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PubMed1998

Positron emission tomography in the evaluation of the negative neck in patients with oral cavity cancer.

OBJECTIVE: Proper management of the clinically negative neck (N0) in patients with squamous cell carcinoma (SCC) of the oral cavity (OC) is controversial. Detecting cervical metastasis in these patients is important, because cervical lymph node metastasis is associated with an unfavourable prognosis. Conventional radiographic studies, such as computerized tomography (CT) and magnetic resonance imaging (MRI), may augment physical examination. However, there are still limitations of these modalities in detecting the presence of metastatic cervical disease. Positron emission tomography (PET) is a functional imaging modality that has recently been used in patients to detect head and neck neoplasms. We report using PET in the evaluation of the N0 neck in 11 consecutive patients with SCC of the OC who underwent neck dissection. METHOD: The results of PET scans were correlated with the pathologic findings of 19 neck dissections. RESULTS: Four patients (36%) undergoing 7 neck dissections (37%) had pathologic evidence of disease. Positron emission tomography scans were positive in all of these patients and in all pathologically confirmed cervical metastasis. Seven patients (64%) undergoing 12 neck dissections (63%) had no pathologic evidence of cervical metastasis. Positron emission tomography scans were negative for malignancy in all of these seven patients. In the patient with SCC of the OC with a clinically N0 neck, we found PET to have an overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 100%. Computerized tomography demonstrated 40%, 88%, 67%, 70%, 69%, respectively. In all statistical categories except specificity (p = .1), PET demonstrated statistical significance (p < .05) over CT. CONCLUSION: Positron emission tomography appears to be a promising diagnostic aid that may be applied when evaluating the N0 neck for patients with SCC of the OC.

Adult↗
PubMed1998

Metastatic tumours of the parotid gland.

Twenty patients (12 men and 8 women, median age 69 years) with metastatic tumours in the parotid gland who presented over a 12-year period were evaluated retrospectively. Preoperative investigations included fine needle aspiration cytology (n = 11) and computed tomography or magnetic resonance imaging (MRI) (n = 14). Most tumours originated from the head and neck region, the two main types being squamous cell carcinoma (n = 10) and malignant melanoma (n = 7). All 20 presented with a parotid mass and 11/20 (55%) had associated lymphadenopathy. Eleven patients (55%) underwent superficial, five total, and four radical, parotidectomy. Neck dissection was required in 16 patients (80%), and all 11 patients with clinically palpable lymph nodes had evidence of tumour in the neck dissection specimens. Half of all patients (n = 10) received adjuvant postoperative radiotherapy. Three-quarters of the patients (n = 15) were alive after a mean follow-up of 31 months and only one developed a marginal recurrence. The cumulative 5-year survival rate was 51%, and there was no significant difference (P = 0.48) in the 3-year survival rates of patients who had radical compared with those who had modified neck dissections. Patients who had superficial parotidectomy had a longer overall survival compared with those who had total or radical parotidectomy (P = 0.04) perhaps reflecting the advanced nature of tumours that required total or radical excision of the gland. We conclude that superficial parotidectomy is usually an adequate treatment for secondary parotid tumours (when disease is clinically limited to the superficial lobe), and we suggest that patients in whom metastatic disease of the parotid gland is suspected do not require neck dissection if they have no palpable lymph nodes and MRI shows no evidence of spread. There seems to be no survival advantage in radical over modified neck dissection.

Adolescent↗
PubMedDate not supplied

[Latero-cervical adenopathies due to occult tumors: clinical experience and considerations on the therapeutic treatment].

The treatment of patients with occult primary tumors presenting cervical metastases is still controversial. Thus the treatment of 10 patients with cervical metastases from unknown primary sites observed from 1978 to 1987 is reviewed. The average age of these patients was 56 years with a male: female ratio of 9:1. Any patients previously treated for cephalic or extracephalic neoplasms were excluded from the study as were those with lymphomas. According to TNM classification (1978) 7 cases (70%) were N1, one (10%) was N2 and two (20%) were N3. Only in one case were the cervical metastases multiple and unilateral, in one case (N2) they were bilateral. Histopathological diagnosis was performed with open biopsy in all cases prior to radical or conservative neck dissection. Five patients (50%) had metastases from epidermoid carcinoma, two (20%) from undifferentiated carcinoma (non nasopharyngeal), one (10%) from a papillary thyroid carcinoma, one (10%) from undifferentiated nasopharyngeal carcinoma and one (10%) from adenocarcinoma. The neck locations of the metastases were as follows: 3 (30%) at the upper cervical nodes (as was the N2 case), 3 (30%) at the mid-jugular nodes, 1 (10%) at the lower cervical nodes, 1 (10%) at the supra-clavicular nodes and 1 (10%) at the jugulo-digastric node. In the only case of multiple and unilateral nodes (10%) a contemporary involvement of the mid-jugular and lower cervical nodes was observed. A complete history was taken and a general physical and E.N.T. examination, X-ray, radioisotope and endoscopic studies were performed for all patients. In all cases treatment was: surgery on N + radiation therapy on the most common sites of unknown primary tumors. In particular, 7 conservative neck dissections (bilateral in one case), 2 radical neck dissections and 1 modified radical neck dissection were performed. The survival rate was 60% at 3 years and 40% at 5 years; it may be due to the radical treatment and to the high number of N1 and epidermoid carcinomas. In conclusion some considerations about the treatment of this pathology were reported.

Adenocarcinoma↗
PubMed2001

[Surgical treatment of carcinoma of the hypopharynx and cervical esophagus].

This paper discusses several recent advances in surgical methods for treatment of cancer of the hypopharynx and cervical esophagus. The standard surgical technique for the primary lesion is laryngo-pharyngo-esophagectomy in which the larynx is usually resected to prevent postoperative aspiration even if the cancer does not directly involve the larynx. Another common technique is total laryngectomy plus partial resection of the hypopharynx, where a very limited lesion in the unilateral pyriform sinus is resected with the surrounding hypopharyngeal mucosa and larynx. In this case, the defect in the hypopharyngeal mucosa is primarily sutured or reconstructed with a graft based on its size. Experience has demonstrated that the larynx can be preserved without any postoperative aspiration if it is not involved by cancer and surgeons design the lines of resection and the postoperative shape of the reconstructed area to prevent aspiration. It has also been demonstrated that even if a part of the larynx is involved and must be resected, the remaining portion of the larynx can sometimes be preserved without any distinct aspiration. There are two common surgical techniques for neck lymph nodes. Radical neck dissection is the classic one, in which the lymphatic tissues together with the surrounding structures, including the sternocleidomastoid muscle, internal jugular vein, and accessory nerve are resected. Conservative neck dissection resects the lymphatic tissues only and preserves other structures. Currently, the standard surgical technique is conservative neck dissection. Radical neck dissection is rarely performed now because its morbidity is much higher and its superiority in treatment results has not been established.

Esophageal Neoplasms↗
PubMed1999

Factors influencing contralateral lymph node metastasis from oral carcinoma.

BACKGROUND: An ipsilateral neck dissection is mandatory during initial treatment stages II-IV oral carcinomas. However, no consensus exists whether or not to perform an elective contralateral neck dissection. METHODS: Five hundred thirteen consecutive cases of squamous cell carcinoma (269 tongue, 135 floor of the mouth, 44 inferior gingiva, 65 retromolar trigone) were reviewed. Tumor stages were: 69 T1, 227 T2, 217 T3-T4, 263 N0, 250 N1-N3. A total of 563 neck dissections were performed in 448 patients. Univariate and multivariate analysis of risk factors were performed using logistic regression. RESULTS: Two hundred twenty-three patients (49.8%) had positive nodes in the specimen (182 ipsilateral, 36 bilateral, 5 contralateral). Contralateral neck recurrences occurred in 38 cases (33 not submitted to a contralateral neck dissection initially). Multivariate logistic regression analysis demonstrated that clinical stage (p = .0001), tumor crossing midline (p = .0011), and floor of the mouth involvement (p = .0236) were the most important predictors of contralateral metastasis. CONCLUSION: The contralateral side of the neck is a common and potentially preventable site of recurrence in tumors of the oral cavity. The multivariate model obtained discriminates patients with low and high risk (more than 20%) of contralateral metastasis. The application of this mathematical model can be useful for the indication of contralateral neck dissections, because not all tumors crossing midline are associated to a high risk (stages I and II tumors not involving the floor of the mouth) and not all tumors not crossing midline are at low risk (stages III and IV tumors involving the floor of the mouth).

Adult↗
PubMed1999

Oncological and functional outcome of conservative surgery for primary supraglottic cancer.

The aim of this study was to verify the oncological and functional outcome of conservative surgical treatment of primary supraglottic squamous cell carcinoma (SGSCC) and related neck disease in order to verify the effectiveness of supraglottic laryngectomy (SL) and the validity of an "observation" policy in the control of clinically negative (N0) necks. Of a total of 252 consecutive patients affected by primary SGSCC seen between 1975 and 1990 at the Department of Otolaryngology of the University of Perugia (1975-1987) and the Catholic University of the Sacred Heart of Rome (1988-1990), a subset of 132 patients treated with classical SL was evaluated after presenting sufficient clinicopathological data and a follow-up period of at least 5 years. Tumors were staged according to the 1992 UICC TNM classification and grouped into stages I-II (n = 94) and III-IV (n = 38). Comprehensive neck dissections were performed only in the clinically positive (N+) necks (25/132 cases), while in the clinically N0 ones (107/132 cases) an "observation" policy under strict follow-up conditions was adopted. After primary surgery, the 5-year relapse-free survival (RFS) was 74%. The RFS was 80% for T1-2 disease and 65% for T3. The RFS was 80% for stages I-II tumors and 71% for stages III-IV. The actual 5-year overall survival (OS) was 89% for T1-T2 tumors and 67% for T3 disease or 93% for stage I-II and 69% for stages III-IV. The OS was 89% for N0 neck and 73% for N+. The 5-year-metastasis-free survival (MFS) was 83% for N0 patients, 74% for N+, 84% for T1-T2 N0, 71% for T1-T2 N+, 81% for T3 N0 and 68% for T3 N+. In all, SL was found to be highly effective in the management of primary SGSCC. In the presence of clinically N0 neck "observation" under strict follow-up with therapeutic comprehensive neck dissection for delayed nodal recurrence, SL was suitable for controlling the neck cancer, as well as for salvaging recurrent disease. Bilateral elective, selective or functional neck dissection in every instance of supraglottic cancer was best performed only in those SGSCC patients who were more likely to have occult nodal disease on the basis of biological factors and imaging data.

Actuarial Analysis↗
PubMed2001

Incidence of cervical node involvement in metastatic cutaneous malignancy involving the parotid gland.

BACKGROUND: The parotid lymph nodes represent an important group of nodes at risk for metastatic involvement from cutaneous malignancies of the head and neck. When treating patients with metastatic disease in the parotid gland it has been our custom to also remove the lymph nodes of the neck on the basis that these nodes represent other nodal groups at risk for metastatic involvement. The aim of this study is to determine the incidence of cervical node involvement among patients with clinical metastatic SCC or melanoma of the parotid to determine whether treatment of the clinically negative neck is warranted. METHODS: The study group consists of 123 prospectively accessioned patients with clinical metastatic cutaneous squamous cell carcinoma (SCC) (n = 73) or melanoma (n = 50) involving the parotid gland and a minimum of 2 years of follow up, irrespective of the clinical status of the neck. RESULTS: Among 73 patients with metastatic SCC in the parotid, 19 (26%) had clinical neck involvement, and 16 of these were pathologically positive (84%). A total of 37 patients had elective neck dissections, and 13 were pathologically positive, which is an overall rate of 52% neck involvement among patients having neck dissection. Among 50 patients with metastatic melanoma in the parotid, 19 (38%) patients were initially seen with clinical neck disease, and all were pathologically positive. Among 31 patients with clinically negative necks, 26 had neck dissections and seven had positive nodes (27%). Overall, 58% of patients with melanoma who had a neck dissection had positive nodes. CONCLUSION: Patients with metastatic cutaneous SCC and melanoma involving the parotid gland had a high incidence of clinical (26% and 38%, respectively) and occult neck disease (35% and 27%). Treatment of the clinically negative neck in the presence of clinical metastatic parotid cancer should be considered to reduce the likelihood of failure in cervical nodes, to define the extent of disease, and to assist with patient selection for adjuvant therapy.

Aged↗
PubMed1999

[A clinical and pathological study on cervical lymph node metastasis in the clinical N0 patient with laryngeal carcinoma].

OBJECTIVE: To study the characteristics of the cervical lymph node metastasis in negative nodes (N0) with clinically with laryngeal carcinoma patients and its implication in clinical treatment. METHODS: Forty patients with laryngeal carcinomas of No category were divided randomly into two groups: 13 radical neck dissections (RND) and 27 functional neck dissections (FND) were performed. Lymph nodes were studied histologically. RESULTS: On an average, 34.2 lymph nodes were obtained in one side of neck in RND group, and 27.4 in FND group (t = 0.86, P > 0.05). The metastases rates were 30.8% (4/13) in RND group and 33.3% (9/27) in FND group, and the total metastasis rate was 32.5% (13/40). Twelve of 13 patients (92.3%) who had positive nodes involved only the levels II and III, and 32 of 33 positive nodes (96.9%) were located in the levels II and III. The 3-year survival rates of the two groups were 69.2% (9/13) and 77.8% (21/17), respectively with no statistical difference (chi 2 = 0.3418, P > 0.5). Total 3-year survival rate was 75% (30/40). CONCLUSION: The supraomohyoid (level Io II and III) or lateral neck (level II, III and IV) dissections seem suitable for the treatment laryngeal carcinoma patients with clinically negative neck nodes.

Adult↗
PubMed2000

Cervical node metastases in laryngeal and hypopharyngeal cancer: a prospective analysis of prevalence and distribution.

BACKGROUND: We have prospectively analyzed the prevalence and distribution of histologic cervical node metastases in laryngeal and hypopharyngeal squamous carcinoma to determine the most appropriate form of neck dissection. METHODS: We have examined specimens from 100 consecutive patients in whom neck dissection was part of the primary treatment of laryngeal and hypopharyngeal carcinoma. Fifty eight patients were treated by unilateral or bilateral selective dissection of levels I to IV +/- VI for N0 disease and 42 by comprehensive dissection for N+ disease. Assessment was by separation of the specimens into node levels at the time of surgery and embedding all the resected material for histologic analysis. RESULTS: Nodal metastases were found in 36% of ipsilateral and 27% of contralateral dissections in the N0 cases. The corresponding prevalences in N+ cases were 90% and 37%, respectively. All metastases in N0 and N1 disease were confined to levels II, III, IV, and VI. Metastases to levels I and V were infrequent even in N+ disease. CONCLUSIONS: Our results support the use of elective dissection of node levels II to IV for N0 laryngeal and hypopharyngeal carcinoma. We suggest the inclusion of level VI nodes for tumors invading the subglottis, pyriform fossa apex, and postcricoid region. The prevalence of bilateral metastases is great enough in midline or bilateral tumors to justify bilateral selective dissection. It is possible that selective neck dissection is also adequate for small palpable metastases, but greater numbers are required to confirm this.

Carcinoma, Squamous Cell↗
PubMed2005

Predictive factors for posterior triangle metastasis in HNSCC.

OBJECTIVE: Surgical modifications sparing uninvolved structures such as the spinal accessory nerve have been implemented since the advent of the radical neck dissection in 1906. The increased morbidity to the spinal accessory nerve involved with the dissection of level V lymph nodes has led to much controversy. In this study, we examine the incidence of nodal metastasis to all nodal levels involved with upper aerodigestive squamous cell carcinoma and attempt to determine when level V dissection is indicated. STUDY DESIGN: Retrospective chart review. METHODS: A study of all radical and modified radical neck dissections was performed at Louisiana State University - Shreveport Health Sciences Center and Overton Brooks Veterans Administration Hospital between 1996 and 2003 for upper aerodigestive squamous cell carcinoma. Univariate and multivariate analyses were performed to determine which neck and patient factors were significantly associated with level V metastasis. RESULTS: Seventy-nine patients with a total of 94 neck dissections were analyzed. The prevalence of level V metastasis was 7.4% of the total neck dissections. Multivariate analysis found that positive lymph nodes involving levels II, III, and IV was the only independent significant factor for level V metastasis (P = .0003). CONCLUSION: Our study is in concordance with other studies in the literature, revealing a low prevalence of level V metastasis in upper aerodigestive squamous cell carcinoma. Unlike other studies, we have found if levels II, III, and IV lymph nodes are found to be positive, dissection of level V is warranted.

Adult↗
PubMed2006

Distributions of cervical lymph node metastases in oropharyngeal carcinoma: therapeutic implications for the N0 neck.

OBJECTIVES: This study sought to investigate the patterns and distributions of lymph node metastases in oropharyngeal squamous cell carcinoma (SCC) and improve the rationale for elective treatment of N0 neck. MATERIALS AND METHODS: One hundred four patients with oropharyngeal SCC who underwent neck dissection between 1992 and 2003 were analyzed retrospectively. All patients had curative surgery as their initial treatment for the primary tumor and neck. A total of 161 neck dissections on both sides of the neck were performed. Therapeutic dissections were done in 71 and 5 necks and elective neck dissection was done on 33 and 52 necks on the ipsilateral and contralateral sides, respectively. Surgical treatment was followed by postoperative radiotherapy for 78 patients. The follow-up period ranged from 1 to 96 months (mean, 30 months). RESULTS: Of the 161 neck dissection specimens evaluated, 90 (56%) necks were found to have lymph node metastases found by pathologic examination. These consisted of 76 (73% of 104 necks) of the ipsilateral side and 14 (25% of 57 necks) of the contralateral side dissections. The occult metastatic rate was 24% (8 of 33) of ipsilateral neck samples and 21% (11 of 52) of contralateral neck samples. Of the 68 patients who had a therapeutic dissection on the ipsilateral side and had lymphatic metastasis, the incidence rate of level IV and level I metastasis was 37% (25 of 68) and 10% (7 of 68), respectively. Isolated metastasis to level IV occurred on the ipsilateral side in three patients. There were no cases of isolated ipsilateral level I pathologic involvement in an N-positive neck or occult metastasis to this group. The incidence rate of level IV metastasis in patients with ipsilateral nodal metastasis was significantly higher in base of tongue cancer (86% [6 of 7]) compared with tonsillar cancer (34% [20 of 59]) (P=.013). Patients with level IV metastasis had significantly worse 5-year disease-free survival rates than patients with metastasis to other neck levels (54% versus 71%; P=.04). CONCLUSION: These results suggest that elective N0 neck treatment in patients with oropharyngeal SCC, especially base of tongue cancer, should include neck levels II, III, and IV instead of levels I, II, and III.

Adult↗
PubMedDate not supplied

[Evaluation of occult lymph node metastasis in lower lip cancers and approach to N(0) neck metastasis].

OBJECTIVES: In this study, we evaluated the incidence of occult lymph node metastasis and the approach to N0 necks in carcinoma of the lower lip. PATIENTS AND METHODS: Sixty-eight patients who underwent surgery for squamous cell carcinoma of the lower lip were monitored for a minimum period of three years. All the patients were males (mean age 54 years; range 36 to 69 years). Preoperatively, 15 and 53 patients had N+ and N0 necks, respectively. Depending on the tumor localization, unilateral or bilateral suprahyoid neck dissections were performed. Nine patients underwent radical neck dissection following detection of metastasis on histopathologic examination. RESULTS: Histopathologic examination revealed metastasis in four patients (4/15; 26%) with N+ necks and in five patients (5/53; 9.4%) with N0 necks. Four patients (6.7%) developed late cervical lymph node metastasis at level 3. No evidence of neck disease was encountered in 93% of patients. CONCLUSION: Suprahyoid neck dissection appears to be effective in detecting occult lymph node metastasis. With improved surgical and histopathologic techniques and consideration of skip metastasis, more aggressive treatment approaches may be employed and better survival rates may be obtained.

Adult↗
PubMed1994

[Clinical significance of intraoperative frozen biopsy of cervical lymph node for laryngeal cancer].

The results of intraoperative and postoperative pathologic examination in 102 cases of laryngeal cancer were reported. The overall consistent rate of intraoperative and postoperative biopsy was 114/116(98%). The consistent rate of positive result was 40/40(100%), while the consistent rate of negative result was 74/76(97%). The pathological and clinical results showed that the intraoperative frozen biopsy could confirm the metastasis of cervical lymph node. When frozen biopsy was positive, the neck dissection should be performed. When frozen biopsy was negative, the neck dissection should not be performed in most cases, or the functional neck dissection may be performed in some cases.

Adult↗
PubMed1997

[Comparison between radiotherapy and radiotherapy after laser operation and neck block dissection in the treatment of nasopharyngeal cancer].

Two groups of patients who suffered from nasopharyngeal carcinoma were treated by different methods. Group one of 67 patients accepted radiotherapy after laser operation and neck block dissection. Group two of 42 patients were treated by radiotherapy only. The survival rate after five years was 76.1% in group one, and 46.9% in group two. The curative results showed that group one was superior to group two. Nd: YAG laser treatment of the original lesion followed by neck block dissection of the metastatic lymph nodes and radiotherapy can yet be regasded as a new method.

Adult↗
PubMed2003

[Regularity and therapeutic strategy of cervical lymph node metastasis in squamous cell carcinoma of the tongue].

BACKGROUND & OBJECTIVE: At present, whether neck dissection should be employed in squamous cell carcinoma (SCC) of the tongue with clinically node negative neck(cN0) is still controversial. This study was designed to explore the regularity of cervical lymph node metastasis in SCC of the mobile part of the tongue, and to discuss the theories and principles of employment of selective neck dissection in cN0 cases. METHODS: A retrospective research was performed on clinical data of 214 cases of SCC of the tongue treated with surgery from 1991 to 1997. Distribution of cervical lymph node metastasis of cN0 pN(+)= (pathologically node positive) and cN(+) (clinically node positive) pN(+)= cases were analyzed; the survival rates of different groups were compared; the factors that impact the survival of SCC of the tongue were screened out by Cox regression analysis. RESULTS: Cervical lymph node metastases were found in 69 cases. The metastatic rate was 32.2%. Metastases occurred in level I, II, III, IV, V of the ipsilateral neck were 22.3%, 33.5%, 22.3%, 4.6%, 1.0%, in level I,II,III, IV,V of the contralateral neck were 6.6%, 3.6%, 3.0%, 2.0%, 0.5%, respectively. The 5-year survival rates of the pN(+)= group and the pN0 group were 47% and 83%, respectively(P< 0.001). T stage and N stage were independent factors that impact the long-term outcome of SCC of the tongue. CONCLUSION: Level I,II,III of the ipsilateral neck tend to be involved when cervical lymph node metastases occur. Selective neck dissection can be used to treat the cervical metastasis in cN0 cases, as well as to evaluate the cervical lymph node status in order to determine whether comprehensive neck dissection should be employed.

Adult↗
PubMed1998

Criteria for diagnosing lymph node metastasis from squamous cell carcinoma of the oral cavity: a study of the relationship between computed tomographic and histologic findings and outcome.

PURPOSE: This retrospective study was conducted to determine the relationship between the computed tomographic findings for cervical lymph nodes (LN), histologic findings, and outcome in patients with squamous cell carcinoma of the oral cavity who underwent radical neck dissection. PATIENTS AND MATERIALS: Sixty-six patients were analyzed. Of these 66 operations, 43 were immediate therapeutic dissections in clinically N+ necks, and 23 were subsequent therapeutic dissections in patients whose necks were initially node free but progressed to positive nodes during observation. RESULTS: When the size criterion (area of the axial section) of nodal metastasis depicted on the scan of 45 mm2 was selected, almost 78% of LN were diagnosed consistent with the histologic diagnosis. As the size of the LN increased, the frequency of extranodal invasion also became higher, whereas patients with the higher histologic grades of malignancy often showed neck metastases with extranodal invasion in the early stage. Patients having LN smaller than 100 mm2, or without extranodal invasion, showed good outcome, whereas those having LN 100 mm2 or larger, with extranodal invasion, showed extremely poor outcome. CONCLUSIONS: These findings indicate that it is possible to delay neck dissection in node-free patients until neck disease is diagnosed with timely CT examination, although great caution is necessary, especially in those with a high histologic grade of malignancy.

Biopsy↗
PubMed2002

Sentinel lymph node biopsy in head and neck squamous cell carcinoma.

OBJECTIVES/HYPOTHESIS: Sentinel lymph node biopsy is a minimally invasive method to stage the regional lymphatics that has revolutionized the management of patients with intermediate-thickness cutaneous melanoma. Head and neck surgeons have been encouraged by the accuracy of sentinel lymph node biopsy in cutaneous melanoma and have applied the technique to patients with head and neck squamous cell carcinoma (HNSCC). The objectives of the study were 1) to study the feasibility and accuracy of sentinel lymph node biopsy as a method to stage the regional lymphatics in HNSCC and 2) to determine whether there are qualitative differences between the cutaneous and mucosal lymphatics that would affect the technique used in HNSCC. STUDY DESIGN: Two methods of investigation were employed: a prospective laboratory study using a feline model for sentinel lymph node biopsy and a retrospective review of patients who received lymphoscintigraphy before neck dissection and intraoperative identification of the sentinel lymph node. METHODS: Lymphoscintigraphy and a gamma probe were used in four felines to study the kinetics of technetium-labeled sulfa colloid (Tc-SC) in the mucosal lymphatics. In the second part of the feline study, eight subjects were studied intraoperatively. Tc-SC and isosulfan blue dye were used to study the injection technique for the mucosal lymphatics and to determine the time course of the dye and Tc-SC to the sentinel lymph node. In Part II of the present study, a retrospective review of 33 patients with HNSCC was conducted. Twenty patients (stage N0) whose treatment included elective neck dissection were studied with preoperative lymphoscintigraphy and underwent intraoperative identification of the sentinel lymph node to determine the accuracy and feasibility of sentinel lymph node biopsy. Eight patients with palpable neck disease and five patients with recurrent or second primary disease whose previous treatment included neck dissection were also studied with lymphoscintigraphy before neck dissection. RESULTS: In the feline study, both Tc-SC and isosulfan blue dye traversed the lymphatics rapidly, appearing in the sentinel lymph node in less than 5 minutes. Modification of the injection technique used for cutaneous melanoma was required to depict the sentinel lymph node of the base of tongue. In the human study, the sentinel lymph node was accurately identified in 19 of 20 (95%) N0 patients. On average, 2.9 sentinel lymph nodes (range, 1-5) were identified in 2.2 (range, 1-4) levels of the neck. Sentinel lymph nodes were bilateral in 4 of 19 patients. When the sentinel lymph node was identified, it accurately predicted the pathological nodal status of the regional lymphatics. Three of 20 patients had cervical metastases, and the sentinel lymph node was identified in 2 of 3 patients with pathologic nodes (pN+). Focal areas of radiotracer uptake were identified in seven of eight patients with palpable disease. These areas corresponded to the level with palpable disease in four patients. The lymphatics delineated by lymphoscintigraphy in the five patients with previous neck dissection were outside the levels that had been dissected. Lymphoscintigraphy depicted collateral patterns of lymphatic drainage. CONCLUSIONS: Sentinel lymph node biopsy is technically feasible and is a promising, minimally invasive method for staging the regional lymphatics in patients with stage N0 HNSCC. Lymphoscintigraphy alone may determine the levels that require treatment in patients with disrupted or previously operated cervical lymphatics.

Adult↗
PubMedDate not supplied

[Gastric pull-up in hypopharyngeal and cervical esophageal cancers].

OBJECTIVES: Gastric pull-up is a common technique in the reconstruction of gastrointestinal continuity following surgery for the primary esophageal and hypopharyngeal tumors with involvement of the esophagus. We evaluated the results of surgery in patients with cervical esophageal and hypopharyngeal cancers. PATIENTS AND METHODS: Eleven patients (4 women, 7 men; mean age 46 years; range 18 to 70 years) underwent surgery for hypopharyngeal and cervical esophageal epidermoid carcinoma. Surgery included pharyngolaryngoesophagectomy, subtotal thyroidectomy, and gastric pull-up in all patients. In addition, nine patients had radical neck dissection on the involved side and modified radical neck dissection on the contralateral side. One patient had bilateral radical neck dissection. Patients who were alive were followed-up for a mean period of 27 months (range 14 to 46 months). RESULTS: The one-, two-, and three-year survival rates were 54% (6/11), 36% (4/11) and 18% (2/11), respectively. Three patients died from early postoperative complications, two from organ failure due to locoregional recurrence (7th month) and to distant metastasis (11th month). CONCLUSION: Despite the small size of the study, the results favor the use of gastric pull-up in selected patients with cervical esophageal and hypopharyngeal cancers.

Adolescent↗