Detection of lymph node micrometastases in patients with squamous carcinoma of the head and neck

Ferlito, Alfio; Rinaldo, Alessandra; Devaney, Kenneth O.; Nakashiro, Koh‐ichi; Hamakawa, Hiroyuki

doi:10.1007/s00405-008-0715-8

Cited by 50 publications

(30 citation statements)

References 58 publications

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“…On the other hand, the presence of micrometastases is clinically significant (8,(18)(19)(20). Nieuwenhuis et al found that the survival of patients with cN0 but with one or more micrometastases (detected by molecular analysis) was worse compared to patients without micrometastases (10).…”

Section: Discussionmentioning

confidence: 99%

“…However, if a lymph node is examined only by one central section, micrometastases, which are typically localized in the subcapsular sinuses of lymph nodes, are likely missed (7). For this reason, it is very difficult to diagnose micrometastases by routine histopathological examinations (6,8). Many authors state significantly increased detection rate of micrometastases by examining serial histological sections in combination with immunohistochemical or molecular procedures (5, 9-11).…”

Section: Discussionmentioning

confidence: 99%

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Detection of Cervical Lymph Node Micrometastases in Patients with Squamous Cell Carcinoma of the Oral Cavity, Pharynx and Larynx

Čelakovský

Kalfeřt

Smatanová

et al. 2015

Acta Med. (Hradec Kralove, Czech Repub.)

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Summary:Background: The goal of this prospective study was to determine the frequency of micrometastases in patients with squamous cell carcinoma (SCC) of the oral cavity, pharynx and larynx in whom elective neck dissection was indicated (cN0). Patients and Methods: A total of 12 patients (10 males and 2 females) were enrolled in the study. The age ranged 42-73 years (median 62 years). Elective neck dissection was performed in all patients (8 ipsilateral, 4 bilateral) and a total of 256 lymph nodes were removed and sent for microscopic examination. Results: The presence of tumor cells in cervical lymph nodes was found in 5/12 (42%) patients. Micrometastases of SCC were found in two patients and isolated tumor cells (ITC) in two other patients. In the remaining one patient with oropharyngeal SCC, a micrometastasis of papillary thyroid carcinoma (PTC) was detected. Positive lymph nodes were localized in level II in three patients with SCC of larynx, hypopharynx and tongue base, respectively, in level I in one patient with SCC of oral tongue and in level III in one patient with PTC. Conclusion: Our results indicate that SCC of head and neck has a high potential for creating micrometastases which frequency is higher compared to clinically detected macrometastases. Therefore, elective neck dissection or radiotherapy of the neck should be considered in patients with high risk of occult metastases or micrometastases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Detection of Cervical Lymph Node Micrometastases in Patients with Squamous Cell Carcinoma of the Oral Cavity, Pharynx and Larynx

Čelakovský

Kalfeřt

Smatanová

et al. 2015

Acta Med. (Hradec Kralove, Czech Repub.)

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“…These diagnostic criteria do not, however, permit detection of micrometastases [19,20], which are defined as tumours of less than 2 mm at nodal sites [21]. Advances in molecular biology have improved diagnostics that were previously based on immunohistochemical procedures with a sensitivity of only 5-58% (average = 19.6%) [20]. Micrometastases are not infrequent with head and neck SCCs [19], and their reported occurrence in the oral cavity is 21.9% [22].…”

Section: Discussionmentioning

confidence: 99%

“…The current approach to carcinomas of the maxilla is to base nodal staging on a series of clinical and radiological parameters. These diagnostic criteria do not, however, permit detection of micrometastases [19,20], which are defined as tumours of less than 2 mm at nodal sites [21]. Advances in molecular biology have improved diagnostics that were previously based on immunohistochemical procedures with a sensitivity of only 5-58% (average = 19.6%) [20].…”

Section: Discussionmentioning

confidence: 99%

Can Early Dissection of Cervical Lymph Nodes Improve Prognosis in Squamous Cell Carcinomas of the Hard Palate

Deneuve

Bodard

Delquignies

et al. 2017

ORL

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Squamous cell carcinomas of the hard palate and maxillary alveolar ridge are rare tumours with a poor prognosis. Lymph node dissection is recommended for tumours with nodal involvement, and is rarely performed in the absence of adenopathy. We report a series of patients with squamous cell carcinomas and evaluate the rate of lymph node invasion and its impact on survival. This is a retrospective study of 72 patients treated for squamous cell carcinoma of the hard palate and maxillary alveolar ridge between January 1, 1998 and December 31, 2008 in two cancer centres. Using clinical and radiological assessment, tumours were classified as T1-T2 in 25 patients (34.7%) and T3-T4 in 47 patients (65.3%). At diagnosis, 16 (22.2%) patients had clinical and/or radiological nodal involvement and 7 patients (9.7%) distal metastasis. Among N0 patients, 13 (18%) experienced isolated lymph node recurrence. Two-year global survival was 60%; 5-year survival was 34%. The rate of lymph node invasion observed in squamous cell carcinoma of the hard palate and maxillary alveolar ridge does not differ from other oral cavity sites. Because nodal recurrence worsens the prognosis of such a patient, lymph node dissection should be considered at an early stage, even among N0 patients.

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“…In order to standardize the definitions of these terms, it is suggested that the same definition already in use for breast carcinomas should be applied to HNSCC, namely, micrometastases are tumor metastases that are between 0.2 mm and 2.0 mm in greatest dimension while isolated tumor cells are groups of tumor cells that are less than 0.2 mm in greatest dimension (Fig. 3); [13].…”

Section: Micrometastasesmentioning

confidence: 99%

Current State of Neck Dissection in the United States

Seethala

2009

Head and Neck Pathol

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The status of the cervical lymph nodes is the most important prognosticator in head and neck squamous cell carcinoma. The neck dissection is both a therapeutic and staging procedure and has evolved to include various types with standardized level designations (I-VI) for lymph node groups: the radical neck dissection, modified radical neck dissection, the selective neck dissection, and the extended neck dissection. The gross and histologic examination of a neck dissection should provide the critical information (size of metastasis, number of lymph nodes involved) for staging purposes. Additionally, extracapsular spread of lymph node metastasis must be reported because of its significance as an adverse prognosticator. Current dilemmas in nodal disease are the detection of micrometastases, isolated tumor cells, and molecular positivity. The significance of these categories of disease is still unclear, though they may explain a subset of the estimated 10% of the regional recurrences in the neck despite pathologic node negativity by traditional methods of evaluation. Sentinel lymph node biopsy has been recently applied to head and neck squamous cell carcinoma to enhance the management of the clinicoradiographically node negative patients. While still investigational, sentinel lymph node biopsy shows promise in selecting patients who require a neck dissection. Rapid highly automated real-time RT-PCR based platforms will allow for incorporation of molecular findings into the intraoperative evaluation of a sentinel lymph node.

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Detection of lymph node micrometastases in patients with squamous carcinoma of the head and neck

Cited by 50 publications

References 58 publications

Detection of Cervical Lymph Node Micrometastases in Patients with Squamous Cell Carcinoma of the Oral Cavity, Pharynx and Larynx

Detection of Cervical Lymph Node Micrometastases in Patients with Squamous Cell Carcinoma of the Oral Cavity, Pharynx and Larynx

Can Early Dissection of Cervical Lymph Nodes Improve Prognosis in Squamous Cell Carcinomas of the Hard Palate

Current State of Neck Dissection in the United States

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