Advances in diagnostic modalities to detect occult lymph node metastases in head and neck squamous cell carcinoma

Abstract

Regional metastasis is a prominent feature of head and neck squamous cell carcinoma (HNSCC) and is an important prognostic factor. The currently available imaging techniques for assessment of the neck have limitations in accuracy; thus, elective neck dissection has remained the usual choice of management of the clinically N0 neck (cN0) for tumors with significant (≥20%) incidence of occult regional metastasis. As a consequence, the majority of patients without regional metastasis will undergo unnecessary treatment. The purpose of this review was to discuss new developments in techniques that potentially improve the accuracy of the assessment of the neck in patients with HNSCC. Although imaging has improved in the last decades, a limitation common to all imaging techniques is a lack of sensitivity for small tumor deposits. Therefore, complementary to improvements in imaging techniques, developments in more invasive diagnostic procedures, such as sentinel node biopsy (SNB) will add to the accuracy of diagnostic algorithms for the staging of the neck.

High-risk cutaneous squamous cell carcinoma and the emerging role of sentinel lymph node biopsy: A literature review

“…3 Although identifying patients with a clinically N0 neck who may have microscopic involvement would allow appropriate regional treatment and reduce the risk of nodal relapse, current investigations (mainly radiologic) add little to the clinical examination, having a relatively low sensitivity for identifying subclinically involved lymph nodes. 16,33 Sentinel lymph node (SLN) biopsy (SLNB) provides a minimally invasive analysis of the nodal basin when there is not clinical or radiological suspicion of involved lymph nodes. SLNB is routinely performed in cutaneous melanoma 34,35 and breast cancer.…”

Fusion of Freehand SPECT and Ultrasound to Perform Ultrasound-Guided Fine-Needle Aspiration Cytology of Sentinel Nodes in Head and Neck Cancer

“…Clinical staging by palpation is typically followed by imaging with CT, MR imaging, positron-emission tomography, ultrasound (US), and/or ultrasound-guided fine-needle aspiration cytology (USgFNAC). 1,2 USgFNAC is the most reliable of these diagnostic techniques, with a sensitivity of 48%-73% and a specificity approaching 100%. 2 In an attempt to select the lymph nodes most likely to contain metastases, the sentinel node (SN) concept has been introduced.…”

“…1,2 USgFNAC is the most reliable of these diagnostic techniques, with a sensitivity of 48%-73% and a specificity approaching 100%. 2 In an attempt to select the lymph nodes most likely to contain metastases, the sentinel node (SN) concept has been introduced. Sentinel node biopsy (SNB) is a diagnostic staging procedure that is applied in a variety of tumor types, including head and neck skin cancers and oral squamous cell carcinoma (OSCC).…”

Tumor classification with MALDI-MSI data of tissue microarrays: A case study

“…Tumor profiling with biomarkers has recently shown promising results [13,14]. A validated gene expression profile accurately predicted the absence of nodal metastasis in 89% of the patients.…”