Does Tumor Depth Affect Nodal Upstaging in Squamous Cell Carcinoma of the Head and Neck?

Alkureishi, Lee W. T.; Ross, Gary; Shoaib, Taimur; Soutar, David S.; Robertson, Andrew G.; Sørensen, Jens Ahm; Thomsen, Jørn Bo; Krogdahl, Annelise; Álvarez, Julio; Barbier, Luis; Santamaría, Joseba; Poli, Tito; Sesenna, Enrico; Kovács, Adorján F.; Grünwald, Frank; Barzan, Luigi; Sulfaro, Sandro; Alberti, Franco

doi:10.1097/mlg.0b013e31815e8bf0

Cited by 60 publications

(57 citation statements)

References 25 publications

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“…Statistical analysis with ROC curves clearly showed that neither of the two values (tumor depth or tumor thickness) can be used as a reliable predictor for occult disease. This result not only stands in contradiction to the previously published results in the context of elective neck dissection, but also in contradiction to the reports in the context of SNB by Alkureishi et al and Bilde et al 47,48 In the study by Alkureishi et al tumors up to stage T 4 and oropharyngeal tumors with significantly higher values of tumor depth were included. 48 The mean tumor depth was 7.85 mm with a wide range of 1-28 mm, whereas the corresponding values in our study achieved 6.45 mm and 0.72-15.15 mm, respectively.…”

Section: Discussioncontrasting

confidence: 54%

“…47 This is in contrast to the report of Alkureishi et al, who found a correlation between T stage and the occurrence of nodal disease. 48 However, in their study larger tumors staged from T 1 to T 4 and tumors arising from the oropharynx were included. Their figures show a risk of upstaging by SNB for T 1 and T 2 tumors of approximately 30% and 50%, and for T 3 and T 4 tumors of approximately 75% and 80%, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Clinical and Histomorphological Parameters as Potential Predictors of Occult Metastases in Sentinel Lymph Nodes of Early Squamous Cell Carcinoma of the Oral Cavity

2009

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Background. Sentinel node biopsy (SNB) for cN0 early squamous cell carcinoma (SCC) of the oral cavity has been validated by numerous studies. Around 30% of SNB will detect occult disease. Several clinical and morphological features of the primary tumor have been claimed to be predictive for occult metastasis in elective neck dissections. The aim of this study was to assess these factors in the context of SNB. Methods. Seventy-eight patients undergoing SNB for T 1/2 oral SCC from the years 2000 to 2007 were prospectively included. Primary tumors were reviewed for the following morphological and clinical parameters: grade of differentiation, tumor depth, tumor thickness, perineural invasion, lymphatic invasion, vascular invasion, muscle invasion, lymphoplasmacytic infiltration, and mode of invasion, age, gender, primary tumor site, tumor side, and cT category. Results. Statistical analysis revealed significance to predict occult metastasis in the SNB for grade of differentiation (P = 0.002), lymphatic invasion (P \ 0.001), and mode of invasion (P \ 0.001). None of the other factors reached significance. The mean tumor depth was 6.45 mm (range 0.72-15.15 mm) and the mean tumor thickness was 7.2 mm (range 0.72-15.15 mm). None of the cutoff values reached significance for predicting occult disease. Conclusions. Tumor depth and tumor thickness failed to achieve statistical significance for prediction of occult metastases in the context of SNB. Patients with cN0 early squamous cell carcinoma of the oral cavity should be offered SNB regardless of their tumor depth and thickness. Poorly differentiated carcinomas, carcinomas with lymphangiosis, and carcinomas with a dissolute mode of invasion show a high probability of positive SNB. Lymph node metastases have been shown to be the strongest prognosticator in head and neck squamous cell carcinoma (HNSCC). The 5-year survival drops considerably from 63-86% in patients with no nodal involvement to 20-36% in patients with lymph node metastases. [1][2][3][4] Whereas therapeutic neck dissection in patients with overt lymph node involvement is considered standard of care, there still exists controversy with regard to elective treatment of the clinically negative neck. Though the benefit of elective neck dissection versus wait-and-see with therapeutic neck dissection in case of nodal relapse has never been proven in large randomized trials, most centers around the world favor an active policy in these situations. The rationale for this lies in the high prevalence of occult disease found on routine elective neck dissection. However, although 20-30% of clinically N0 patients will show occult metastases on elective neck dissection, a considerably large number of patients will remain pathologically N0, and therefore do not benefit from the surgical intervention. 5,6 During the last decade sentinel node biopsy (SNB) has been adopted from the treatment of breast cancer and melanoma, and successfully introduced in the treatment regimen of early oral and oropharyngeal squamous cel...

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Evaluation of Clinical and Histomorphological Parameters as Potential Predictors of Occult Metastases in Sentinel Lymph Nodes of Early Squamous Cell Carcinoma of the Oral Cavity

2009

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“…Currently, many studies have demonstrated a good correlation between depth of tumor invasion and the presence of occult lymph node metastasis, prompting many institutions to adopt depth of invasion as an indicator for necessity of lymph node dissection. However, these aforementioned studies have used several different cut-off points for depth of invasion, ranging from 1.5 to 10 mm [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. The studies also report differing methods of measurement, thus further complicating the issue.…”

Section: Introductionmentioning

confidence: 99%

Muscle Invasion in Oral Tongue Squamous Cell Carcinoma as a Predictor of Nodal Status and Local Recurrence: Just as Effective as Depth of Invasion?

Chandler

Vance

Budnick

et al. 2011

Head and Neck Pathol

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Tumor depth of invasion (DOI) is a histologic feature that consistently correlates with lymph node metastasis; however, there are many difficulties with accurately assessing DOI. The aim of this study was to identify a simpler and more reproducible method of determining DOI, by using skeletal muscle invasion as a surrogate marker of depth. Oral tongue squamous cell carcinoma American Joint Committee on Cancer (AJCC) stage T1 cases were identified in the Emory University Department of Pathology database. 61 cases, with a minimum of 2 years of follow-up, were included in the study. Cases were examined histologically to assess muscle invasion and DOI. The two methods of measurement were analyzed to determine the positive predictive value (PPV) of DOI or muscle invasion for both nodal disease and local recurrence. Cases with muscle invasion had a 23.3% PPV of occult lymph node metastasis. Cases with DOI of greater than 3 mm had a 29.7% PPV of occult lymph node metastasis. Cases with muscle invasion had a 43.7% PPV of local tumor recurrence. Cases with maximum DOI of greater than 3 mm had a 40.4% PPV of tumor recurrence. Although the PPV of muscle invasion in regards to nodal status was slightly less than DOI, it represents a more easily reproducible parameter which could guide surgeons in determining if the case warrants an elective neck dissection in a cN0 (clinically negative) neck. Interestingly, the PPV of local recurrence was higher with muscle invasion than DOI, and may represent an important indicator for extent of resection.

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“…A few studies have shown that tumor thickness has similar prognostic value in head and neck cancers, such as buccal, soft palate and laryngeal carcinoma [8][9][10]. In tongue cancer, some studies [4,[11][12][13][14][15][16] suggested that the depth of invasion was associated with neck metastasis and affected nodal up staging. The increasing depth of invasion might determine the proximity to the vascular and lymphatic systems of tongue, thus facilitating the tumor's ability to metastasis.…”

Section: Introductionmentioning

confidence: 97%

MRI-derived tumor thickness: an important predictor of outcome for T4a-staged tongue carcinoma

Chen

et al. 2011

Eur Arch Otorhinolaryngol

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The objectives of this paper are to evaluate the heterogeneity of magnetic resonance imaging (MRI)-derived tumor thickness within tumors of the same T4a-staged tongue carcinoma and to elucidate the effects of tumor thickness on treatment outcomes. A sequential and prospectively maintained head and neck cancer database was retrospectively searched for newly diagnosed tongue carcinoma treated with surgery between 2003 and 2006. Fifty-eight patients with newly diagnosed T4a-staged tongue carcinoma were included in this study. Tumor thickness was obtained from preoperative magnetic resonance imaging. The mean MRI-derived tumor thickness was 22.29 mm. The patients with long tumor thickness (>26 mm) were associated with a significantly poor disease-specific survival (P = 0.015). The 2-year disease-specific survival rates were 72% in patients with short tumor thickness and only 27% in patients with long tumor thickness within the same T4a-staged disease. A substantial variation in MRI-derived tumor thickness was present within the same T4a-staged tongue carcinoma, and tumor thickness represented an important prognostic factor.

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Does Tumor Depth Affect Nodal Upstaging in Squamous Cell Carcinoma of the Head and Neck?

Abstract: Tumor depth is an important prognostic factor for patients with SCC of the oral cavity or oropharynx. Tumors greater than 4 mm are associated with greater risk of upstaging; however, this optimum cutoff value may vary between primary tumor sites.

Cited by 60 publications

References 25 publications

Evaluation of Clinical and Histomorphological Parameters as Potential Predictors of Occult Metastases in Sentinel Lymph Nodes of Early Squamous Cell Carcinoma of the Oral Cavity

Evaluation of Clinical and Histomorphological Parameters as Potential Predictors of Occult Metastases in Sentinel Lymph Nodes of Early Squamous Cell Carcinoma of the Oral Cavity

Muscle Invasion in Oral Tongue Squamous Cell Carcinoma as a Predictor of Nodal Status and Local Recurrence: Just as Effective as Depth of Invasion?

MRI-derived tumor thickness: an important predictor of outcome for T4a-staged tongue carcinoma

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