Micrometastases in carcinoma of the upper aerodigestive tract: Detection, risk of metastasizing, and prognostic value of depth of invasion

Abstract

Background. The purpose of this study was to investigate the incidence of micrometastases from squamous cell carcinomas of the upper aerodigestive tract in neck dissection specimens, and to determine whether features of the primary tumor might be of prognostic value for metastasizing. Methods. Seventy‐six originally pN0 staged neck dissection specimens from 60 patients were evaluated using serial sectioning in 10‐μm intervals, H&E‐staining and immunostaining with an antibody to pan‐cytokeratin. The influence of the variables pT‐category, cytologic grade, and maximum depth of invasion of the primary tumor on the nodal status was analyzed in 128 patients. Results. The examination of 1020 lymph nodes from 76 neck dissection specimens revealed 8 micrometastases in 6 specimens (7.9%) from 6 patients with oral and pharyngeal primaries, resulting in upstaging. Six micrometastases were located in lymph nodes of 3–6 mm in diameter. Depth of invasion was the only significant risk factor for metastasizing selected in logistic regression. Conclusion. The surgeon should be aware of a relatively high incidence of micrometastases from oral and pharyngeal carcinomas, which are neither detectable preoperatively nor histopathologically by a reasonable effort. The measurement of the maximum depth of invasion of the primary can delineate a group of patients who should be treated by elective neck dissection. © 1995 Jons Wiley & Sons, Inc.

Disparity in pathologic and clinical lymph node staging in oral tongue carcinoma

“…Other adjunctive methods to detect micrometastatic tumor deposits include immunohistochemical staining for cytokeratin, which has identified micrometastatic disease in 5-8% of previously staged pN0 patients. [37][38][39] Molecular analysis for oncogenes or tumor suppressor genes also has been utilized to identify pathologic lymph node disease in head and neck carcinoma. 40 -43 The clinical significance and prognostic impact of micrometastatic disease in squamous cell carcinoma of the head and neck (SCCHN) remain unclear.…”

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

“…Tumor depth and thickness were defined and measured according Ambrosch et al as follows: 14 Tumor depth was measured vertically from the mucosal surface to the deepest point of tumor infiltration. If there was no mucosal surface due to ulceration or exophytic growth a virtual mucosa line connecting the adjacent mucosal surface of both sides was used.…”

“…The most promising factor emerging from these studies seemed to be the depth of tumor infiltration. [14][15][16][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Even nowadays, many centers still rely on cutoff values of 4 or 5 mm of tumor depth for indication of elective neck treatment. With regard to the much more focused and precise histological staging of sentinel lymph nodes in contrast to nodes in neck dissection specimens, the aim of this study was to assess whether any of the formerly evaluated clinical or histologic factors in the primary tumors were still significantly predictive of occult disease in the context of SNB.…”

Sentinel lymph-node biopsy in head and neck cancer

“…In two of the patients, however, they were discovered exclusively after additional sections had been stained with H&E. In another case, tumour cells were found by immunohistochemical staining only. An intensive sectioning and standard H&E staining as well as immunohistochemical staining will reveal more metastases than standard singleblock examination of a lymph node (Ambrosch et al, 1995;van den Brekel et al, 1996). Thus, performing a sentinel node-biopsy and basing the therapy of the neck on the status of the sentinel lymph node mandates an intensive and profound patho-and immunohistochemical work-up.…”