Cervical Metastasis In Patients Research Articles

The effectiveness of the method for determining the level of thyroglobulin in needle washouts of fine-needle aspiration biopsy in the differential diagnosis of metastases of highly differentiated thyroid cancer in the lymph nodes of the neck

Introduction. Thyroid cancer is one of the most common malignant neoplasms of the endocrine system. well-differentiated thyroid cancer constitutes about 90 % of all malignant tumors of the thyroid gland. Despite growing morbidity and high incidence of this pathology, in case of timely diagnosis and treatment well-differentiated thyroid cancer has favorable prognosis.Aim. using clinical examples, to demonstrate the possibility of thyroglobulin measurement in needle washouts of fineneedle aspiration biopsy in the detection of cervical metastases of highly differentiated thyroid cancer.Materials and methods. five patients (2 patients with combined oncological pathology, 2 patients with nodes in the thyroid gland, 1 patient after a thyroidectomy) with cervical adenopathy measured the level of thyroglobulin in the wash out fluid of lymph-nodes biopsy using the immunoradiometric method using the commercial kits of the Institute of Isotopes-IRmA (Hungary).Results. Cervical metastases of highly differentiated thyroid cancer were detected or excluded by the determination of fine-needle aspiration biopsy in patients with non-informational cytological studies. The determination of fineneedle aspiration biopsy is a useful diagnostic method in the differential diagnosis of cervical metastases in patients who have other morphological forms of cancer in addition to well-differentiated thyroid cancer, as well as for the differential diagnosis of cervical adenopathy in patients with a history of highly differentiated thyroid cancer.Conclusion. Determination of thyroglobulin level in puncture needle washout is a simple and useful diagnostic method for differential diagnosis of metastases in lymph nodes of the neck in patients with several morphological forms of malignant tumors.

Impact of Hayes Martin Maneuver and Anterograde Dissection on Identification and Preservation of Marginal Mandibular Nerve during Neck Dissection in Patients with Oral Squamous Cell Carcinoma

Background: Hayes Martin maneuver (HMM) and Anterograde dissection technique (ADT) were originally described in 1951 as a means of preserving the marginal mandibular nerve (MMN) during level 1B clearance in a neck dissection procedure address the cervical metastasis in patients with oral squamous cell carcinomas.
 Objectives: To compare and evaluate the efficacy of HMM and ADT in preservation of MMN using Electromyography of muscles supplied by the nerve ie Mentalis, Depressor labii inferioris and depressor anguli oris, to evaluate muscle function.
 Methodology: 20 patients undergoing neck dissection over a period of 6 months grouped were into two groups (10 patients for Hayes Martin manoeuvre and 10 patients for anterograde dissection technique) calculated by purposive sampling method. Postoperative Electromyography and assessment of nerve function using House and Brackmann grading was done on day 5,15 and 30.
 Expected Results: HMM proves to be a less time consuming technique than Anterograde dissection by a significant margin considering perifacial node clearance and level 1B clearance. Anterograde dissection technique proved to be more effective than Hayes Martin Maneuver for preservation of MMN as average neuromuscular electrical activity in anterograde dissection cases was higher than the average of HMM cases. Although, no significant statistical difference was found when the neural function was compared on a house and brackmann grading scale
 Conclusion: Anterograde dissection technique is technique sensitive, relatively time consuming and requires a higher surgical operator skill. However, provides statistically proven better results in terms of neural electric activity and post-operative functional neural deficit in the operated subjects.

Evaluation and Correlation of Preoperative Serum C- Reactive Protein, Neutrophil-lymphocyte Ratio and Platelet-lymphocyte Ratio for Cervical Metastasis in Patients of Primary Oral Squamous Cell Carcinoma

Background: The influence of cervical metastasis on prognosis in a person who is suffering from oral squamous cell carcinoma (OSCC) has been notorious. C- reactive protein (CRP) is a prior biomarker for inflammation. Recent literature provide evidence of systemic inflammatory markers playing important role in determining survival rate on patient with OSCC. Hence, in current study the “utility of Neutrophil-lymphocyte ratio (NLR) ,Platelet-lymphocyte ratio (PLR), and serum CRP are evaluated and correlated for cervical metastasis”.
 Objectives: This study intends to evaluate and correlate preoperative serum CRP, NLR, and PLR for cervical metastasis in patients of primary oral squamous cell carcinoma.
 Methodology: The clinicopathological data, CRP and the preoperative complete blood investigation details were obtained from 40 primary OSCC patients who will undergo surgery. The optimal cut-off value of CRP, PLR and NLR was determined. The prognostic significance of markers will be determined by Univariate and multivariate analysis.
 Expected Results: The elevation of CRP, NLR, and PLR levels will significantly evaluate and correlate with cervical metastasis.
 Conclusion: Preoperative serum CRP, NLR, and PLR level will be a prognosticator in OSCC.

Study of microscopic neck metastasis in clinically N0 neck in oral squamous cell carcinoma

Background: Metastasis of aerodigestive tract cancers to cervical lymph nodes is one of the otolaryngologists’ concerns that relies on a variety of factors such as the size of the primary tumor and its spread. We aimed to study the prevalence of occult cervical metastases in patients with clinical N0 neck in oral cavity squamous cell carcinoma. Methods: In this cross-sectional analytic study, the researchers referred to the archive of Emam Reza Hospital and studied medical files of patients with a definite diagnosis of oral cavity squamous cell carcinoma admitted from April 2011 to April 2016 while collecting relevant data such as age, gender, size of the primary mass, place of the lesion, clinical and pathological nodal involvement. The data was analyzed employing SPSS 19 whereas the statistical significance level in all exams was set at 0.05. Results: Average age of participants was 61.67 ± 14.02, and they were mostly male. Forty-five percent of participants had a clinical N0 neck and the majority of them didn’t have metastasis in the pathological study. The prevalence of metastatic lymph nodes in patients with clinical N0 was 30%. No significant relationship was observed between the number of lymph nodes containing occult metastasis and T of the tumor (P = .578). Conclusion: In squamous cell carcinoma of oral cavity, the prevalence of metastatic lymph nodes in the neck is 30% and is significantly related to the location of the lesion while no significant relationship to T of the tumor is observed.

Effectiveness of Preoperative Lymphoscintigraphy for the Detection of Cervical Lymph Node Metastasis in Patients with Oral Squamous Cell Carcinoma.

Background:Oral squamous cell carcinoma (OSCC) is one of the most common malignant tumor. OSCC is the malignancy of squamous epithelium of oral cavity, which is the sixth most common malignancy reported worldwide and one with highest mortality rate among all malignancies.Aims:The aims of this study is to assess the diagnostic performance of lymphoscintigraphy (LSG) for the detection of cervical lymph node metastasis in patients with OSCC.Materials and Methods:This was a prospective study done in Oral and Maxillofacial Surgery Department and National Institute of Nuclear Medicine and Allied Science, Bangabandhu Sheikh Mujib Medical University during July 2015–June 2016. Thirty-six patients with OSCC were included in this study. Radioisotope technique was used in the detection of cervical metastases in patients with histologically proven OSCC. Patients were assessed by LSG after diagnosis of OSCC, and then, it was compared with postoperative histopathology report.Results:Lymphoscintigraphically out of 36 patients, 23 had lymphatic channel obstruction where histologically 20 patients had lymph node metastasis. There were 20 true positive cases, 13 true negative cases, and 3 false positive cases but no false negative case was found. The test of validity result reveals that sensitivity 100.0%, specificity 81.25%, accuracy 96.66%, positive predictive value 86.96%, and negative predictive value 100.0%.Conclusion:LSG for the detection of cervical lymph node metastasis has an important role for the management of OSCC. It is also cost-effective and decreases the morbidity.

Preoperative ultrasonography for evaluation of clinically N0 neck in oral cavity carcinoma

The aim of this study was to evaluate preoperative ultrasound criteria to detect lymph node (LN) cervical metastasis in patients with clinically node-negative neck (cN0) oral cavity squamous cell carcinoma (OCSCC). A prospective, single-center, observational study was conducted in 90 patients undergoing cancer excision with or without elective neck dissection (END) between 2005 and 2012. A surgeon and an experienced radiologist performed preoperative cervical ultrasonography in all cases. The primary objective was to obtain an a priori sensitivity of 90% and specificity >50% in cN0 OCSCC staging. The sonographic criteria for LN assessment were as follows: number; neck levels; clusters; aspect; heterogeneity; longitudinal diameter (L); transverse diameter (T); L/T ratio; and combination in series or in parallel of T and L/T ratio. The gold standard for comparison was the LN histological identification of metastasis after END or the occurrence in the follow-up at least 36 months. Statistically significant sonographic criteria in univariate analysis (P < 0.05) were as follows: multilevel lymph nodes, T diameter >6.5 mm, and the combination T > 6.5 mm or L/T < 1.3 ratio; and in multivariate logistic regression analysis were (P < 0.05): combination T > 6.5 mm and L/T < 1.3 ratio, LN in level II, and moderately-poorly differentiated OCSCC. By using selected sonographic criteria, ultrasound can be a valid preoperative diagnostic method to optimize staging cervical metastasis and to help decide about neck dissection.

Ultrasound-guided fine needle aspiration cytology in the assessment of cervical metastasis in patients undergoing elective neck dissection.

Background:In head and neck cancer patients, diagnosis of metastatic cervical adenopathy is essential for treatment planning and prognosis assessment. Treatment of patients with head and neck cancer with clinically negative cervical lymph node (N0) remains controversial. While routine neck treatment would result in overtreatment in many patients, observation may delay the diagnosis and decrease the patients’ survival.Objectives:To gain insights into the unclear questions regarding the value of diagnostic modalities in patients with N0 neck, this study was designed to compare the diagnostic efficacy of palpation, ultrasonography (US) and ultrasound-guided fine needle aspiration (USGFNA) in detecting cervical lymph node metastasis.Patients and Methods:Forty-two patients with head and neck cancer who underwent US and USGFNA prior to elective neck dissection were studied. Histopathologic findings of the neck specimens were compared with each diagnostic technique.Results:Of the 53 neck dissection specimens, histopathology showed metastases in 16 cases. The overall accuracy of USGFNA, US and palpation was 96%, 68% and 70%, respectively. The specificity of USGFNA was superior to palpation and US alone. USGFNA had the highest sensitivity, predictive value and accuracy in detecting cervical metastases compared with other performed tests.Conclusions:In our study, USGFNA was superior to palpation and US in detecting metastasis in clinically negative necks. This method can be recommended as a diagnostic tool in preoperative assessment of patients without palpable metastasis, but further investigations are needed before this modality could be considered as an alternative to elective neck dissection.

Preoperative plasma fibrinogen predicts cervical metastasis in patients with stage I/II carcinoma of the tongue

The aim of this study was to evaluate the association of preoperative plasma fibrinogen levels with clinico-pathological parameters and disease-free survival in patients with oral tongue squamous cell carcinoma (OTSCC). We retrospectively studied 76 patients with OTSCC who underwent a partial glossectomy only, at a single centre, between 1996 and 2007. Among the 76 patients, 30 eventually developed cervical metastasis. Preoperative plasma fibrinogen levels were determined and correlated with clinico-pathological findings by t-test or analysis of variance methods. Univariate and multivariate analyses were used to determine the association of preoperative plasma fibrinogen levels and disease-free survival. Elevated levels of plasma fibrinogen were positively related with growth type (P<0.001), differentiation (P<0.001), thickness (P<0.001), and the infiltrative growth ratio (P=0.032). Univariate analysis showed that growth type (P<0.001), differentiation (P<0.001), thickness (P<0.001), and preoperative plasma fibrinogen levels (P<0.001) were significantly correlated with disease-free survival. Multivariate analysis showed that the plasma fibrinogen level remained an independent factor for disease-free survival after partial glossectomy for OTSCC (P=0.029). A high preoperative plasma fibrinogen level is an independent predictor of cervical metastasis after partial glossectomy for OTSCC. A conservative supraomohyoid neck dissection is appropriate in patients with stage I/II carcinoma of the tongue whose preoperative plasma fibrinogen is >300mg/dl.

A diagnostic meta-analysis: sentinel lymph node biopsy for neck metastasis in patients with early oral squamous cell carcinoma

To evaluate the value of sentinel lymph node biopsy in diagnosis of cervical metastasis in patients with early oral squamous cell carcinoma. Cochrane library, evidence-based medicine (EBM), PubMed, China national knowledge internet (CNKI) were searched for 2001 - 2011 literatures on sentinel lymph node biopsy in patients with oral squamous cell carcinoma as early diagnosis of cervical metastasis. The results were analysed by using Meta-analysis software Metadisc1.4. There were 12 studies in which, a total of 793 patients with oral squamous cell carcinoma were involved in Meta-analysis. The combined sensitivity and specificity were 0.86 (95%CI: 0.81 - 0.90) and 0.99 (95%CI: 0.98 - 1.00) respectively. For early oral cancer patients, the sensitivity and specificity of sentinel lymph node biopsy are relatively high. The sentinel lymph node biopsy could be used to select which patients need neck dissection.

Role of level VI lymph nodes metastasis in cervical metastasis of patients with papillary thyroid cancer

To study the features of level VI lymph node metastasis in papillary thyroid cancer (PTC) and the distribution of metastatic lymph nodes in the neck levels, and to provide evidences for the treatments of cervical metastasis in patients with PTC. Ninety-seven PTC cases were reviewed retrospectively. The tumors in all cases were limited to one side lobe. Of them, 72 patients were cN0 and 25 patients were cN+; 32 patients with tumors ≤ 1 cm and 65 patients with tumors > 1 cm. Pathological examinations of frozen biopsies of level III and IV lymph nodes were taken in the operation. The extent of lymph node dissection depending on pathological examination results of level III and IV lymph nodes and the size and location of the tumor. For the patients with metastatic lymph nodes in level III and IV, the modified neck dissection including level VI was performed. Ipsilateral VI lymph node dissection was performed for the patients with tumors ≤ 1 cm and bilateral VI lymph node dissection for the patients with tumors > 1 cm or with extra-thyroidal invasion. In 97 patients, 122 sides of VI lymph node dissection were performed. Positive nodes in level VI were found in 45.1% (55/122) patients. The positive rates of nodes metastases in level VI were 45.8% (33/72) for 72 patients with cN0 and 76.0% (19/25) for 25 patients with cN+ respectively, with a significant difference statistically (χ(2) = 6.790, P = 0.009). Positive rates of node metastases in level VI were 65.0% (13/20) in 10 patients with extra-thyroidal invasion and 41.2% (42/102) in 77 patients without extra-thyroidal invasion respectively, with a significant difference statistically (χ(2) = 3.833, P = 0.047). Positive rate of node metastasis in level VI was 43.8% (14/32) in 32 patients with tumors ≤ 1cm. Of 65 patients with tumors > 1cm, ipsilateral and bilateral node metastasis rates were 69.2% (45/65) and 23.1% (15/65) respectively, with a significant difference statistically (χ(2) = 5.843, P = 0.016). Cervical lymph node metastasis in level VI can occur at early stage of PTC. The patients with extra-thyroidal invasion were prone to have lymph node metastasis in level VI. Ipsilateral positive nodes in level VI can exist in the patients with tumors ≤ 1 cm, while bilateral positive nodes in level VI can occur in the patients with tumors > 1 cm. The cervical lymph node metastasis of PTC may take place in level VI alone or in level VI and in lateral neck levels simultaneously. Pathological examinations of frozen biopsies of level III and IV lymph nodes should be taken for PTC patients, when the presence of positive lymph node, the modified neck dissection including level VI should be performed.

Immunomodulation of Vitamin D in Head and Neck Cancer

Problem Quantitate the intratumoral differentiation of HNSCC induced immunoinhibitory CD34+ in response to enteral treatment of 1,25 dihydroxyvitamin D3 (1,25D3). Methods 8 patients with HNSCC were treated orally with 3 weeks of 1,25D3 before surgical excision. Tumor tissue was collected and analyzed using immunohistochemistry to test the hypothesis that treatment would drive differentiation of immune inhibitory CD34+ cells into immune stimulatory dendritic cells. Patients’ clinical data for high risk pathological features were also analyzed. Results After 1,25D3 treatment, intratumoral levels of CD34+ cells significantly dropped. Levels of DC-lamp, a cellular marker for mature dendritic cells, significantly increased while there was not a change in intratumoral levels immature dendritic cell marker DC-sign. Levels of CD4+ cells were unchanged while levels of CD8+ cells were significantly decreased. There were no associated statistically significant correlations between CD34+ levels and histological features, although there was a trend of increasing cervical metastasis in patients with increased intratumoral CD34+ cells. Conclusion CD34+ cells are hematopoietically immature cells that have been shown to differentiate to dendritic cells when grown in culture. This is the first study to analyze the effects of enteral 1,25D3 on intratumoral immune infiltrate, specifically CD34+ cells. 1,25D3 stimulated differentiation of CD34+ immunosuppressive cells to differentiate into immunostimulatory dendritic cells. Significance Despite recent advances in treatment, patients with HNSCC have a five year mortality rate of less than 50%. One aspect contributing to the poor prognosis is the profound immunoinhibitory effects induced by HNSCC. It has been shown that CD34+ suppressor cells are a component of this immunosuppresion induced by the carcinoma. Adding 1,25D3 in the treatment of HNSCC decreased levels of intratumoral CD34+ cell population and diminish the profound immunoinhibitory effects of the cancer. These studies support the use of 1,25D3 as a neo-adjunctive therapy to overcome HNSCC profound immunosuppression thereby potentiating other promising immunotherapies. Support Clinical Sciences Research Service, Department of Veterans Affairs, Washington, D.C. Vitamin D therapy to enhance intratumoral anti-cancer immune reactivity October 2004 - September 2009 $747,000; University Research Committee Resident Research Grant, Medical University of South Carolina January 2008 $2,000.

Clinicopathological factors related to cervical lymph node metastasis in a patient with carcinoma of the oral floor

Conclusion. Tumors developing into the muscle layer and tumor thickness ≥5 mm are the most important risk factors associated with nodal metastasis. Objective. It is necessary to identify the risk factors associated with cervical metastasis in patients with oral floor cancer to reveal the role of elective neck dissection for oral floor cancer. Patients and methods. Forty-eight patients with oral floor cancer were retrospectively analyzed for a correlation between clinicopathologic factors and cervical lymph node metastasis using Fisher's exact test and a logistic regression test. Results. Univariate analysis showed significantly positive correlations for growth type, mitosis, perineural invasion, vascular invasion, lymphatic invasion, depth, thickness, and infiltration growth ratio. Multivariate analysis had a significantly positive correlation with nest formation and depth in all patients, and with thickness in patients with T1 or T2. In patients with bilateral cervical lymph node metastasis, lymph node metastasis was significantly positively correlated with perineural invasion.

Predictive Markers for Late Cervical Lymph Node Metastasis in Patients with N0 Squamous Cell Carcinoma of the Tongue

Objective: To find useful markers for predicting late cervical metastasis in patients with N0 squamous cell carcinoma of the tongue.Materials and Methods: The clinicopathological features of 57 consecutive patients with previously untreated N0 squamous cell carcinoma of the tongue were reviewed. Thirty patients had T1 disease, 20 had T2 disease, and 7 had T3 disease. All patients were treated with partial glossectomy without elective neck dissection. Clinicopathological factors were analysed to determine the factors predicting late cervical lymph node metastasis.Results: The overall cervical lymph node metastasis rate was 19.3%. The clinicopathologic factors significantly associated with the development of cervical lymph node metastasis were tumour size (30 mm), tumour depth (4 mm), differentiation (moderate), mode of invasion (G4C 4D), microvascular invasion (present), muscle invasion (present), and invasive front grading (12 points). In a multivariate logistic regression analysis, invasive front grading ≥12 points in squamous cell carcinoma of the tongue with a tumour depth ≥4 mm had predictive value for late cervical lymph node metastasis.Conclusion: The results indicate that patients with N0 invasive tongue carcinoma with a tumour depth ≥4 mm or invasive front grading ≥12 points should be considered at high risk for late cervical lymph node metastasis. These factors should be considered in the decision to electively treat the neck.

S100A2 expression as a predictive marker for late cervical metastasis in stage I and II invasive squamous cell carcinoma of the oral cavity

The purpose of this study was to discover whether S100A2 expression is associated with late cervical metastasis in patients with stage I and II invasive squamous cell carcinoma of the oral cavity. We retrospectively investigated the clinicopathological parameters and S100A2 expression in surgical specimens taken from 52 patients with T1-2N0M0 invasive squamous cell carcinoma of the oral cavity (OSCC) who had not undergone elective neck dissection or irradiation to the neck. All of the clinicopathological factors and S100A2 expression were compared in terms of late cervical metastasis. In univariate analysis, late cervical metastasis correlated with poor overall survival. A higher rate of late cervical metastasis was observed in patients with S100A2-negative tumors than those with S100A2-positive tumors. Multivariate analysis on late cervical metastasis revealed that S100A2 expression was demonstrated to be the only independent factor for late cervical metastasis. Our results indicate that patients with stage I or II invasive OSCC without S100A2 expression should be considered a high-risk group for late cervical metastasis when a wait-and-see policy for the neck is being considered.

Predictive Markers for Late Cervical Metastasis in Stage I and II Invasive Squamous Cell Carcinoma of the Oral Tongue

Patients with oral tongue carcinoma treated by intraoral excision only should be followed up carefully for cervical lymph node metastasis and salvaged immediately if found, because some patients have a more aggressive clinical course. The purpose of this study was to find useful markers for predicting late cervical metastasis in patients with stage I and II invasive squamous cell carcinoma of the oral tongue. We investigated clinicopathologic factors and immunohistochemical biomarkers predicting late cervical metastasis in surgical specimens from 56 patients with T(1-2)N(0)M(0) invasive squamous cell carcinoma of the oral tongue who did not undergo elective neck dissection. Histopathologic factors including tumor thickness, mode of invasion, Broders grade, total score of three different malignancy grading systems, eight other clinicopathologic parameters, and immunohistochemical expression of p53, cyclin D1, Ki-67, epidermal growth factor receptor, microvessel density, cyclooxygenase-2, MUC1, laminin-5 gamma2, E-cadherin, and beta-catenin were examined. All of the clinicopathologic factors and immunohistochemical expression of biomarkers were compared in terms of survival. In the univariate analysis, tumor thickness (P = 0.009), Broders grade (P = 0.017), nest shape (P = 0.005), mode of invasion (P < 0.001), Anneroth score (P = 0.029), Bryne score (P < 0.001), and E-cadherin expression (P = 0.003) were correlated with late cervical metastasis. Multivariate analysis on late cervical metastasis revealed that tumor thickness >4 mm, mode of invasion grade 3 or 4, and E-cadherin expression were independent factors. Late cervical metastasis was the only prognostic factor for overall survival (P = 0.002). Our results indicate that patients with stage I and II invasive squamous cell carcinoma of the oral tongue with tumor thickness >4 mm, mode of invasion grade 3 or 4, and low expression of E-cadherin should be considered a high-risk group for late cervical metastasis when a wait-and-see policy for the neck is adopted.

Magnetic resonance imaging versus clinical palpation in evaluating cervical metastasis from head and neck cancer

We prospectively compared the value of MRI and clinical palpation for detecting cervical metastases in patients with primary cancer of the head and neck. Sixty patients with squamous cell carcinoma of the upper aerodigestive tract were evaluated with MRI and clinical palpation before undergoing a total of 81 neck dissections. The results of preoperative clinical palpation and MRI were compared with the histopathologic outcome. The sensitivity and specificity were 75.6% and 97.5%, respectively, for clinical palpation and 73.2% and 95%, respectively, for MRI. The rate of occult cervical metastasis was 24% with clinical palpation and 26.8% with MRI. The use of MRI did not improve the rate of early detection of occult metastasis, nor did it improve the detection of extracapsular spread. Our findings show that we could not depend on palpation or MRI alone to determine the need for elective neck dissection. However, MRI can be used to improve the preoperative grading of cervical lymph nodes. In selected cases, this may direct surgeons to convert the treatment plan to choose a more conservative neck dissection or, after sentinel node sampling and frozen-section control, to convert the treatment to a more radical dissection. (Otolaryngol Head Neck Surg 2000;123:324–7.)

Tumor thickness predicts cervical metastasis in patients with Stage I/II carcinoma of the tongue: T. Asakage, T. Yokose, K. Mukai, S. Tsugane, Y. Tsubono, M. Asai, S. Ebihara

Tumor thickness predicts cervical metastasis in patients with Stage I/II carcinoma of the tongue: T. Asakage, T. Yokose, K. Mukai, S. Tsugane, Y. Tsubono, M. Asai, S. Ebihara

Tumor thickness predicts cervical metastasis in patients with stage I/II carcinoma of the tongue.

The incidence of cervical metastases after surgery for Stages I/II carcinoma of the tongue is 30-40%. Postoperative cervical metastases are an adverse prognostic factor for patients with this malignancy. The purpose of this study was to evaluate the clinicopathologic factors associated with late cervical metastases in patients with carcinoma of the tongue. The clinicopathologic features of 44 patients with previously untreated Stage I/II carcinoma of the tongue were reviewed. All patients were treated with partial glossectomy only. Cervical metastases developed in 21 of 44 patients within 5 years. Factors significantly associated with the development of cervical metastases were invasive growth, differentiation, nuclear polymorphism in the deep portion, tumor border, nest formation, infiltrative growth ratio, depth, and thickness. No statistical correlations between cervical metastases and age, gender, tumor location, clinical stage, Brinkman index, alcohol index, mitosis, connective tissue, lymphocytic infiltration, or perineural invasion were found. Multivariate analysis demonstrated that only tumor thickness > 4 mm had a predictive value for cervical metastasis (risk ratio 9.4; 95% confidence interval, 1.5-57.7). The current study data indicate that patients with Stage I/II carcinoma of the tongue > 4 mm in thickness are at increased risk for subsequent cervical metastasis. Thus, conservative supraomohyoid neck dissection is indicated in patients with Stage I/II carcinoma of the tongue > 4 mm in thickness.

Evaluating the rational extent of dissection in radical esophagectomy for invasive carcinoma of the thoracic esophagus.

To define the rational extent of dissection in radical esophagectomy for esophageal cancer, survival was studied according to nodal status in 154 patients undergoing extended radical esophagectomy. The incidence of cervical metastasis in patients with upper or middle esophageal tumors did not differ between those with favorable (grade N < or = 4) or unfavorable (grade N > or = 5) lymph node status, at 28.6% vs 20%, respectively. On the other hand, in patients with lower esophageal tumors, the incidence of cervical metastasis was significantly lower in those with favorable grade (grade N < or = 4) node status than in those with unfavorable grade (grade N > or = 5) node status, at 6.5% vs 46.7%, respectively. Survival did not differ in patients with upper or middle esophageal tumors according to whether they had regional (n = 42) or distant (n = 15) lymph node metastases, the 5-year survival rates being 11.6% vs 25%, respectively. However, in patients with lower esophageal tumors, none of 10 patients with distant node metastases survived for more than 4 years, whereas the survival rate was 43.7% at 5 years for 36 patients with regional node metastases. These results show that cervical lymphadenectomy should only be performed as part of radical esophagectomy in those patients with upper or middle esophageal cancer.

Squamous cell carcinoma of the lower lip

Purpose: Most patients with squamous cell carcinoma of the lower lip present with early disease and follow a rather indolent clinical course. Determinant 5-year survival rates range from 85% to 95%. This study was undertaken in an attempt to gain insight into the cause of failure in those few patients who develop recurrent disease. Patients and Methods: A retrospective review was completed on patients treated between 1964 and 1990. Patients were staged according to the American Joint Committee. Patients with no palpable adenopathy had either a unilateral or bilateral suprahyoid dissection performed. Patients with palpable adenopathy underwent radical neck dissection. All patients were followed for evidence of recurrent disease. Results: The records of 92 patients treated surgically for squamous cell carcinoma of the lower lip were available and complete. Palpable adenopathy was present in 38 patients; however, only 8 of these patients (21%) were histologically positive. Of the 54 patients judged to be free of disease, 3 (5.5%) had histologic evidence of metastasis. Overall, the incidence of cervical metastasis was 12%. Conclusion: The incidence of cervical metastasis in patients with squamous cell carcinoma of the lip is low; however, these data suggest that the size of the primary tumor does not correlate closely with predicting the incidence of regional lymph node metastases.