Micrometastases from squamous cell carcinoma in neck dissection specimens

Mw, van den Brekel; Hv, Stel; P, van der Valk; I, van der Waal; Cj, Meyer; Gb, Snow

doi:10.1007/bf00179388

Cited by 94 publications

(43 citation statements)

References 22 publications

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“…The reported incidence of micrometastases may vary according to the method used for detection (e.g. semiserial sections and/or histochemistry for cytokeratins and molecular analysis) [7,[11][12][13]. While such reporting obviously has staging implications, the clinical impact of such information is unclear, as the staging systems and treatment reports have previously been based upon standard hematoxylin and eosin staining.…”

Section: Elective Treatment Of the Neckmentioning

confidence: 98%

“…Frozen section biopsy is a valuable tool for intraoperative evaluation of suspect nodes [6], although even neck nodes reported as pathologically disease-free following light microscopic study may not truly be free of occult metastases. This may be due to disease located at another level in the lymph node or, rarely, to having been overlooked by the microscopist [7]. It is disconcerting to note that approximately 20-30% of nodal metastases may be unrecognized by pathologists on routine final histological examination [8].…”

Section: Elective Treatment Of the Neckmentioning

confidence: 99%

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Surgical Treatment of the Neck in Cancer of the Larynx

Ferlito¹,

Silver²,

Rinaldo³

et al. 2000

ORL

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Current concepts in management of the clinically negative and clinically positive neck in laryngeal cancer are reviewed. Occult disease in the neck not detected by physical and radiographic examination may also be difficult to identify on routine histologic examination. Immunohistochemistry or molecular analysis may detect metastatic involvement not apparent by light microscopy. The surgeon should be aware of the relatively high incidence of micrometastases in patients with laryngeal cancer to establish optimal treatment approaches. Elective treatment of the neck is recommended for supraglottic tumors staged T2 or higher, and glottic or subglottic tumors staged T3 or higher.The neck may be treated electively by either surgery or irradiation, but irradiation is best reserved for cases where that modality is employed for the primary tumor. Elective neck dissection provides important information for prognostic purposes and therapeutic decisions, by establishing the presence, number, location and nature of occult lymph node metastases. The selective lateral neck dissection (levels II, III and IV), unilateral or bilateral, is the procedure of choice for elective treatment. Paratracheal nodes (level VI) should be dissected in cases of advanced glottic and subglottic cancer. Complete radical or functional neck dissections are excessive in extent, as levels I and V are almost never involved. Sentinel lymph node biopsy may fail to detect tumor on frozen section examination or may not reveal ‘skip’ metastases.The clinically involved neck is usually treated by complete radical or functional neck dissection of levels I through V. Selective neck dissection has been employed successfully in selected cases, particularly for N1 or occasionally N2 nodal involvement. The selective neck dissection can be extended to include structures at risk. More advanced disease has been treated in this manner often in association with adjuvant chemotherapy and/or irradiation. While the benefit of adjuvant treatment is difficult to assess, it appears most useful in cases with extranodal spread of disease, a factor associated with the worst prognosis.

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Section: Elective Treatment Of the Neckmentioning

confidence: 98%

Section: Elective Treatment Of the Neckmentioning

confidence: 99%

Surgical Treatment of the Neck in Cancer of the Larynx

Ferlito¹,

Silver²,

Rinaldo³

et al. 2000

ORL

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“…[34][35][36] Çünkü görünüşte negatif olan diseksiyonların bile %5-8'inde rutin patolojik incelemelerle mikrometastaz tespit edilmiştir. 37,38 Ayrıca ışık mikroskobu ile gösterilemeyen mikrometastatik hastalığın immunohistokimyasal ve moleküler çalış-malar ile %5 oranında gösterilebildiği unutulmamalıdır. 39,40 Ayrıca yapılan bir çalışmadada, ipsilateral boyun disseksiyonu yapıldığı halde metastaz tespit edilmeyen %5.5 oranında bir hasta gurubunda kontralateral tarafta ileriki dönemlerde nüks geliş-miştir.…”

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The relationship between the frequency of cervical metastases and tumor related factors in laryngeal cancer and outcome of surgical treatment in these cases

Şengül

Bağlam²,

Çevik³

et al. 2012

J Clin Exp Invest

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Objectives: We aimed to assess the associations between localization, size, stage and histopathological differentiation of primary tumor in larynx and neck metastases and the impact of disease stage on survival. Materials and methods:We analyzed the medical records of 333 laryngeal cancer patients who underwent total or partial laryngectomy as primary treatment, combined with neck dissection and/or postoperative radiotheraphy if required, between 2000 and 2010 years at our clinic. Age and gender of patients, tumor localization, size, stage and histopathological differentiation of tumor; presence of preoperative positive lymph nodes, performed operations, operation findings and histopathological results were analysed retrospectively. Results:Tumor localizations were glottic in 172 (51.6%) cases, supraglottic in 108 (32.4%), and transglottic 53 (15.9%) of the the cases. In glottic cancers; cervical metastases were observed in 18.6% of the patients, whereas occult metastases in 11%. In supraglottic cancers; cervical metastasis rate was 45.3% and occult metastases rate was 24%. In transglottic cancers, cervical metastases rate was 49% and occult metastases was 22.6%. Postoperative recurrence was 41 (12.3%). Postoperative radiotherapy was recommended to 111 of 333 patients. The overall survival rate was 75.4% at 50th month and the cumulative survival rate was 68.9%. Conclusion:In conclusion, although there is controversy regarding the optimal treatment in the N0 larynx cancers, in case of a high risk for occult metastases, elective unilateral or bilateral neck dissection should be performed according to the anatomic localization of the tumor. In addition, survival rate decreased significantly with the increasing tumor stage. J Clin Exp Invest 2012; 3(2): 214-222Key words: Larynx cancer, localization, stage, cervical lymph node metastases, survival ÖZET Amaç: Çalışmamızda larenkste tespit edilen primer tümörün lokalizasyonu, büyüklüğü, evresi, histopatolojik diferansiasyon derecesi, tutmuş olduğu anatomik yapı ile boyun metastazı arasındaki ilişkisi ve tümörün evresinin sağkalım üzerine olan etkisini araştırdık. Gereç ve yöntem:Kliniğimizde 2000-2010 yılları arasında larenks kanseri nedeniyle primer tedavi olarak cerrahi (total veya parsiyel larenjektomi) uygulanmış olan, gerektiğinde boyun diseksiyonu yapılan ve gerektiğinde postoperatif radyoterapi uygulanan 333 hastanın dosyaları incelendi. Hastaların yaşı, cinsiyeti, tümörün lokalizasyonu, tümörün büyük-lüğü, tümörün evresi, histopatolojik diferansiasyon derecesi, preoperatif pozitif lenf nodu bulunup bulunmadığı, yapılan ameliyatlar, ameliyat bulguları ve postop spesmenin histopatolojik değerlendirme sonuçları retrospektif olarak incelendi. Bulgular: Tümörün yerleşim bölgesine göre; vakaların 172'si (%51.6) glottik, 108'i (%32.4) supraglottik, 53'ü (%15.9) ise transglottik yerleşimliydi. Glottik tümörlerde %18.6 oranında servikal metastaz, %11 oranında occult metastaz tespit edilirken, supraglottik tümörlerde %45.3 oranında servikal metastaz, %24 oranında...

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“…Micrometastases have been detected in specimens obtained from therapeutic and elective neck dissections in patients with head and neck cancers [2,3]. The demonstration of micrometastases in a so-called pathologically negative neck dissection would seem to be more important than finding additional micrometastases in a resection with overt nodal disease [4].…”

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confidence: 99%