10 research outputs found
The assessment of oral squamous cell carcinoma:A study on sentinel lymph node biopsy, lymphatic drainage patterns and prognostic markers in tumor and saliva
Around 20-30% of the patients with a small tumor of the oral mucosa will have metastasis to one of the lymph nodes in the neck. It is important to predict the presence or absence of lymph node metastases to choose the optimal neck treatment for the individual patient. Lymph node metastases are frequently too small to detect by MRI or CT scan. In the past, a substantial number of lymph nodes of the neck were removed by surgery and microscopically examined postoperatively to find these lymph node metastases. However, the majority of the patients receive prophylactic surgery of the neck and consequently risk the morbidities related to this surgery without having lymph node involvement. Therefore, the less invasive sentinel lymph node biopsy (SLNB) procedure was introduced in head and neck cancer. The sentinel lymph node (SLN) is the first lymph node affected with metastases. With the SLNB procedure, only the SLN is removed and microscopically examined. Only in patients with a metastasis-positive SLN, the other lymph nodes in the neck are removed by second surgery.Koos Boeve studied the SLNB procedure in small oral cavity tumors and concluded that this technique is a reliable procedure to detect lymph node metastasis in the neck. He concluded also that the SLNB procedure is useful in patients with previous treatment of the neck, in whom it is most likely that lymphatic drainage patterns are altered. The SLNB procedure provides important information about individual drainage patterns.Moreover, Boeve studied also the possibility to predict lymph node metastasis using molecular characteristics of the oral cavity tumor. His research showed that the expression of several proteins might predict the presence of metastases in both sentinel lymph nodes and non-sentinel lymph nodes. In the end, Boeve detected the presence of tumor specific DNA in saliva of patients with an oral cavity tumor. This is a potential technique to use saliva for screening for oral cavity tumors or to detect recurrences of oral cavity tumors after initial treatment
Cortactin expression assessment improves patient selection for a watchful waiting strategy in pT1cN0-staged oral squamous cell carcinomas with a tumor infiltration depth below 4 mm
BACKGROUND: In this feasibility study we aimed to evaluate the value of previously reported molecular tumor biomarkers associated with lymph node metastasis in oral squamous cell carcinoma (OSCC) to optimize neck strategy selection criteria. METHODS: The association between expression of cortactin, cyclin D1, FADD, RAB25, and S100A9 and sentinel lymph node status was evaluated in a series of 87 (cT1‐2N0) patients with OSCC treated with primary resection and SLNB procedure. RESULTS: Tumor infiltration depth and tumor pattern of invasion were independent prognostic markers for SLN status, while none of the tumor makers showed a better prognostic value to replace SLNB as neck staging technique in the total cohort. However, in the subgroup of patients with pT1N0 OSCC, cortactin expression (OR 16.0, 95%CI 2.0–127.9) was associated with SLN classification. CONCLUSIONS: Expression of cortactin is a promising immunohistochemical tumor marker to identify patients at low risk that may not benefit from SLNB or END
Contralateral Regional Recurrence in Lateralized or Paramedian Early-Stage Oral Cancer Undergoing Sentinel Lymph Node Biopsy-Comparison to a Historic Elective Neck Dissection Cohort
Introduction: Nowadays, two strategies are available for the management of the clinically negative neck in early-stage (cT1-2N0) oral squamous cell carcinoma (OSCC): elective neck dissection (END) and sentinel lymph node biopsy (SLNB). SLNB stages both the ipsilateral and the contralateral neck in early-stage OSCC patients, whereas the contralateral neck is generally not addressed by END in early-stage OSCC not involving the midline. This study compares both incidence and hazard of contralateral regional recurrences (CRR) in those patients who underwent END or SLNB. Materials and Methods: A retrospective multicenter cohort study, including 816 lateralized or paramedian early-stage OSCC patients, staged by either unilateral or bilateral END (n = 365) or SLNB (n = 451). Results: The overall rate of occult contralateral nodal metastasis was 3.7% (30/816); the incidence of CRR was 2.5% (20/816). Patients who underwent END developed CRR during follow-up more often than those who underwent SLNB (3.8 vs. 1.3%; p = 0.018). Moreover, END patients had a higher hazard for developing CRR than SLNB patients (HR = 2.585; p = 0.030). In addition, tumor depth of invasion was predictive for developing CRR (HR = 1.922; p = 0.009). Five-year disease-specific survival in patients with CRR was poor (42%) compared to patients in whom occult contralateral nodal metastases were detected by SLNB or bilateral END (88%), although not statistically different (p = 0.066). Conclusion: Our data suggest that SLNB allows for better control of the contralateral clinically negative neck in patients with lateralized or paramedian early-stage OSCC, compared to END as performed in a clinical setting. The prognosis of those in whom occult contralateral nodal metastases are detected at an earlier stage may be favorable compared to those who eventually develop CRR, which highlights the importance of adequate staging of the contralateral clinically negative neck
Lymphatic drainage patterns of oral maxillary tumors:Approachable locations of sentinel lymph nodes mainly at the cervical neck level
Background. There is debate if the lymphatic drainage pattern of oral maxillary cancer is to the retropharyngeal lymph nodes or to the cervical lymph nodes. Insight in drainage patterns is important for the indication for neck treatment. The purpose of this study was to identify the lymphatic drainage pattern of oral maxillary cancer via preoperative lymphoscintigraphy. Methods. Eleven consecutive patients with oral maxillary cancer treated in our center between December 1, 2012, and April 22, 2016 were studied. Sentinel lymph nodes identified by preoperative lymphoscintigraphy after injection of Tc-99m-nanocolloid and by intraoperative detection using a gamma-probe, were surgically removed and histopathologically examined. Results. In 10 patients, sentinel lymph nodes were detected and harvested at cervical levels I, II, or III in the neck. In 2 patients, a parapharyngeal sentinel lymph node was detected. One of the harvested sentinel lymph nodes (1/19) was tumor positive. Conclusion. This study suggests the likelihood of 73% of exclusively cervical level I to III sentinel lymph nodes in oral maxillary cancer. (C) 2016 Wiley Periodicals, Inc
Elective Neck Dissection or Sentinel Lymph Node Biopsy in Early Stage Oral Cavity Cancer Patients: The Dutch Experience
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Addition of tumour infiltration depth and extranodal extension improves the prognostic value of the pathological TNM classification for early-stage oral squamous cell carcinoma
AIMS: In the 8th edition of the American Joint Committee on Cancer (AJCC) TNM staging Manual, tumor infiltration depth and extranodal extension are added to the pathological classification for oral squamous cell carcinoma. Currently available 8th TNM validation studies are lacking patients with conservative neck treatment, while changes in the classification especially affect patients with small tumors. This study's aim was to determine the potential impact of the changes within the 8th edition pTNM classification on the prognosis and treatment strategy of oral squamous cell carcinoma in a well-defined series of pT1-T2 patients with a long-term follow-up. METHODS AND RESULTS: 211 first primary pT1-T2 oral squamous cell carcinoma patients, with surgical resection as primary treatment were analyzed retrospectively. 173 patients received a neck dissection and 38 patients had a frequent clinical neck assessment. Long-term follow-up (median: 64 months) and reassessed tumor infiltration depth were available. Classification according to the 8th edition criteria resulted in 36% total upstaging with the T classification and 16% with N classification. T3 restaged patients (n=30, 14%) had lower 5-year disease specific survival rates compared to T2 staged patients (81% versus 67%, p = 0.042). Postoperative (chemo)radiotherapy could have been considered in another 7 (3%) patients based on the 8th edition criteria. CONCLUSIONS: Addition of tumor infiltration depth and extranodal extension within the 8th TNM classification leads to the identification of oral squamous cell carcinoma patients with a worse prognosis who might benefit from an improved postoperative treatment strategy. This article is protected by copyright. All rights reserved
Neonatal arterial switch operation complicated by intramural left coronary artery and treated by left internal mammary artery bypass graft
Elective neck dissection or sentinel lymph node biopsy in early stage oral cavity cancer patients: The dutch experience
Background: Sentinel lymph node biopsy (SLNB) has been introduced as a diagnostic staging modality for detection of occult metastases in patients with early stage oral cancer. Comparisons regarding accuracy to the routinely used elective neck dissection (END) are lacking in literature. Methods: A retrospective, multicenter cohort study included 390 patients staged by END and 488 by SLNB. Results: The overall sensitivity (84% vs. 81%, p = 0.612) and negative predictive value (NPV) (93%, p = 1.000) were comparable between END and SLNB patients. The END cohort contained more pT2 tumours (51%) compared to the SLNB cohort (23%) (p < 0.001). No differences were found for sensitivity and NPV between SLNB and END divided by pT stage. In floor-of-mouth (FOM) tumours, SLNB had a lower sensitivity (63% vs. 92%, p = 0.006) and NPV (90% vs. 97%, p = 0.057) compared to END. Higher disease-specific survival (DSS) rates were found for pT1 SLNB patients compared to pT1 END patients (96% vs. 90%, p = 0.048). Conclusion: In the absence of randomized clinical trials, this study provides the highest available evidence that, in oral cancer, SLNB is as accurate as END in detecting occult lymph node metastases, except for floor-of-mouth tumours
High rate of unexpected lymphatic drainage patterns and a high accuracy of the sentinel lymph node biopsy in oral cancer after previous neck treatment
RATIONALE: This study evaluates the lymphatic drainage patterns and determines the accuracy of the sentinel lymph node biopsy (SLNB) in patients diagnosed with a cT1-2N0 OSCC and a history of neck surgery or radiotherapy in three Dutch head and neck centers. MATERIALS AND METHODS: Retrospective analysis of 53 cT1-2N0 OSCC patients, who underwent SLNB between 2007 and 2016, after a history of neck surgery or radiotherapy. Ten patients had previous treatment of the neck only contralateral from the current tumour. These ten patients were not used for the analysis of lymphatic drainage patterns. The 43 patients with previous ipsilateral or bilateral treatment of the neck had a history of ipsilateral SLN extirpation (n = 9; 21%), neck dissection (n = 16; 37%), radiotherapy (n = 10; 23%), or combined neck dissection and radiotherapy (n = 8; 19%). RESULTS: SLNs were detected in 45 patients, resulting in an identification rate of 85% (45/53). Three patients (7%) had at least one positive SLN. One patient (1/45; 2%) was diagnosed with regional recurrence during the follow-up after a negative SLNB (sensitivity 75%, negative predictive value 98%). The first SLN was detected in level I-III in 58% of the patients, unexpected drainage patterns were observed in 30% (first SLN level IV 9% and level V 5% and contralateral neck in well-lateralized tumours 16%). In 12% no lymphatic drainage pattern was visible. CONCLUSIONS: SLNB seems to be a reliable procedure for neck staging of cT1-2N0 OSCC patients with a previously treated neck. SLNB determines the individual lymphatic drainage patterns, enabling visualization of unexpected drainage pattern variability in 30% of these patients
High rate of unexpected lymphatic drainage patterns and a high accuracy of the sentinel lymph node biopsy in oral cancer after previous neck treatment
RATIONALE: This study evaluates the lymphatic drainage patterns and determines the accuracy of the sentinel lymph node biopsy (SLNB) in patients diagnosed with a cT1-2N0 OSCC and a history of neck surgery or radiotherapy in three Dutch head and neck centers. MATERIALS AND METHODS: Retrospective analysis of 53 cT1-2N0 OSCC patients, who underwent SLNB between 2007 and 2016, after a history of neck surgery or radiotherapy. Ten patients had previous treatment of the neck only contralateral from the current tumour. These ten patients were not used for the analysis of lymphatic drainage patterns. The 43 patients with previous ipsilateral or bilateral treatment of the neck had a history of ipsilateral SLN extirpation (n = 9; 21%), neck dissection (n = 16; 37%), radiotherapy (n = 10; 23%), or combined neck dissection and radiotherapy (n = 8; 19%). RESULTS: SLNs were detected in 45 patients, resulting in an identification rate of 85% (45/53). Three patients (7%) had at least one positive SLN. One patient (1/45; 2%) was diagnosed with regional recurrence during the follow-up after a negative SLNB (sensitivity 75%, negative predictive value 98%). The first SLN was detected in level I-III in 58% of the patients, unexpected drainage patterns were observed in 30% (first SLN level IV 9% and level V 5% and contralateral neck in well-lateralized tumours 16%). In 12% no lymphatic drainage pattern was visible. CONCLUSIONS: SLNB seems to be a reliable procedure for neck staging of cT1-2N0 OSCC patients with a previously treated neck. SLNB determines the individual lymphatic drainage patterns, enabling visualization of unexpected drainage pattern variability in 30% of these patients