Micrometastases and isolated tumour cells in sentinel lymph nodes in oral and oropharyngeal squamous cell carcinoma

Atula, Timo; Hunter, Keith D.; Cooper, Lorna; Shoaib, Taimur; Ross, Gary; Soutar, David S.

doi:10.1016/j.ejso.2008.12.014

Cited by 38 publications

(30 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However every carcinoma has a distinct biological behaviour and the significance of ITCs and MMs in squamous cell carcinoma of the head and neck remains to be ascertained. Recently the effect of adopting the UICC/ TNM protocols and definitions (see Boxes 1, 2) on the Canniesburn series has been evaluated [11]. Eighty-six sentinel nodes were reassessed using the UICC/TNM definitions and the results were linked to the pathological findings in the subsequent neck dissections.…”

Section: Histopathology Protocolsmentioning

confidence: 99%

Head and Neck Sentinel Lymph Node Biopsy: Current State of the Art

Sloan

2009

Head and Neck Pathol

View full text Add to dashboard Cite

Sentinel node biopsy is an alternative to elective neck dissection for the management of T1/T2 oral and oro-pharyngeal squamous cell carcinomas and is also finding application to head and neck cancer at other sites. The main clinical aim of sentinel node biopsy is to achieve better staging and there is now evidence that the procedure reduces morbidity. Reported detection rates for sentinel neck nodes are greater than 95% and there is also a negative predictive value of 95% for negative sentinel nodes. Current histopathological protocols have been developed for use in the research setting and are designed to identify all micrometastatic disease. However the use of step serial sectioning at 150 micron intervals with pan-cytokeratin immunohistochemistry is currently advised and appears to upstage nodes by approximately 20% over the initial single routine stained section. Adoption of the UICC/TNM definitions is recommended for future sentinel node studies, but further refinements and descriptions are required. The SENT trial has recruited over 300 cases from 10 European centres and a quality control study of the pathological material is in progress. At the first consensus meeting of the SENT pathology group there were excellent levels of agreement on the diagnosis of positive and negative nodes, and a number of potential pitfalls such as non-malignant inclusions and staining artefacts were identified.

show abstract

Section: Histopathology Protocolsmentioning

confidence: 99%

Head and Neck Sentinel Lymph Node Biopsy: Current State of the Art

Sloan

2009

Head and Neck Pathol

View full text Add to dashboard Cite

show abstract

“…With regard to the issue of ITCs, there is growing evidence that in head and neck cancer, ITC could be associated with a worse prognosis compared with pN0 SLN, a finding that contrasts with that which is observed in breast adenocarcinoma (Atula et al, 2009). Consequently, we assessed the ability of PVA mRNA quantification to diagnose ITC by varying the PVA cutoff point.…”

Section: Discussionmentioning

confidence: 95%

“…Lymph nodes are usually diagnosed as either metastatic or non-metastatic by examining one or two sections of the maximal cut surface. However, as the median size of the metastatic tissue to be diagnosed is B350 mm, the sensitivity of routine frozen sectioning is only 20% (Atula et al, 2009). Semi-serial sectioning, associated with IHC, has a higher detection rate of MI than examination of only a few sections, and can reach the sensitivity of intra-operative fine-sectioned frozen sectioning of 93% (Tschopp et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

Pemphigus vulgaris antigen mRNA quantification for the staging of sentinel lymph nodes in head and neck cancer

et al. 2009

View full text Add to dashboard Cite

BACKGROUND: Molecular diagnosis has been proposed to enhance the intra-operative diagnosis of sentinel lymph node (SLN) invasion in head and neck squamous cell carcinoma (HNSCC). Although cytokeratin (CK) mRNA quantification with real-time reverse transcriptase-PCR (QRT -PCR) has produced encouraging results, the more discriminating markers remain to be identified. METHODS: Pemphigus vulgaris antigen (PVA), squamous cell carcinoma antigen (SCCA), and CK17 mRNA were quantified using QRT -PCR, and the results were compared with an extensive histopathological examination of the entire SLNs on 78 SLNs harvested from 22 patients with HNSCC. RESULTS: SCCA and CK17 quantification showed significantly higher mRNA values for macrometastases (MAs) than for either negative or isolated tumour cell (ITC) SLNs (Po0.01). Pemphigus vulgaris antigen allowed the discrimination of all MAs and micrometastases from both negative and ITC SLNs (Po0.001). For the neck staging of patients, considering metastatic vs non-metastatic status, receiver-operating characteristic curve analysis found areas under the curve of 93.8, 97.9, and 100% for CK17, SCCA, and PVA, respectively. With PVA, a cutoff value of 562 copies per 100 ng of cDNA permitted the correct distinction between patients with positive as opposed to negative neck nodes in all cases. CONCLUSION: PVA seems to be a highly promising marker for accurate intra-operative SLN staging in HNSCC by QRT -PCR.

show abstract

“…2,3 This may be in part the result of more detailed histopathologic assessment including additional step sectioning and immunohistochemical staining performed on SLNs that is typically beyond the standard H&E staining of a single section performed at most institutions on an END specimen. Atula et al 14 similarly showed an increased rate of positive SLNs with the addition of step sectioning and cytokeratin staining when compared with standard histologic evaluation (33% vs 22%, respectively).…”

Section: Discussionmentioning

confidence: 96%

Use of a Novel Receptor-Targeted (CD206) Radiotracer,^99mTc-Tilmanocept, and SPECT/CT for Sentinel Lymph Node Detection in Oral Cavity Squamous Cell Carcinoma

Marcinow

Hall

Byrum

et al. 2013

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

IMPORTANCE Sentinel lymph node biopsy has been proposed as an alternative to up-front elective neck dissection (END) for determination of pathologic nodal status in patients undergoing surgical treatment for oral cavity squamous cell carcinoma (OSCC) with clinically negative neck (cN0). Sentinel lymph node biopsy using current standard tracer agents and imaging adjuncts such as radiolabeled sulfur-colloid and planar lymphoscintigraphy (LS), however, is associated with several drawbacks. OBJECTIVE To assess the preliminary utility of technetium Tc 99m(99mTc)-tilmanocept, a novel molecular imaging agent for sentinel lymph node (SLN) mapping, in OSCC. DESIGN, SETTING, AND PARTICIPANTS Prospective, nonrandomized, single-arm, part of an ongoing phase 3 clinical trial. Patients had previously untreated, clinically and radiographically node-negative OSCC (T1-4aN0M0) at an academic tertiary referral center. INTERVENTIONS Patients received a single dose of 50 μg 99mTc-tilmanocept injected peritumorally followed by dynamic planar LS and fused single-photon emission computed tomography/computed tomography (SPECT/CT) prior to surgery. Surgical intervention consisted of excision of the primary tumor and radioguided SLN dissection followed by planned END. The excised lymph nodes (SLNs and non-SLNs) underwent histopathologic evaluation for presence of metastatic disease. MAIN OUTCOMES AND MEASURES False-negative rate and negative predictive value of SLNB using 99mTc-tilmanocept and comparison of planar LS with SPECT/CT in SLN localization. RESULTS Twelve of 20 patients (60%) had metastatic neck disease on pathologic examination. All 12 had at least 1 SLN positive for metastases. No patients had a positive END node who did not have at least 1 positive SLN. These data yield a false-negative rate of 0% and negative predictive value of 100% using 99mTc-tilmanocept in this setting. Dynamic planar LS and SPECT/CT revealed a mean (range) number of hot spots per patient of 2.9 (1-7) and 3.7 (1-12), respectively. Compared with planar LS, SPECT/CT identified additional putative SLNs in 11 of 20 cases (55%). CONCLUSIONS AND RELEVANCE The high negative predictive value and low false-negative rate in identification of occult metastases shows 99mTc-tilmanocept to be a promising agent in SLN identification in patients with OSCC. Use of SPECT/CT improves preoperative SLN localization including delineation of SLN locations near the primary tumor when compared with planar LS imaging. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00911326

show abstract

Micrometastases and isolated tumour cells in sentinel lymph nodes in oral and oropharyngeal squamous cell carcinoma

Cited by 38 publications

References 27 publications

Head and Neck Sentinel Lymph Node Biopsy: Current State of the Art

Head and Neck Sentinel Lymph Node Biopsy: Current State of the Art

Pemphigus vulgaris antigen mRNA quantification for the staging of sentinel lymph nodes in head and neck cancer

Use of a Novel Receptor-Targeted (CD206) Radiotracer,^99mTc-Tilmanocept, and SPECT/CT for Sentinel Lymph Node Detection in Oral Cavity Squamous Cell Carcinoma

Contact Info

Product

Resources

About

Micrometastases and isolated tumour cells in sentinel lymph nodes in oral and oropharyngeal squamous cell carcinoma

Cited by 38 publications

References 27 publications

Head and Neck Sentinel Lymph Node Biopsy: Current State of the Art

Head and Neck Sentinel Lymph Node Biopsy: Current State of the Art

Pemphigus vulgaris antigen mRNA quantification for the staging of sentinel lymph nodes in head and neck cancer

Use of a Novel Receptor-Targeted (CD206) Radiotracer,99mTc-Tilmanocept, and SPECT/CT for Sentinel Lymph Node Detection in Oral Cavity Squamous Cell Carcinoma

Contact Info

Product

Resources

About

Use of a Novel Receptor-Targeted (CD206) Radiotracer,^99mTc-Tilmanocept, and SPECT/CT for Sentinel Lymph Node Detection in Oral Cavity Squamous Cell Carcinoma