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

Abstract

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...

High sex determining region Y-box 2 expression is a negative predictor of occult lymph node metastasis in early squamous cell carcinomas of the oral cavity

“…The hitherto published predictive factors for metastatic disease in SNB include histomorphological parameters of the primary tumour including mode of invasion (morphological appearance of the infiltrating tumour front), grade of differentiation, lymphatic invasion and intratumoural lymphatic density. 40 In our recent study, 41 all these parameters failed to predict metastasis in SNB of oral SCC. Therefore, additional biomarkers may be of help for better patient stratification to select for SNB or elective neck dissection.…”

Podoplanin expression correlates with sentinel lymph node metastasis in early squamous cell carcinomas of the oral cavity and oropharynx

“…Additional biomarkers may be of help for better stratification of patients selected for SNB in contrast to END. The hitherto published predictive factors for metastatic disease in SNB include histomorphological parameters of the primary tumor like mode of invasion (morphological appearance of the infiltrating tumor front), depth of tumor infiltration, grade of differentiation, lymphatic invasion 11 and intratumoral lymphatic density. 31 Podoplanin is a potential additional marker, because podoplanin expression indicates an increased risk for lymph node metastasis.…”

“…Meanwhile, sentinel node biopsy (SNB) for the cN0 neck in early HNSCC of the oral cavity has been validated by multiple studies and has become one of the standards of care. 10 However, as clinical and conventional histologic parameters have failed to predict occult disease with reliable certainty, 11 the search has to be extended to additional markers with the potential to predict nodal metastases and, therefore, to select patients for neck dissection.…”

The role of elective supraomohyoidal neck dissection in the treatment of early, node-negative oral squamous cell carcinoma (OSCC): A retrospective analysis of 122 cases

“…Such occult, clinically not detectable metastases are associated with a significant decrease in overall and disease-free survival of the patients (Cheng and Schmidt, 2008). Several histopathologic parameters, such as tumour depth, grade of differentiation and lymphatic invasion have been suggested as predictor of occult metastases in node-negative OSCC, but currently, due to their limited sensitivity, none of them can be used in routine clinical management (Goerkem et al, 2010). To address the risk of cervical lymph node metastases, head and neck cancer patients historically have frequently been treated with radical neck dissection.…”