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PubMedDate not supplied

Sentinel lymph node evaluation in squamous cell carcinoma of the head and neck cancer: preliminary results.

INTRODUCTION: Sentinel lymph node biopsy is a new technique in staging the clinically NO neck. Tumour spread to the neck is the most important prognostic factor in head and neck squamous cell carcinoma (HNSCC). MATERIAL AND METHODS: Patients with histologically confirmed HNSCC, with no clinical and no radiological (CT or MRI) evidence of cervical lymph node involvement were eligible for this prospective study. The lymph node mapping was performed by preoperative lymphoscintigraphy and intraoperative use of hand-held gamma probe. Four injections (with Tc 99m-labeled nanocolloids) were performed around the primary tumour. The SLN, as indicated by dynamic scintigraphy and the neck dissection specimen, were sent separately for histological analysis. The presence of occult metastasis in the SLN and in the neck dissection specimen were compared. RESULTS: Ten consecutive patients (8 males ; 2 females) with a mean age of 61 years (range 47 to 74 years) were prospectively entered into the study. The primary tumour was located on the oral tongue in 4 cases, in the floor of the mouth in 5 cases and in the oropharynx in 1 case. Primary tumours were staged T2 in nine cases, one tumour was staged T1 according to UICC 1997. All the tumours were clinically staged cN0 by palpation and computed tomography (or MRI). Lymphoscintigraphy was performed and revealed a SLN in all cases. The sentinel node biopsy technique permitted an upstaging of the clinically cN0 neck in 3/10 cases. The SLN technique was false negative in one patient with a skip metastasis. CONCLUSION: SLN evaluation in HNSCC is feasible and provides a highly accurate staging of NO necks in oral and oropharyngeal carcinomas.

Aged↗

PubMed2003

Management of cystic cervical metastasis.

An adult older than 40 years present with a cystic lump in the upper neck should be considered at risk of having an underlying malignancy of the head and neck-a mucosal squamous cell carcinoma or a papillary thyroid carcinoma. Although the likelihood of malignancy is small, should the diagnosis of malignancy be confirmed pathologically, this consequential diagnosis will result in devastating physical and psychologic upset to the patient and their caretakers, the treating surgeons, and possibly many other clinical groups. It is therefore recommended that all such patients be investigated by radiologic imaging-CT/MRI and fine needle aspiration cytology, followed by panendoscopy of the head and neck, which includes an ipsilateral tonsillectomy biopsy and an excision biopsy of the cystic neck lesion. Should the lesion prove to be an isolated cystic metastatic squamous cell carcinoma, a neck dissection should be performed with or without adjuvant radiotherapy. Should the lesion prove to be a metastatic papillary thyroid carcinoma, a total thyroidectomy and neck dissection should be performed. In general, patients with cystic metastasis have a better prognosis than patients who present with a noncystic neck mass.

Biopsy, Needle↗

PubMed2000

[Surgical treatment of cervical lymph nodes in 301 patients with oral squamous cell carcinoma].

OBJECTIVE: To evaluate cervical lymph metastases and its surgical treatment of oral carcinoma with regard to primary location and TNM classification. METHODS: 301 previously untreated patients were included in the follow-up study to calculate the rate of histopathologically positive lymph metastasis and the rate of recurrences in untreated necks and after FND (functional neck dissection). RESULTS: Lymph node pathologic positive rates were N0 7.4%, N1 14.7%, N2 76.2%. Recurrences occurred in 32.1% untreated necks and 14.7% necks after FND of carcinomas of tongue, buccal, lower-gingiva and oral floor, while rarely in necks of carcinomas of palate and upper-gingiva. CONCLUSIONS: TNM classification is useful to estimate lymph metastasis. Application of elective neck dissection needs to expand in carcinomas of the above four sites. It should be careful when choose FND.

Adult↗

PubMed2006

High energy probe for detecting lymph node metastases with 18F-FDG in patients with head and neck cancer.

AIM: of this study was to validate a newly developed high energy probe (positron emission probe, PEP) optimised for localising PET tracers in vivo. PATIENTS AND METHODS: Physical investigations included determination of full width at half maximum (FWHM) values at a distance of 1 cm and angular resolution using different point sources. Values obtained with the new probe were compared to those of a conventional gamma probe (CGP). Additionally, PET studies were performed in 36 patients (6 women, 30 men) with proven head and neck cancer and suspected lymph node metastases (Axis, Marconi/Philips) after administering 250-320 MBq (18)F-FDG. Subsequent to PET investigations (18)F-FDG uptake in cervical regions was measured using the PEP. PEP investigations were carried out bilaterally in 5 lymph node (LN) levels (Robbins' classification of the neck). Results of probe studies were correlated with visual and semiquantitative PET evaluations, US and histological findings. RESULTS: FWHM of the new probe was 7 mm (CGP 22 mm) at 662 keV ((137)Cs) and angular resolution resulted in 8 degrees (CGP 60 degrees ). In 29 out of 36 patients LN metastases were suspected due to ultrasound investigations. After neck dissection, histology confirmed LN metastases in 21 patients. Sensitivity (sens.) of US amounted to 95% and specificity to 40%. In 18/21 patients LN metastases were detected by PET (sens. 86%). PET scans failed to diagnose the LN status correctly in 6/36 patients (accuracy 83%). Employing the PEP probe in 20/21 patients LN metastases were identified (sens. 95%), and LN status was determined accurately in 29/36 patients (accuracy 81%). Tumour/background ratios of PEP measurement and results of semiquantitative PET analyses were comparable. CONCLUSIONS: PEP measurement is a promising method for preoperative planning of the extent of neck dissection in patients with head and neck cancer and further for radioguided localising PET tracer accumulation during surgery.

Adult↗

PubMed2006

Multiagent concurrent chemoradiotherapy for locoregionally advanced squamous cell head and neck cancer: mature results from a single institution.

PURPOSE: A retrospective review with long-term follow-up is reported from the Cleveland Clinic Foundation studying radiation and concurrent multiagent chemotherapy in patients with locoregionally advanced squamous cell head and neck cancer. PATIENTS AND METHODS: Between 1989 and 2002, 222 patients were treated with 4-day continuous infusions of fluorouracil (1,000 mg/m2/d) and cisplatin (20 mg/m2/d) during weeks 1 and 4 of either once daily or twice daily radiation therapy. Primary site resection was reserved for patients with residual or recurrent primary site disease after chemoradiotherapy. Neck dissection was considered for patients with N2 or greater disease, irrespective of clinical response, and for patients with residual or recurrent neck disease. RESULTS: With a median follow-up of 73 months, the Kaplan-Meier 5-year projected overall survival rate is 65.7%, freedom from recurrence rate is 74.0%, local control without the need for surgical resection rate is 86.7%, and overall survival rate with organ preservation is 62.2%. Including patients undergoing primary site resection as salvage therapy, the overall local control rate is 92.4%. Regional control rate at 5 years is 92.4%. Among patients with N2-3 disease, regional control was significantly better if a planned neck dissection was performed. Distant control at 5 years was achieved in 85.4% of patients and was significantly worse in patients with hypopharyngeal primary sites and patients with poorly differentiated tumors. CONCLUSION: Concurrent multiagent chemoradiotherapy can result in organ preservation and cure in the majority of appropriately selected patients with locoregionally advanced, nonmetastatic, squamous cell head and neck cancer. Distant metastatic disease was the most common cause of treatment failure. Late functional outcomes will require further investigation.

Adult↗

PubMed2005

Utility of positron emission tomography for the detection of disease in residual neck nodes after (chemo)radiotherapy in head and neck cancer.

BACKGROUND: This study evaluates the utility of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) in patients with a node-positive mucosal head and neck squamous cell carcinoma who achieved a complete response at the primary site but had a residual mass in the neck 8 weeks or more after definitive (chemo)radiotherapy. METHODS: Between October 1996 and July 2002, 39 eligible patients were identified. The reference PET scan was performed at a median of 12 weeks (range, 8-32 weeks) after treatment. RESULTS: PET showed no metabolic activity in the residual mass in 32 patients. Five of these patients had a neck dissection and were all pathologically negative. The remaining 27 patients were observed for a median of 34 months (range, 16-86 months), with only one locoregional failure. The negative predictive value of PET for viable disease in a residual anatomic abnormality was 97%. CONCLUSION: Patients who have achieved a complete response at the primary site but have a residual abnormality in the neck that is PET negative approximately 12 weeks after treatment do not require neck dissection and can be safely observed. Head Neck

Adult↗

PubMed2002

Cervical node metastases in oropharyngeal squamous cell carcinoma: prospective analysis of prevalence and distribution.

The treatment of cervical lymph node metastases is an important part of the management of oropharyngeal squamous cell cancer. Metastases are already clinically present in 61 per cent (+ or -2.6 per cent) of patients at presentation. Previous studies concerning the prevalence and distribution of neck node metastases in oropharyngeal carcinoma have been retrospective, and little or no information is available about the histopathological methods used. This study has prospectively analysed 85 neck dissection specimens in 72 consecutive patients with squamous cell carcinoma of the oropharynx, both with clinically N(0) and N+ve necks, to identify the prevalence and distribution of cervical metastases. We have used a technique to separate the neck dissection into nodal levels per-operatively, and then embedded the entire specimen for histological examination to avoid missing metastatic disease in small lymph nodes (<3mm diameter).

Carcinoma, Squamous Cell↗

PubMed1985

Papillary carcinoma of the thyroid. A clinicopathologic study of 241 cases treated at the University of Florence, Italy.

A clinicopathologic study of 241 cases of papillary thyroid carcinoma treated at the University of Florence Medical School, Florence, Italy is presented. The features of greatest prognostic value were patient's age at presentation, small tumor size, total encapsulation, extrathyroid extension, multicentricity, and presence of distant metastases. The prognosis of the disease was not influenced by the pattern of tumor growth, presence of solid areas, initial presence or subsequent development of cervical lymph node metastases, type of initial thyroid operation, performance of neck dissection, or prophylactic administration of radioactive iodine. It is concluded that conservative thyroid surgery in the form of lobectomy, without neck dissection or prophylactic administration of iodine 131 (131I), constitutes adequate therapy for most cases of papillary thyroid carcinoma. More extensive therapy should be considered for older patients and for those in whom the tumor exhibits extrathyroid extension or easily detectable multicentricity.

Adolescent↗

PubMed2026

Accuracy of frozen section for HPV-Associated squamous cell carcinoma of unknown primary.

INTRODUCTION: Current guidelines for the management of metastatic squamous cell carcinoma of unknown primary (SCCUP) recommend submission of suspicious primary sites for frozen section analysis (FSA). This study aims to investigate the diagnostic accuracy of FSA for identification of HPV-associated SCCUP. METHODS: A retrospective cohort study of patients with biopsy-proven p16-positive SCCUP who underwent diagnostic operation at two tertiary care institutions was performed. Sensitivity, specificity, PPV, and NPV of diagnostic FSA were assessed. RESULTS: 77 patients were included in analysis. 66 patients underwent definitive TORS (diagnostic TORS operation with subsequent neck dissection after identification of the occult primary tumor), 7 patients underwent diagnostic TORS (TORS to identify occult primary tumor, no neck dissection), and 4 patients underwent direct laryngoscopy and biopsy only. Primary tumors were identified in 63 patients (82%) with a mean tumor size of 1.1 cm. There was no significant difference in size between patients whose tumor was identified on FSA (mean 1.1 cm) and on permanent only (mean 0.9 cm) (p = 0.26). The sensitivity, specificity, PPV, and NPV of FSA for SCCUP was 86%, 100%, 100%, and 86%, respectively. Diagnostic frozen specimens included 52 direct laryngoscopy biopsies and 69 TORS excisions. In the biopsies, sensitivity was 100% and NPV was 100%, whereas in the TORS-excised specimens, sensitivity was 77% and NPV was 77%. CONCLUSIONS: In this case series of 77 patients with SCCUP, the sensitivity and NPV of FSA for identification of the primary tumor was over 85%. FSA is valuable during diagnostic operation for SCCUP.

Humans↗

PubMedDate not supplied

[Involvement of the submadibular region in epidermoid carcinoma of the mouth floor. Prospective study of 31 cases].

BACKGROUND: To evaluate the primary or secondary involvement of the submandibular gland in floor of mouth squamous cell carcinoma. METHODS: An analytic-observational study of prospective type was carried out on 31 patients operated for floor of mouth carcinoma, between June 1993 and January 1996, in a reference hospital for a population of 1,100,000 inhabitants. The investigated variables were: age, sex, tumor localization, clinical TNM, type of cervical surgery, evolution, number of positive cervical metastasis, state of the submandibular gland and presence of the periglandular metastasis. The follow-up period was about 48 to 76 months. The exact Fischer test was used for the statistical study. RESULTS: Histopathological examination identified cervical metastasis as 34.1% of the ipsilateral neck dissections. The average number of positive nodes was 3 (range: 1-9). Cervical periglandular metastases were found in 31.7% of neck dissections, but in no case was microscopic affectation of the submandibular gland found. The existence of intraglandular positive nodes was not found either. In our study, the sensibility and specificity of the clinical exploration of the submandibular region were high (84% and 88% respectively). The presence of cervical metastasis and the size of the tumor conditioned the appearance of recurrences. CONCLUSIONS: In accordance with our study, periglandular metastases in carcinoma of the floor of mouth, are frequent, but submandibular gland involvement is unusual.

Adult↗

PubMed1999

Pathology of the N0 neck.

The incidence, extent and distribution of nodal metastasis is described in 152 neck dissections from patients with an NO neck undergoing surgery for an intraoral/oropharyngeal squamous cell carcinoma. The preoperative N stage had been determined by palpation under general anaesthesia and magnetic resonance imaging. Metastasis was detected histologically in 32 (21%) of the 152 NO necks. The number of positive nodes per NO neck ranged from 1 to 6. In total, 52 positive nodes were found and 29 (56%) measured 10 mm or less in maximum dimension. Twenty-one dissections (66%) contained a single positive node and 24 (75%) showed a single positive anatomical level. Three cases showed 'skipping' of levels within the neck and one case showed 'peppering'. Seventeen (53%) of the 32 positive NO necks and 31 (60%) of the 52 positive nodes contained only 'micrometastases' (deposits < 3 mm). Microscopic extracapsular spread was evident in five NO necks including one case with extracapsular spread at multiple levels. The study concludes that preoperative staging by palpation and routine magnetic resonance imaging cannot be relied upon to detect early cervical metastatic disease, and the topographic distribution of positive nodes indicates that modified neck dissections should include level IV when the primary tumour involves the tongue.

Adult↗

PubMed2005

The number of sentinel nodes identified as prognostic factor in oral epidermoid cancer.

In patients with oral cavity epidermoid cancer without palpable nodes, the standard cervical treatment is supraomohyoid dissection; nevertheless, lymphatic mapping with sentinel node (SN) biopsy has been useful and allows the identification of a group of patients where neck dissection may be prevented. The objective of this study was to examine which factors diagnose the possibility of metastasis in SN. A non-randomized prospective study was performed during a two year period and included patients with T1-2, N0 oral cavity cancer >4 mm thick, SN was identified by blue dye and Rhenium colloid. All patients underwent pre-operatory lymphogammagraphy and elective-selective neck dissection. Age, gender, tumor site, T, tumor thickness and number of sentinel nodes found were evaluated. In 48 patients, at least one sentinel node was found, 2 per patient on average. 10.4% showed drainage outside the supraomohyoid region, 13/48 had nodular metastasis, 4 with negative SN(8.3%). T, location, thickness and number of SN are related to non-SN metastasis. Identification of 3SN or more was related to the possibility of SN metastasis p=0 (RR 10.1, I. C. 95% 1.1 91.2). The combined technique (dye-colloid) offers a high index of success in the identification of SN in patients with oral cavity cancer, while lymphogammagraphy identifies patients with anatomically unexpected drainage. Patients with T1 less than 2cm, not located on the tongue with thickness <5 mm and more than 2 SN were less likely to have metastasis in non-sentinel nodes. The identification of at least 3 sentinel nodes decreases the possibility of identifying patients with hidden metastasis (p=0.04).

Adult↗

PubMed1995

Supraglottic laryngectomy with or without postoperative radiotherapy in supraglottic carcinomas.

A retrospective review of 193 previously untreated patients with primary supraglottic carcinoma was undertaken to ascertain the efficacy of postoperative radiotherapy. All the patients received a supraglottic laryngectomy, and patients received a total of 284 elective or therapeutic neck dissections. Ninety-four (48.7%) of the patients received postoperative radiotherapy. The incidence of local recurrence was 8.2% but the recurrence rate was unrelated to the use of postoperative radiotherapy. Neck recurrence was observed in 12.9% of patients, with no influence of postoperative radiotherapy in the dissected neck. The incidence of locoregional recurrences by stage in irradiated and nonirradiated patients did not reach significant difference. The 3-year survival was 74.3%. The overall survival of the whole series and by stage was not statistically altered in combined therapy compared to surgery.

Adult↗

PubMed2005

Diagnosis and management of neck metastases from an unknown primary.

Neck lymph node metastases from occult primary constitute about 5%-10% of all patients with carcinoma of unknown primary site. Metastases in the upper and middle neck (levels I-II-III-V) are generally attributed to head and neck cancers, whereas the lower neck (level IV) involvement is often associated with primaries below the clavicles. Diagnostic procedures include a careful clinical evaluation and a fiberoptic endoscopic examination of the head and neck mucosa, biopsies from all suspicious sites or blindly from the sites of possible origin of the primary, computerized tomography scan, and magnetic resonance. The most frequent histological finding is Squamous Cell Carcinoma, particularly when the upper neck is involved. In these cases, a systematic tonsillectomy in the absence of suspicious lesions is discussed since up to 25% of primary tumours can be detected in this site. Thoracic, and abdominal primaries (especially from lung, oesophagus, stomach, ovary or pancreas) should be sought in the case of adenocarcinoma and involvement of the lower neck. Positron emission tomography with fluoro-2-deoxy-D-glucose allows detection of primary tumour in about 25% of cases, but this procedure is still considered investigational. Therapeutic approaches include surgery (neck dissection), with or without post-operative radiotherapy, radiotherapy alone and radiotherapy followed by surgery as reported by several guide-lines. In early stages (N1), neck dissection and radiotherapy seem to have similar efficacy, whereas more advanced cases (N2, N3) require combined approaches. The extent of radiotherapy (irradiation of bilateral neck and mucosa versus ipsilateral neck radiotherapy) remains debatable. A potential benefit from extensive radiotherapy should be weighed against its acute and late morbidity and difficulties in re-irradiation in the case of subsequent primary emergence. The role of other methods, such as chemotherapy and hyperthermia, remains to be determined.

Aged↗

PubMed1984

Results of twice-a-day irradiation of squamous cell carcinomas of the head and neck.

The results of twice-a-day irradiation for moderately advanced and advanced squamous cell carcinomas of the head and neck in 57 patients, treated at the University of Florida between March 1978 and July 1981, are reviewed. Fifty patients received irradiation alone to the primary site with or without neck dissection; 7 patients received preoperative irradiation (5040-6000 rad) followed in 4-6 weeks by resection of the primary tumor and neck dissection(s). Two 120 rad treatments were administered daily, with a 4-6 hour interval between fractions. External beam tumor doses were usually 7440-7680 rad when irradiation alone was used for the primary lesion; 2 of 3 T2 and 11 of 13 (85%) T3 lesions that received greater than or equal to 7440 rad remain locally controlled at 2-5 years' follow-up. External beam doses of 7440 rad controlled only 1 of 10 T4 cancers; higher doses controlled 3 of 8 T4 lesions. One severe complication of irradiation and 2 severe complications of salvage surgery have occurred in the group that received irradiation alone to the primary lesion. Five of the 7 patients who received planned combined preoperative irradiation plus surgery to the primary tumor were alive and free of disease at 2 years. Absolute disease-free survival at 2 years for the entire patient group was 23/57 (40%).

Adult↗

PubMed1994

[Small-cell carcinoma of the parotid gland. Apropos of a case].

One case of primary small cell carcinoma of the left parotid gland is reported. A total parotidectomy with facial nerve preservation and left functional neck dissection was performed, with postoperative radiotherapy to the surgical area. A lymph node metastases appears 4 months later, and it needs radical neck dissection followed by chemotherapy. 18 months following initial surgery, our patient is free of disease. The ultrastructural and immunohistochemical studies does not suggest an origin neuroendocrine of the carcinoma. This tumor appears to have a better prognosis than small cell carcinoma of the lung, which it resembles histologically.

Carcinoma, Small Cell↗

PubMed1994

Performance status after treatment for squamous cell cancer of the base of tongue--a comparison of primary radiation therapy versus primary surgery.

PURPOSE: To compare the quality of life and functional outcome in patients with squamous cell cancer of the base of tongue treated with primary radiation vs. primary surgery. METHODS AND MATERIALS: At our institution, patients with base of tongue cancer are primarily treated either by radiation or surgery depending upon the philosophy of their primary physician. Primary radiation consists of 45-54 Gy external beam radiation followed by an 192Ir implant delivering an additional 20-30 Gy over 2-3 days. A neck dissection is done at the same time as the implant for those with involved nodes. Primary surgery consists of resection of the base of tongue lesion, neck dissection and postoperative radiation therapy. Because both groups have similar local control in our experience (80-90%), we used a subjective performance status scale for head and neck cancer patients to assess the quality of life in these patients (0-100, 0 = worst function, 100 = normal function). This scale measures ability to eat in public, understandability of speech, and normalcy of diet. There were 30 radiation patients (21: T1-T2; nine: T3-T4) and ten surgery patients (five: T1-T2; five: T3-T4) available for long-term quality of life assessment. RESULTS: Patients treated with radiation had consistently better performance status scores and quality of life according to our study. This was true for those with early (T1-2) as well as more advanced (T3-4) disease. For eating in public, T1-2 patients had scores of 85 vs. 75 (p = .31) and T3-4 patients had scores of 82 vs. 35 (p < .0001) for radiation vs. surgery, respectively. For understandability of speech, T1-2 patients had scores of 92 vs. 65 (p = .0021), and T3-4 patients had scores of 95 vs. 35 (p < .0001) for radiation vs. surgery, respectively. For normalcy of diet, T1-2 patients had scores of 74 vs. 50 (p = .047), and T3-4 patients had scores of 78 vs. 32 (p = .0012) for radiation vs. surgery, respectively. In addition, we compared scores for early vs. advanced disease treated by the same modality. For radiation, there was no difference in all three functional categories for T1-2 vs. T3-4 (p = .84), showing that quality of life scores remain high for all stages. For surgery, functional status deteriorated significantly when comparing T1-2 vs. T3-4 (p = .0014), consistent with the fact that larger tumors require more extensive operations. CONCLUSION: Radiation therapy provides a better performance status than surgery for base of tongue cancer. This is true for both early and advanced disease. Because radiation also provides similar local control and survival, our data suggests that radiation may be the preferred strategy. Functional scores remain high for all T stages treated with radiation, but deteriorate with more advanced T stages for patients treated with surgery. Similar studies using objective criteria are needed to further compare these treatments.

Adult↗

PubMedDate not supplied

[Positron emission tomography in carcinomas of the head and neck].

Recently published studies indicate a potential clinical application of PET in head and neck tumors. In the preoperative staging phase, PET enables confirmation of regional lymph node extension and guides nodal neck dissection or systemic treatment. In this phase, a high negative predictive value, near 100%, could make it possible to avoid many negative neck dissections. This is a reliable technique for confirming or excluding the presence of recurrent/residual tumor and for obtaining an early evaluation of chemotherapeutic and radiotherapeutic response. PET imaging in many cases makes it possible to locate and guide histological study of tumors with an unknown primary. PET imaging for these indications is a perfect complementary method for clinical exploration and better than other imaging techniques.

Head and Neck Neoplasms↗

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