A complete magnetic sentinel lymph node biopsy procedure in oral cancer patients: A pilot study

Nieuwenhuis, Eliane R.; Kolenaar, Barry; Bemmel, Alexander J.M. van; Hof, Jurrit J.; Baarlen, Joop van; Christenhusz, Anke; Pouw, Joost Jacob; Haken, Bernard ten; Alic, Lejla; Bree, Remco de

doi:10.1016/j.oraloncology.2021.105464

Cited by 10 publications

(14 citation statements)

References 16 publications

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“…A magnetic SLNB is proposed as an alternative for a radioactive SLNB in, e.g., breast cancer [10,11], prostate cancer [12], and, more recently, for thyroid carcinoma [13] and oral cancer [14,15]. The magnetic SLNB utilizes a magnetic tracer (superparamagnetic iron oxide (SPIO) nanoparticles) and a magnetometer.…”

Section: Introductionmentioning

confidence: 99%

“…Injected tracer can be used for preoperative SPIO-enhanced magnetic resonance imaging (MRI) to visualize and identify the location of LNs with iron uptake [16,17]. Simultaneously, SPIOs are also used for intraoperative detection of SLNs by a magnetometer [10][11][12][13][14][15]. What should be considered is the difference in SPIO-sensitivity between MRI and the magnetometer [18].…”

Section: Introductionmentioning

confidence: 99%

“…Since a magnetic SLNB procedure in oral oncology was recently shown to be feasible [14,15], it raises the question of whether it is possible to develop a comprehensive grading system. This grading system could be based on a combination of preoperative MRI, intraoperative LN detection and post-operative histopathology.…”

Section: Introductionmentioning

confidence: 99%

“…This grading system could be based on a combination of preoperative MRI, intraoperative LN detection and post-operative histopathology. In the complex anatomy of the head and neck area, a grading system should be of help in discriminating SLNs from higher echelon nodes and determining the effect of signal voids in SPIO-enhanced MRI [15]. Furthermore, determination of the amount of iron within excised magnetic SLNs gives insight into what is still detectable and how much of the injected dose drains to SLN(s).…”

Section: Introductionmentioning

confidence: 99%

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A Comprehensive Grading System for a Magnetic Sentinel Lymph Node Biopsy Procedure in Head and Neck Cancer Patients

Nieuwenhuis

Kolenaar

Hof

et al. 2022

Cancers

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A magnetic sentinel lymph node biopsy ((SLN)B) procedure has recently been shown feasible in oral cancer patients. However, a grading system is absent for proper identification and classification, and thus for clinical reporting. Based on data from eight complete magnetic SLNB procedures, we propose a provisional grading system. This grading system includes: (1) a qualitative five-point grading scale for MRI evaluation to describe iron uptake by LNs; (2) an ex vivo count of resected SLN with a magnetic probe to quantify iron amount; and (3) a qualitative five-point grading scale for histopathologic examination of excised magnetic SLNs. Most SLNs with iron uptake were identified and detected in level II. In this level, most variance in grading was seen for MRI and histopathology; MRI and medullar sinus were especially highly graded, and cortical sinus was mainly low graded. On average 82 ± 58 µg iron accumulated in harvested SLNs, and there were no significant differences in injected tracer dose (22.4 mg or 11.2 mg iron). In conclusion, a first step was taken in defining a comprehensive grading system to gain more insight into the lymphatic draining system during a magnetic SLNB procedure.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Comprehensive Grading System for a Magnetic Sentinel Lymph Node Biopsy Procedure in Head and Neck Cancer Patients

Nieuwenhuis

Kolenaar

Hof

et al. 2022

Cancers

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“…However, nearly 70% of early stage OSCC patients undergo unnecessary neck dissection [ 5 ]. The sentinel lymph node biopsy has aroused great attention for its considerable sensitivity to detect metastasis in lymph nodes during surgery, thus helping surgeons make personalized operation plan [ 6 , 7 ]. Many researchers now have used molecular biomarkers for LNM prediction.…”

Section: Introductionmentioning

confidence: 99%

The neuropeptide calcitonin gene-related peptide links perineural invasion with lymph node metastasis in oral squamous cell carcinoma

et al. 2021

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Objective Although perineural invasion (PNI) is well-known to be correlated with and able to predict lymph node metastasis (LNM) in oral squamous cell carcinoma (OSCC), the clinical and molecular correlation between PNI and LNM has not been elucidated, and preoperative biomarkers for LNM prediction in OSCC are urgently needed. Materials and methods The correlation between PNI and LNM was retrospectively evaluated using a cohort of 218 patients diagnosed with OSCC. Candidate neuropeptides were screened based on TCGA database and verified via immunohistochemistry and Western blot analyses. ELISA was used to detect calcitonin gene-related peptide (CGRP) in patient plasma. In vitro assays were used to explore the effects of CGRP on OSCC cells. Results OSCC patients with PNI had a higher incidence of LNM (69.86% vs. 26.2%, P < 0.0001, n = 218). CGRP expression was upregulated in the PNI niche and in metastatic lymph nodes, and was correlated with poor overall survival of OSCC patients. Preoperative plasma CGRP levels were higher in OSCC patients (n = 70) compared to healthy donors (n = 60) (48.59 vs. 14.58 pg/ml, P < 0.0001), and were correlated with LNM (P < 0.0001) and PNI (P = 0.0002). Preoperative plasma CGRP levels alone yielded an AUC value of 0.8088 to predict LNM, and CGRP levels combined with preoperative T stage reached an AUC value of 0.8590. CGRP promoted proliferation and migration abilities of OSCC cells, which could be antagonized by either pharmacological or genetic blockade of the CGRP receptor. Conclusions The neuropeptide CGRP links PNI and LNM in OSCC, and preoperative plasma CGRP levels can be used to predict LNM in OSCC.

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Step Serial Sectioning in Head and Neck Squamous Cell Carcinoma of Unknown Primary

Hardman,

Harrington,

O’Leary

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportancePatients with suspected head and neck squamous cell carcinoma of unknown primary (HNSCCUP) may undergo tonsillectomy and tongue base mucosectomy (TBM) to help identify clinicoradiologically occult primary disease. It is hypothesized that when these diagnostic specimens are analyzed, conventional histopathological (CH) techniques risk missing small primary tumors that may be hidden in the tissue blocks.ObjectiveTo establish the outcomes of a step serial sectioning (SSS) histopathological technique vs CH when analyzing diagnostic tissue specimens from TBM and tonsillectomy performed for HNSCCUP.Design, Setting, and ParticipantsThe MOSES prospective multicenter noninterventional cohort study was conducted over a 25-month period from November 2019 at secondary and tertiary care ear, nose, and throat departments in the United Kingdom and included adults with clinicoradiologically occult HNSCCUP who were undergoing TBM.InterventionConventional histopathological techniques performed on TBM and tonsillectomy specimens at participating centers, followed by SSS performed at the central laboratory.Main OutcomeIdentification of cancer on central histopathological review of TBM and tonsillectomy specimens.ResultsTissue from 58 eligible patients was analyzed (median [range] age, 58 [47-82] years; 10 women [17%]), with 20 480 sections cut in the laboratory and 4096 sections directly examined by a pathologist (median [range], 64 [28-135] per patient). The overall identification rate for TBM following SSS according to study protocol was 50.0% (95% CI, 37.5%-62.5%) and by subgroups was 42.9% (95% CI, 21.4%-67.4%) when performed following a negative bilateral tonsillectomy, 46.7% (95% CI, 24.8%-69.9%) at the same time as bilateral tonsillectomy, and 57.1% (95% CI, 36.5%-75.5%) following historic tonsillectomy. Conventional histopathological techniques at central review identified 2 undiagnosed primary tumors and revised the diagnosis of 2 other cases (1 nonmalignant and another down staged). Step serial sectioning identified a single additional tumor: an ipsilateral synchronous tongue base tumor for which a contralateral tumor had been identified on CH. Multifocal disease was seen in 5 (8.6%); all were human papillomavirus–related and in the tongue base.Conclusions and RelevanceIn this multicenter cohort study of patients undergoing TBM for HNSCCUP, SSS was associated with added considerable histopathological workload with minimal additional diagnostic benefit. A second opinion for conventional histological techniques may be more beneficial. Synchronous primary disease should be considered when planning diagnostic oropharyngeal surgery for these patients.

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A complete magnetic sentinel lymph node biopsy procedure in oral cancer patients: A pilot study

Cited by 10 publications

References 16 publications

A Comprehensive Grading System for a Magnetic Sentinel Lymph Node Biopsy Procedure in Head and Neck Cancer Patients

A Comprehensive Grading System for a Magnetic Sentinel Lymph Node Biopsy Procedure in Head and Neck Cancer Patients

The neuropeptide calcitonin gene-related peptide links perineural invasion with lymph node metastasis in oral squamous cell carcinoma

Step Serial Sectioning in Head and Neck Squamous Cell Carcinoma of Unknown Primary

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