomy and modified and selective neck dissection that resulted in blindness. CASE REPORT The authors report on a patient submitted to total laryngectomy and selective neck dissection on the left side, and modified radical neck dissection on the right, who developed blindness. This was probably due to intraoperative hypotension plus the contribution of decompensated diabetes mellitus and thrombosis of the internal jugular vein on the right side. The possible causes, risk factors and care to be taken to prevent this rare but highly debilitating complication are discussed.
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Affiliation(s)
- R C Mamede
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.
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27
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Ferlito A, Partridge M, Brennan J, Hamakawa H. Lymph node micrometastases in head and neck cancer: a review. Acta Otolaryngol 2001; 121:660-5. [PMID: 11678163 DOI: 10.1080/00016480152583584] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- A Ferlito
- Department of Otolaryngology--Head and Neck Surgery, University of Udine, Italy.
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28
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Ferlito A, Shaha AR, Buckley JG, Rinaldo A. Selective neck dissection for hypopharyngeal cancer in the clinically negative neck: should it be bilateral? Acta Otolaryngol 2001; 121:329-35. [PMID: 11425196 DOI: 10.1080/000164801300102671] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- A Ferlito
- Department of Otolaryngology-Head and Neck Surgery, University of Udine, Italy.
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