Detection of occult carcinomatous diffusion in lymph nodes from head and neck squamous cell carcinoma using real-time RT–PCR detection of cytokeratin 19 mRNA

Abstract

The aim of the present study was to evaluate the occult lymph node carcinomatous diffusion in head and neck squamous cell carcinoma (HNSCC). A total of 1328 lymph nodes from 31 patients treated between 2004 and 2005 were prospectively evaluated by routine haematoxylin -eosin -safran (HES) staining, immunohistochemistry (IHC) and real-time Taqman reverse -transcriptase polymerase chain reaction (real-time RT -PCR) assay. Amplification of cytokeratin 19 (CK19) mRNA transcripts using real-time RT -PCR was used to quantify cervical micrometastatic burden. The cervical lymph node metastatic rates determined by routine HES staining and real-time RT -PCR assay were 16.3 and 36.0%, respectively (Po0.0001). A potential change in the nodal status was observed in 13 (42.0%) of the 31 patients and an atypical pattern of lymphatic spread was identified in four patients (12.9%). Moreover, CK19 mRNA expression values in histologically positive lymph nodes were significantly higher than those observed in histologically negative lymph nodes (Po0.0001). These results indicate that real-time RT -PCR assay for the detection of CK19 mRNA is a sensitive and reliable method for the detection of carcinomatous cells in lymph nodes. This type of method could be used to reassess lymph node status according to occult lymphatic spread in patients with HNSCC.

Diagnostic potential of 1‐step nucleic acid amplification assay in patients with head and neck squamous cell carcinoma based on CK19 expression in a primary lesion

“…The CK19‐positive rate in cancerous tissue of patients with oral squamous cell carcinoma was 91% detected using immunohistochemistry . It is considered to be a highly sensitive and useful marker for detecting lymph node metastasis in various types of cancer, including head and neck squamous cell carcinoma …”

“…26 It is considered to be a highly sensitive and useful marker for detecting lymph node metastasis in various types of cancer, including head and neck squamous cell carcinoma. 27,28 This protein is expressed in most, but not all, breast cancer cases. Although the 1-step nucleic acid amplification assay has proven useful in breast cancer, this prevalent expression of CK19 suggests there is a risk of false negative results by the 1-step nucleic acid amplification assay when testing CK19-negative patients who have breast cancer 10 and, similarly, those with head and neck squamous cell carcinoma.…”

Detection of micrometastasis in lymph nodes of oral squamous cell carcinoma: A comparative study

“…[5] Micrometastases represent tumor deposits measuring less than 2 mm in diameter. As histopathological analysis of neck dissection specimens is usually performed on several 3-4-μm sections from each lymph node, micrometastases can be easily missed on routine light microscopy.…”

Prognostic impact of lymph node micrometastasis in oral and oropharyngeal squamous cell carcinomas

“…This variability in clinical behavior has led to numerous studies on the relationships between the clinical, pathological, and, more recently, the molecular factors associated with tumor aggressiveness. Because metastatic lymph nodes are a major prognostic factor in oral and oropharyngeal SCCs, detection of occult cancer cells undetected by routine histopathology may identify N0 patients at high risk of recurrence, as has already been shown in other solid tumors …”

“…Because metastatic lymph nodes are a major prognostic factor in oral and oropharyngeal SCCs, detection of occult cancer cells undetected by routine histopathology may identify N0 patients at high risk of recurrence, as has already been shown in other solid tumors. [2][3][4][5] Routine histopathological examination easily overlooks micrometastatic tumor deposits within neck nodes of patients with head and neck SCC, consequently resulting in underestimation of the actual occult metastasis rate. 6 It has been reported that micrometastasis occurs in 3% to 7% of nodes and 9% to 22% of patients with clinically N0 necks.…”