Extracapsular Spread in Ipsilateral Neck and Contralateral Neck Metastases in Laryngeal Cancer

Abstract

We investigated the incidence of extracapsular spread (ECS) and the impact of ECS on contralateral neck metastasis in 67 patients with ipsilateral nodal metastasis (IpN+) whose records were extracted retrospectively from those of 155 laryngeal cancer patients. The incidence of ECS in association with variables was determined: T stage, N stage, tumor location, tumor extension, number of positive nodes, and contralateral neck status. The variables were evaluated to identify their impact on the rates of contralateral neck metastasis (CNM) and 3-year survival. Of the 67 patients, 30 (44.7%) had ECS. A significant relationship was found between ECS positivity and increased N stage, tumor extension up to the midline, number of positive nodes, and CNM (p = .04, p = .0001, p = .018, p = .0001, respectively). Multivariate analysis revealed that N stage (p = .002; odds ratio, 3.5517) and the presence of ECS (p = .0036; odds ratio, 7.7840) in IpN+ were associated with the greatest risk of CNM. The 3-year survival rate of patients with ipsilateral ECS was significantly lower than that of patients without ECS (43% versus 81%, p = .0002). Both CNM and presence of ECS in IpN+ emerged as significant independent predictors for survival with Cox multivariate analysis (p = .0086 and p = .0234, respectively). This result indicates the necessity of treating the contralateral N0 neck in cases of IpN+ with ECS.

Head and Neck Squamous Cell Carcinoma: Value of Diffusion-weighted MR Imaging for Nodal Staging

“…Nevertheless, our current study findings indicate that the degree to which DW imaging changes the accuracy of nodal differentiation, by depicting subcentimeter nodal metastases, may affect the clinical management in specific situations. In cases of tumors growing close to the midline or extensive ipsilateral nodal metastatic involvement, the detection or exclusion of metastatic spread to the contralateral neck is pivotal to treatment (13,34). The high sensitivity of DW imaging in the detection of contralateral metastases combined with the high NPV enabled the reliable detection or exclusion of contralateral neck disease in mainly small lymph nodes.…”

“…Thus, a number of micrometastases in the contralateral neck may have remained undetected and been eradicated at postoperative radiation therapy. However, none of the patients who underwent unilateral neck dissection had a tumor near the midline, any indication of extensive nodal involvement, or signs of extranodal spread, so the likelihood of contralateral metastases was minimal (34).…”

Diffusion-weighted magnetic resonance imaging in neck lymph adenopathy

“…For instance, if the risk for contralateral metastases can be minimized sufficiently, DW-MRI may help to increase the number of patients eligible for parotid sparing RT, where the contralateral neck is irradiated with de-escalated doses [ 20 ] . However, as for all imaging modalities, a number of micrometastatic depositions are likely to remain undetected and potential applications should be balanced against relevant clinical risk factors for regional tumour spread [ 21 , 22 ] .

Figure 3 (A) Patient presenting with a T2 tumour of the left oral tongue (arrow).

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Diagnostic utility of central node necrosis in predicting extracapsular spread among oral cavity squamous cell carcinoma

“…The presence of lymph node metastasis is one of the strongest predictors for adverse outcome in oral cavity SCC. When metastatic oral cavity SCC breaches the lymph node capsule it is called extracapsular spread (ECS), and when present, it portends a poor prognosis . ECS is associated with decreased 5‐year disease‐specific survival to approximately 40%, compared to 70% among those without ECS .…”