Nodal Yield in Neck Dissection and the Likelihood of Metastases

Agrama, Mark T; Reiter, David; Cunnane, Mary F.; Topham, Allan; Keane, William M.

doi:10.1067/mhn.2003.67

Cited by 55 publications

(53 citation statements)

References 20 publications

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“…One must also consider that the neck is an infrequent site of isolated recurrence and lymph node metastases reveals an aggressiveness phenotype which is not only regional. Agrama et al 3 reported a higher probability of finding metastases when more than 20 lymph nodes are dissected. Moreover, there is an expectation that approximately 7% of the pN0 cases have unidentified micrometastases in routine sections 7 .…”

Section: Resultsmentioning

confidence: 99%

“…Metastatic lymph nodes represent one of the most relevant aspects associated with treatment, characterizing an advanced clinical stage (stages III or IV), and it is associated with a 50% reduction in survival 1 . Although the number of lymph nodes removed is prognostically relevant in other areas of the body (colon and breast), very few studies have assessed their meaning in head and neck tumors [2][3][4][5][6] . Moreover, the number of lymph nodes removed may also be an indicator of how radical the dissection is as a staging method.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Significado prognóstico do número de linfonodos no esvaziamento cervical eletivo no câncer de língua e soalho de boca

Amar¹,

Chedid²,

Rapoport³

et al. 2012

Braz. j. otorhinolaryngol.

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The presence of metastatic lymph nodes is a relevant aspect in the treatment of head and neck cancer, bringing about a 50% reduction in survival.Objective: To assess the number of lymph nodes removed in the neck dissection and their relationship with the prognosis.Methods: A retrospective study involving 143 patients with tongue and mouth floor epidermoid carcinoma, which histological exam showed no lymph node metastases. Among those, 119 were males and 24 females, with mean age of 54 years. As to the primary tumor site, 65 were in the tongue and 78 in the mouth floor. T stage distribution was of four T1, 84 T2, 36 T3 and 19 T4. We carried out 176 neck dissections, unilateral in 110 cases and bilateral in 33. Of these, 78 were radical and 98 selective. The patients were broken down into three groups, according to the 33 and 66 percentiles of the number of lymph nodes resected. Results:The mean number of resected lymph nodes was 27; 24 in selective dissections and 31 in the complete ones. We did not have statistically significant differences when associated to the T and N stages. Conclusions:The larger number of lymph nodes dissected in the neck dissection identifies the group of better prognoses among pN0 cases. Braz J Otorhinolaryngol. 2012;78(2):22-6. BJORL ORIGINAL ARTICLE

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Significado prognóstico do número de linfonodos no esvaziamento cervical eletivo no câncer de língua e soalho de boca

Amar¹,

Chedid²,

Rapoport³

et al. 2012

Braz. j. otorhinolaryngol.

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“…Some authors claim that the number of removed lymph nodes carries prognostic value in pN0 patients, to suggest a more accurate staging or a more responsive immune system [5][6][7][8][9] . The presence of metastatic lymph nodes is one of the most significant prognostic indicators in malignant had and neck tumors.…”

Section: Discussionmentioning

confidence: 99%

“…Lymph node metastasis lead to a reduction of approximately 50% on survival, and prognosis is significantly worse when three or more metastatic lymph nodes are found 10,11 . The length of the neck clearance procedure, the surgical approach, and the level of histopathological investigation determine the degree to which lymph nodes are examined for metastasis detection and, thus, the likelihood of finding metastases in the lymph nodes at risk 6 . Thus, it is expected that these factors determine the pN lymph node stage (negative or positive).…”

Section: Discussionmentioning

confidence: 99%

A densidade do linfonodo metastático como fator prognóstico no carcinoma espinocelular da língua e soalho bucal

Amar¹,

Rapoport²,

Curioni³

et al. 2012

Braz. j. otorhinolaryngol.

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The presence of metastatic lymph nodes is a relevant prognostic factor in oral cancer.Objective: This paper aims to assess metastatic lymph node density (pN+) in patients with tongue and floor-of-mouth squamous cell carcinoma (SCC) and the association of this parameter with disease-free survival (DFS). Materials and Methods:A group of 182 patients seen between 1985 and 2007 was included, 169 of which were males. Five were on stage I, 35 on stage II, 56 on stage III, and 85 on stage IV. Median values were considered in lymph node density assessment, and the Kaplan-Meier curve was used to evaluate DFS; survival differences within the group were elicited through the log-rank test.Results: An average 3.2 metastatic lymph nodes were excised from the patients in the group. Density ranged from 0.009 to 0.4, with a mean value of 0.09. Five-year DFS rates were of 44% and 28% for the groups with lymph node densities below and above the median respectively (p = 0.006). Twoyear local/regional control was achieved for 71% and 49% for the patients below and above the median density respectively (p = 0.01). In terms of pN staging, local/ regional control was achieved in 70% and 54% of pN1 and pN2 patients respectively, albeit without statistical significance (0.20%). Conclusion:Lymph node density may be used as a prognostic indicator for tongue and floor-ofmouth SCC. Braz J Otorhinolaryngol. 2012;78(3):86-90. ORIGINAL ARTICLE BJORL

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“…A nyirokcsomóhozam prognózisra gyakorolt hatása hasonlónak bizonyult a papillaris pajzsmirigyrákok [13,14], valamint a szájüreg [12,[15][16][17][18], az oropharynx [17] és a hypopharynx [17,19] laphámrákjai esetében is. Egy, a közelmúltban megjelent multicentrikus tanulmány megerősítette a nyirokcsomóhozam független prognosztikai szerepét a cN0 nyaki stádiumú szájüregi laphámrák miatt elektív és szelektív nyaki dissectión át-esett betegeknél is [18].…”

Section: öSszefoglaló Közleményunclassified

A nyaki dissectiók onkológiai hozamának maximalizálása a sebészi morbiditás egyidejű minimalizálása mellett

et al. 2016

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A regionális nyaki lymphadenectomia -elterjedt nevén nyaki dissectio -a fej-nyaki tumorsebészet fontos alapműtéte. Ezen műtét 110 éves evolúciója során a különböző iskolák, nevezéktanok és műtéti technikák keveredése nyomán olyan mértékű zavar alakult ki az irodalomban és a mindennapi szakmai életben, amely szinte lehetetlenné teszi a sebészi és onkológiai eredmények standardizálását és objektív összehasonlítását. Ezt a helyzetet kísérlik meg a szerzők jelen összefoglaló munkájukban közérthetően tisztázni, a multidiszciplináris fej-nyaki terápiás döntésekben részt vevő kollégák kommunikációját megkönnyítendő annak érdekében, hogy a fej-nyaki tumoros betegek számára minden esetben optimális terápiás döntés szülessék. A közlemény történeti és irodalmi áttekintést ad, valamint ismerteti a két legelterjedtebb műtéti technika eredményeinek statisztikai összehasonlítását. A műtéti technika megválasztása szignifikáns hatással van az onkológiai hozamra. A megfelelő sebészi koncepció az onkológiai haszon maximalizálása mellett a betegek életminőségét a lehető legkisebb mértékben befolyásolja, egyrészt a primer sebészi terápiás morbiditás csökkentése, másrészt az adjuváns indikációk optimalizálása révén. Orv. Hetil., 2016, 157(47), 1871-1879. Kulcsszavak: fej-nyaki daganatok, nyaki dissectio, nyirokcsomóhozam, nyaki fascia, sebészi stádiummeghatározásMaximizing nodal yield while minimizing surgical morbidity: the appropriate neck dissection Cervical regional lymphadenectomy, also known as neck dissection, is a fundamental procedure in head and neck surgery. Its evolution over 110 years resulted in a great deal of confusion in the literature and in clinical practice, due to the heterogenicity in training, classification and surgical techniques, which makes outcomes comparability virtually impossible. The authors aim to clarify this situation in a structured manner, in order to facilitate communication among all specialists involved in multidisciplinary head and neck cancer care. The ultimate goal is to make sure that each and every head and neck cancer patient receives their optimal treatment. Review of the history and literature with statistical comparison of the two mainstraim methods regarding their nodal yield results. The applied surgical technique has a significant impact on nodal yield. An appropriate surgical concept achieves maximum oncologic benefit, minimum surgical morbidity with optimized adjuvant indications.

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Nodal Yield in Neck Dissection and the Likelihood of Metastases

Abstract: In T1 and T2 cases of HNSCC, nodal yield >20, increased age, male sex, and primary site correspond with an increased likelihood of finding cervical metastases.

Cited by 55 publications

References 20 publications

Significado prognóstico do número de linfonodos no esvaziamento cervical eletivo no câncer de língua e soalho de boca

Significado prognóstico do número de linfonodos no esvaziamento cervical eletivo no câncer de língua e soalho de boca

A densidade do linfonodo metastático como fator prognóstico no carcinoma espinocelular da língua e soalho bucal

A nyaki dissectiók onkológiai hozamának maximalizálása a sebészi morbiditás egyidejű minimalizálása mellett

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