Contralateral Neck Metastasis Research Articles

Occult metastasis is no burden factor in oral squamous cell carcinoma patients when adhering to a standardized approach in neck dissection

ObjectivesManagement of the neck in patients with oral squamous cell carcinoma (OSCC) is pivotal to oncologic control and survival. However, there is controversy regarding necessity of neck dissection (ND) in patients with clinically node-negative neck. We aimed to assess risk factors for occult metastasis and to explore whether the presence of occult lymph node metastases (LNMs) has an impact on recurrence and survival.Material and methodsA retrospective cohort study was performed including patients with primary OSCC who underwent radical tumor resection and ND in a high-volume center adhering to the prevailing German guideline. The ND was performed according to a standardized approach.ResultsFour hundred twenty-one patients with primary surgically treated OSCC were included. The incidence of occult metastasis was 14.49%. A pathological T stage > 1 (multivariate analysis, odds ratio (OR) 3.958, p = 0.042) and the presence of extranodal extension in LNMs (multivariate analysis, OR 0.287, p = 0.020) were identified as independent risk factors for occult metastasis. When comparing patients with and without occult metastasis, there were no significant differences in terms of progression-free survival (log-rank, p = 0.297) and overall survival (log-rank, p = 0.320). There were no cases of ipsilateral neck recurrence. One patient developed contralateral neck metastasis; however, he initially presented with a unilateral pT1 pN0 tumor.ConclusionsOverall, our findings suggest that conducting a standardized approach in ND should be applied in terms of management of the neck in order to maintain survival rates and to prevent neck recurrence in OSCC patients.Clinical relevance.None of the risk factors for occult metastasis can be reliably assessed preoperatively. Although elective ND does not guarantee the complete prevention of neck recurrence, it increases the likelihood of either timely removal of micrometastases or strengthens the justification for adjuvant therapy. Consequently, this approach leads to improvements in clinical outcomes.

Exploring the Role of Circulating Tumor Cells in Contralateral Neck Metastasis

Background: The management of neck nodes in oral cavity cancers discernibly depends on the approach adopted for the primary tumor. There are abundant literature and consensus guidelines established for ipsilateral neck metastasis in small lateralized oral cavity cancers. However, the literature on the mechanism of contralateral neck metastasis and their management in recurrent settings is sparse. The current analysis aims at elucidating the role of circulating tumor cells (CTCs) in contralateral neck metastasis and the incidence of the same. Materials and Methods: We performed a retrospective cohort study to include all the patients with recurrent ipsilateral oral cavity squamous cell carcinoma who underwent treatment between January 2016 and October 2021. Various parameters were analyzed, and the data were curated to arrive at a conclusion. Results: The analysis of several parameters, including demographics of the patient, tumor site, individual tumor, lymph node, metastasis (TNM) category, depth of invasion (DOI), extra-nodal extension (ENE) status, CTCs, adjuvant treatment received after first surgery followed by TNM category, DOI, worst pattern of invasion, ENE, type of neck dissection, histological grading of tumor, perineural invasion, lymphovascular invasion, nodal yield, and number of nodes positive in the contralateral neck were studied in detail. Conclusion: The study showed a significant correlation between contralateral neck metastasis and CTCs.

Contralateral lymph node metastasis: A rare skip pattern

Neck lymph node metastasis is the most critical factor influencing the survival and prognosis of oral squamous cell carcinoma. The outcome of patients with lymph node metastases occurring after excision or radiotherapy of the primary tumor is poor. In the absence of ipsilateral nodal metastases, contralateral lymph neck metastasis is extremely rare. Reports of skip metastases have been recorded for lesions of the tongue and floor of the mouth as there is free communication between the two sides of the tongue. Intraoperative frozen sections of neck nodes have been used as a modality for the detection of occult metastases and to guide the extent of neck dissection but have not provided satisfactory results. The case described in this report is a rare phenomenon that demonstrates a well-lateralized clinically advanced buccal mucosa carcinoma with histologically proven node-negative neck but exhibited contralateral positive neck after a span of 1 month.

Prediction of Occult Contralateral Nodal Metastasis in Surgical Treated p16 Negative Oropharyngeal Squamous Cell Carcinoma

It is well known that p16 negative oropharyngeal squamous cell carcinoma (OPSCC) has a high probability of spreading to the ipsilateral neck. However, no consensus exists as to whether to perform elective treatment for clinical nodal negative in contralateral neck. A total of 85 patients with p16 negative OPSCC who underwent primary tumor excision and bilateral neck dissections between 2005 and 2018 were analyzed retrospectively. Clinicopathologic variables were used to identify factors predicting occult contralateral nodal metastasis (OCNM). A nomogram was developed to assess the risk of OCNM and the model was validated internally by using bootstrap resampling. The overall prevalence of pathologically positive contralateral nodes was 30.6% (26/85) in our cohort, and the rate of OCNM was 18.3% (11/60). The presence of ipsilateral clinical extranodal extension (cENE) was significantly associated with contralateral neck metastasis (odds ratio, 5.662; 95% CI, 2.079-15.415) with increased risk of OCNM (odds ratio, 4.271; 95% CI, 1.045-17.458). Moreover, the concordance index of the proposed nomogram model without ipsilateral cENE was 0.623 and could increase to 0.717 with the inclusion of ipsilateral cENE in the calculation. The risk of OCNM in p16 negative OPSCC with ipsilateral cENE is notable. Ipsilateral cENE-based nomogram might assist in individual decision-making regarding contralateral nodal negative neck management and help avoid the over- and under-treatment of p16 negative OPSCC.

Midline involvement and perineural invasion predict contralateral neck metastasis that affects overall and disease-free survival in locally advanced oral tongue squamous cell carcinoma.

Although patients with oral squamous cell carcinoma who develop contralateral neck metastasis (CLNM) have worse survival outcomes than those without CLNM, accurate prediction of occult CLNM in clinically negative contralateral neck (contralateral cN0) remains difficult. This study aimed to identify clinicopathological factors that could reliably predict CLNM in patients with locally advanced (clinical T3 and T4a) tongue squamous cell carcinoma (TSCC). The medical data of 32 patients with cT3-4a TSCC who underwent curative surgery between 2010 and 2017 were retrospectively analyzed. The correlation of clinicopathological variables with CLNM was examined using logistic regression analysis. The diagnostic performance of significant variables was evaluated using the area under the receiver operating characteristic curves (AUC). Overall survival (OS) and disease-free survival (DFS) were assessed using a Cox proportional hazards model. CLNM was eventually confirmed in 11 patients (34.4%). Multivariate logistic regression showed that midline involvement [odds ratio (OR) = 23.10, P = 0.017] and perineural invasion (PNI, OR = 14.96, P = 0.014) were independent predictors of CLNM. Notably, the prediction model comprising a combination of midline involvement and PNI exhibited superior diagnostic performance with an even higher OR of 80.00 (P < 0.001), accuracy of 90.3%, and AUC of 0.876. The multivariate Cox hazards model revealed independent significance of CLNM as an unfavorable prognostic factor for both OS [hazard ratio (HR) = 5.154, P = 0.031] and DFS (HR = 3.359, P = 0.038), as well as that of PNI for OS (HR = 5.623, P = 0.033). Our findings suggest that coexisting midline involvement and PNI of the primary tumor is highly predictive of CLNM development, which independently affects both OS and DFS in patients with locally advanced TSCC. Such reliable prediction enables efficient control of CLNM by optimizing management of the contralateral cN0 neck, which will likely contribute to improved prognosis of those patients without unnecessarily compromising their quality of life.

Treatment and Prognosis of Oral Cancer Patients with Confirmed Contralateral Neck Metastasis: A Multicenter Retrospective Analysis.

The prognosis of oral cancer that has metastasized to the contralateral cervical lymph nodes is poor, although the appropriate treatment method has not been established because of its rarity. A multicenter retrospective study on the treatment and prognosis of pN2c oral cancer patients was conducted. We investigated the treatment and prognosis of 62 pN2c patients out of 388 pN+ patients with oral squamous cell carcinomas. Statistical analysis was performed on the various factors with overall survival (OS) and disease specific survival (DSS). In multivariate cox regression analysis, advanced T stage was significantly correlated with poor OS (p = 0.011) and DSS (p = 0.023) of patients with pN2c neck. In pN2c patients, OS, DSS, and neck control was not different between those undergoing ipsilateral neck dissection initially and those undergoing bilateral neck dissection. Thus, contralateral elective neck dissection is not recommended. The most important risk factor for prognosis in pN2c oral cancer patients is advanced T stage. No evidence was found to recommend contralateral elective neck dissection in clinically N1/2b patients. Therefore, the indication for contralateral elective neck dissection in N1/2b patients should be carefully determined in consideration of individual conditions.

Occult contralateral central neck metastasis in papillary thyroid carcinoma with preoperatively documented ipsilateral lateral neck metastasis

BackgroundThis study was conducted to evaluate risk factors and long-term prognosis of contralateral central neck metastasis (CCNM) in papillary thyroid cancer (PTC) patients with ipsilateral lateral neck metastasis. We present clinical evidence to aid in surgical decision-making regarding the extent of central neck dissection (CND), focusing on separation between ipsilateral and contralateral sides. MethodsA total of 379 PTC patients who underwent total thyroidectomy and concomitant bilateral central neck dissection with ipsilateral lateral neck dissection (LND) at a single institution was retrospectively included between January 1997 and December 2015. ResultsThe median follow-up time was 83.2 months, the mean age was 44.3 years, and the mean tumor size was 1.5 cm. Among the study sample, 266 patients were female (70.2%) and 113 (29.8%) were male. Of 379 patients, CCNM was present in 34.6%. In multivariate analysis, male sex (adjusted OR = 2.46, p = 0.002), bilaterality (adjusted OR = 2.58, p = 0.004), number of metastatic ipsilateral central lymph nodes (adjusted OR = 1.15, p = 0.002), number of metastatic lateral lymph nodes (adjusted OR = 1.48, p < 0.001), and three-level metastasis (adjusted OR = 2.46, p = 0.012) were identified as risk factors of CCNM. Overall recurrence occurred in 6.0% and 11.5% of patients in the CCNM (-) group and CCNM (+) group, respectively. In addition, contralateral recurrence was observed in 1.2% patients and 0.8% patients in the CCNM (-) group and CCNM (+) group, respectively. However, CCNM did not significantly increase risk of recurrence (adjusted HR = 1.01, p = 0.981). ConclusionsAlthough the probability of pathological CCNM is not negligible, CCNM was not associated with higher risk of recurrence. This study suggest that central neck dissection may be limited to the ipsilateral side, and the result regarding prognosis of CCNM may help to avoid bilateral CND so that it could have potential to minimize unnecessary surgery-related complications such as recurrent laryngeal nerve(RLN) injury or hypoparathyroidism.

Role and extent of neck dissection for neck lymph node metastases in differentiated thyroid cancers

Differentiated thyroid cancers (DTC) consist of 95% of thyroid tumors and include papillary thyroid cancer (PTC), follicular thyroid cancer (FTC), and Hurthle cell thyroid cancer (HTC). Rates of lymph node metastases are different depending on histologic subtypes and <5% in FTC and between 5% and 13% in HTC. Lymph node metastasis is more frequent in PTC and while rate of clinical metastasis can be seen approximately 30% rate of routine micrometastasis can be seen up to 80%.Lymph node metastasis of DTC mostly develops first in the Level VI lymph nodes at the central compartment starting from the ipsilateral paratracheal lymph nodes and then spreading to the contralateral paratracheal lymph nodes. Spread to the Level VII is mostly after Level VI invasion. Subsequent spread is to the lateral neck compartments of Levels IV, III, IIA, and VB and sometimes to the Levels IIB and VA. Occasionally skip metastasis to the lateral neck compartments develop without spreading to the central compartments and this situation is more frequent in upper pole tumors.Although application of prophylactic central neck dissection (pCND) in DTC increases the rate of complication, due to its unclear effects on oncologic results and quality of life, the interest to the pCND is decreasing and debate on its surgical extent is increasing. pCND is not essential in DTC and characteristics of patient and tumor and experience of surgeon should be considered when deciding for pCND. Due to lower complication rate of one sided pCND compared to bilateral central neck dissection (CND), low possibility of contralateral central neck metastasis and low risk of recurrence, application of one-sided CND is logical. Although therapeutic CND (tCND) is the standart treatment when there is a clinically involved lymph node, extent of dissection is a matter of debate. A case-based decision for the extent of tCND can be made by considering patient and tumor characteristics and experience of the surgeon.Due to the higher complication risk of bilateral CND, unilateral tCND can be performed if there is no suspicious lymph node on the contralateral side and bilateral tCND can be applied when there is a suspicion for metastasis only on the contralateral side or there are features for risk of metastasis to the contralateral side. In patients with clinical central metastasis owing to intra-operative pathology results by frozen section procedure are compatible with post-operative pathology results, when there is a suspicion for contralateral metastasis, a decision for one- or two-sided dissection can be made using frozen section procedure. In DTC, it can be stated that there is a consensus in the literature about not performing prophylactic lateral neck dissection (LND), but performing therapeutic LND (tLND). In addition, there is a debate on the extent of tLND.In a meta-analysis about lateral metastasis, the rates of metastasis to the Levels IIA, IIB, III, IV, VA, and VB were 53.1%, 15.5%, 70.5%, 66.3%, 7.9%, and 21.5%, respectively. Ultrasonography (USG) is an effective procedure for detection of cervical nodal metastasis on lateral compartment. Pre-operative imaging with USG and/or combination with the fine needle aspiration biopsy (cytology/molecular test/Thyroglobulin test) can allow pre-operative detection and verification of lateral lymph node metastasis.Extent of tLND can be determined to minimize morbidity considering pre-operative USG findings, pre-operative tumor and clinical features of lateral metastasis. Especially in the presence of limited lateral metastases, limited selective LND such as Levels III, IV or Levels IIA, III, IV can be applied according to the patient. Levels IIB and VB should be added to the dissection in the presence of metastases in these regions. In cases that increase the risk of Level IIB involvement, such as presence of metastasis at Level IIA, extranodal tumor involvement, presence of multifocal tumor, and in cases that increase the risk of Level VB involvement such as macroscopic extranodal spread, and simultaneous metastases at Levels II, III, IV; Levels IIB and VB can be added to dissection material. Levels I and VA should be added to the dissection in the presence of clinically detected metastases.

Salvage Surgery for Recurrent Tongue Cancer With Contralateral Neck Metastasis

Treatment recommendations have been widely reported for primary tongue squamous cell carcinoma (TSCC) with contralateral neck metastases (CNMs), but little is known concerning recurrent TSCCs with CNMs, especially in patients who have undergone ipsilateral neck dissection. The aim of this study was to estimate overall survival (OS) and to identify prognostic factors associated with OS in patients treated for recurrent TSCCs. We performed a retrospective cohort study of patients who underwent salvage surgery (SS) for recurrent TSCC in our institution between January 2010 and December 2014. Before SS, all patients had been surgically treated for primary TSCC with ipsilateral neck dissection. The primary outcome variable was OS, and the patients were grouped by the primary predictor variable of CNM status for comparison. Other heterogeneous variables of interest included demographics, medical histories, clinicopathologic characteristics, surgical data, and adjuvant treatment modalities. In addition, the midline involvement and anatomic subsites of local recurrences were evaluated. Univariate log-rank and Cox regression tests were used for statistical analyses. The study sample included 177 subjects with a mean age of 55.4years, and 44.6% were males. The median OS was 18months. Within the entire cohort, the incidence of CNM was 23.7% (n=42), with an inclination (n=30) for contralateral level I or II. Factors associated with improved survival included CNM (hazard ratio [HR], 2.108; 95% confidence interval [95% CI], 1.341 to 3.315; P=.001), disease-free interval (HR, 0.601; 95% CI, 0.387 to 0.934; P=.023), and local recurrence subsite score (HR, 3.276; 95% CI, 0.924 to 11.623; P=.001). Patients with both recurrent TSCCs and CNMs had a dismal prognosis (OS rate, 16.2%) compared with those without CNMs (OS rate, 52.7%). SS for TSCC patients with collateral failures should be used cautiously because of the very unfavorable outcomes.

Platysma myocutaneous flap revised in the free flaps era: clinical experience in 61 patients.

SUMMARYReconstruction of oral cavity and oropharyngeal defects following radical surgery for squamous cell carcinoma (SCC) can be achieved by a variety of options. In selected cases myocutaneous platysma flap (MPF) may be a valid choice. However, several anatomical and oncological controversies on the use of this flap are debated. A retrospective study on 61 patients treated between January 2005 and December 2017 in two referral centres in which MPF was used for the reconstruction of defects following surgical resection of SCC of the oral cavity and oropharynx was conducted. The technique of flap harvesting with anatomic details is described. In all cases the submental artery was sacrificed preserving the facial artery. All clinical data were collected. Tumours involved the oral cavity in 95.1% of cases, and the oropharynx in 4.9%. Pathological staging (TNM 7th edition) of tumours was: pT1 (42.6%), pT2 (39.3%), pT3 (4.9%) and pT4a (13.1%). Success rate of the flap was 93.4%. Four (6.5%) patients developed a partial necrosis of the skin paddle without platysma muscle involvement; none required surgical revision. The mean follow-up was 69 months (5-153 months). Thirteen patients (21.3%) developed a local recurrence, and in 1 patient was associated with contralateral neck metastasis. The MPF can be a suitable option in head and neck reconstruction of small or medium-sized defects in selected cases. The vascular pedicle can be provided by branches of the facial artery achieving both oncological radicality and optimal flap vascular supply.

Rational choice of neck dissection in clinically N0 patients with supraglottic cancer.

The mainstay treatment of the neck for clinically negative neck (cN0) supraglottic laryngeal carcinoma (SGLC) is neck dissection. However, the optimal extent remains controversial. This study's purpose is to determine whether ipsilateral level II-III neck dissection is appropriate for cN0SGLC patients. The records of 220 consecutive untreated cN0SGLC patients were retrospectively reviewed. Relevant factors related to occult and contralateral neck metastasis were analyzed and the distribution of metastasis was described. Seventy-seven and 143 patients underwent unilateral and bilateral neck dissection, respectively. The rate of occult neck metastases was 21.4%. The histologic differentiation was an independent risk factor for occult neck metastasis. In the bilateral neck dissection group, the incidence of contralateral neck metastasis of patients with noncentral tumors was 0.7%. Moreover, only 1.7% of patients had positive nodes at level IV, and no isolated nodal metastases existed in level IV. Ipsilateral level II-III neck dissection is feasible for patients with noncentral cN0SGLC.

Carbon nanoparticles guide contralateral central neck dissection in patients with papillary thyroid cancer.

The treatment of contralateral central neck lymph node metastasis is controversial in patients with papillary thyroid cancer. The present study reports the use of carbon nanoparticles (CNs) as lymph node tracers and discusses the potential role of predicting contralateral central neck metastasis is evaluated, so as to guide contralateral central neck dissection (CND). A total of 70 consecutive patients with papillary thyroid cancer were enrolled in the present study. All patients underwent a total or near-total thyroidectomy plus bilateral CND, during which CNs were used as a lymph node tracer. Of the 70 enrolled patients, 51 (72.86%) were confirmed to have lymph node metastasis in the central neck, 50 (71.43%) patients in the ipsilateral central neck and 14 (20.00%) in the contralateral central neck. A total of 579 (84.90%) lymph nodes were stained black by CNs. Of the 193 metastatic lymph nodes, 168 were located in the ipsilateral central compartment and the other 25 in the contralateral central compartment. A total of 147 (76.17%) metastatic lymph nodes were stained black. A total of 21 metastatic lymph nodes were found in the contralateral central compartment, 4 metastatic lymph nodes of contralateral central compartment were not black-stained. The sensitivity and specificity of CNs for contralateral metastasis was 84 and 25%, respectively. Contralateral central lymph node metastasis was significantly associated with extrathyroid extension and the presence of ipsilateral central neck lymph node metastasis. Together, the results of the present study reveal that CNs might accurately predict contralateral central lymph nodes metastasis and could be used to direct CND.

Contralateral neck metastases in lateralised, resectable advanced stage oropharyngeal squamous cell carcinoma-Results of 57 patients undergoing bilateral selective neck dissection.

Contralateral neck metastases in lateralised, resectable advanced stage oropharyngeal squamous cell carcinoma-Results of 57 patients undergoing bilateral selective neck dissection.

A nomogram predicting contralateral central neck lymph node metastasis for papillary thyroid carcinoma.

Central compartment neck dissection (CCND) is recommended for patients with papillary thyroid carcinoma (PTC). However, whether to perform contralateral CCND remains unclear. An individualized estimation of the contralateral central neck metastasis (CNM) risk would assist in the tailoring of treatment for PTC patients. Consecutive patients who underwent bilateral CCND for unilateral PTC between 2012 and 2014 in a tertiary center were identified. The clinicopathological data of 142 patients were analyzed retrospectively. The variables that had clinical significance in the final multivariate logistic regression model were built into a nomogram to assess the risk of metastasis of the contralateral central compartment. This model was internally validated using bootstrap resampling. This nomogram demonstrated good calibration and discrimination, with a concordance index of 0.834 (bootstrap corrected, 0.824). The variables with the greatest influence on the risk of contralateral CNM in this model included tumor size, the number of positive lymph nodes, and extranodal extension in the ipsilateral central neck. This nomogram integrates three variables to estimate an individualized risk of contralateral CNM in unilateral PTC patients. This model may assist in individual decision-making regarding contralateral CCND and help avoid the over- and under-treatment of PTC. J. Surg. Oncol. 2016;114:703-707. © 2016 Wiley Periodicals, Inc.

Sentinel lymph node biopsy in T1/T2 squamous cell carcinomas of the tongue: A prospective study.

Commonly used staging procedures often cannot predict the absence of cervical metastases (CM) in squamous cell carcinomas (SCCs) of the oral cavity. Due to the high incidence of occult CM in numerous N0 cases in the clinic, an elective neck dissection (ND) is performed. The sentinel lymph node biopsy (SNB) is a common concept in the modern surgical therapy of malignancies. The present study evaluates the applicability of this concept for T1/T2-SCC of the tongue. In a prospective clinical study, 10 consecutive patients with T1/T2-SCC of the tongue and cN0 necks, were enrolled. Following sentinel lymph node (SLN) scintigraphy, all patients underwent SNB with a γ-probe and a subsequent ND. SNB specimens were compared with histopathological assessments of surgical specimens from the ND. A total of 5 female and 5 male patients (mean age, 52 years; women, 62 years; men, 42 years), with a median follow-up time of 33.5 months (range, 10–40 months), were treated. All patients presented with detectable SLNs. In 7 cases, the SLN(s) and the residual ND were negative for CM. In 3 cases, the SLN(s) were positive without further CM in the other neck nodes. Furthermore, 1 patient showed additional CMs after 10 months in the contralateral neck and lung metastasis after 18 months, but none at the time of the initial treatment. The concept of an SNB appears to be applicable to the management of the cN0 neck in small SCC of the tongue. The role of SNB in the management of SCC requires further investigation by prospective trials with larger patient numbers.

Role of Elective Neck Dissection in Early Stage Lip Cancers.

To date, the management of the neck in early stage lower lip cancers remains controversial. The aim of this study is to investigate if prophylactic neck dissection is necessary in early stage lower lip cancers. Charts of 11 patients who underwent surgery of the primary site and neck because of T1-2N0 lower lip cancer between 1997 and 2011 were retrospectively examined. Clinical stages, surgeries, histopatological examination results, and loco-regional recurrences were evaluated. Of the 11 patients, 10 were male (90.9%) and 1 was female (9.09%). The follow-up time of these patients was between 24-168 months (mean, 56.6 months). There were 5 patients with clinically diagnosed T1N0 tumors and 6 patients with clinically diagnosed T2N0 tumors. Suprahyoid neck dissection was performed in 4/5 T1N0 patients and supraomohyoid neck dissection was performed in the remaining 1 patient. For T2N0 tumors, 4 suprahyoid, 1 supraomohyoid, and 1 comprehensive neck dissection was performed. Histopathological examination revealed no occult metastasis in any of the patients. In 1 patient who had lower lip resection and suprahyoid neck dissection for T1N0 lower lip cancer, a contralateral neck metastasis was detected 22 months postsurgery, and a comprehensive neck dissection was performed. Our results show that in patients with T1N0 lower lip tumors, neck dissection may not be necessary; however, close follow-up is mandatory. Further researches with larger series dividing T2N0 tumors into subgroups for tumor size and thickness are necessary to determine neck treatment in these tumors.

The effect of midline crossing of lateral supraglottic cancer on contralateral cervical lymph node metastasis

Conclusion: The degree of midline crossing of lateral supraglottic cancer does not significantly change its rate of contralateral cervical metastasis. The rate of occult metastasis is too high to take the risk of contralateral regional recurrence. We support routine bilateral neck dissection even in lateral supraglottic cancers with no or minimal midline crossing. Objectives: Data on the rate of contralateral cervical metastasis of laterally located supraglottic cancer, the effect of its degree of midline crossing on contralateral cervical metastasis, and its treatment are still controversial. Methods: This was a retrospective cohort, chart review involving 305 surgically treated patients with T1–3 squamous cell carcinoma of the supraglottic larynx. In all, 184 patients had bilateral neck dissection; 86 N0 contralateral necks were followed up. Thirty-five patients who needed postoperative radiation therapy because of the primary tumor or ipsilateral neck dissection specimen also received radiation therapy to the contralateral neck. The degree of midline crossing at the epiglottis was measured on a laryngectomy specimen with a ruler and expressed as ‘no,’ ‘<5 mm’ or ‘≥5 mm.’ Results: The rates of occult and overall contralateral metastasis in our series were 16% and 28%, respectively. There was no statistically significant difference between contralateral neck metastasis and recurrence rates in the neck dissection, follow-up, and irradiation groups according to the degree of midline crossing.

Clinical usefulness of [18F]FDG PET-CT and CT/MRI for detecting nodal metastasis in patients with hypopharyngeal squamous cell carcinoma.

The aim of this study was to investigate whether pretreatment imaging modalities, including [18F]fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) and CT/magnetic resonance imaging (MRI) are helpful for the selection of patient groups requiring contralateral neck dissection in patients with hypopharyngeal squamous cell carcinoma (SCC). A total of 72 consecutive patients with histologically proven hypopharyngeal SCC who underwent both PET-CT and CT/MRI preoperatively were recruited. To assess the diagnostic accuracy of each imaging modality, the neck was divided into levels based on the imaging-based nodal classification, and the histopathologic results of the surgical specimen were used as a standard reference. Fifty-one (70.8%) of the 72 patients had neck metastasis, and 12 (26.7%) had contralateral metastatic nodes. The sensitivities of PET-CT and CT/MRI for detecting nodal metastasis in the contralateral neck were significantly lower than those in the ipsilateral neck (60.0 and 53.3 vs. 89.1 and 84.8%, respectively; p < 0.001). Among the patients who underwent bilateral neck dissection (n = 45), three (13.0%) of the 23 patients with a palpably negative neck on the ipsilateral side showed occult contralateral lymph node metastasis, while none of the 11 patients without ipsilateral metastatic nodes on imaging studies had contralateral neck metastasis. With accurate assessment of ipsilateral neck metastasis in hypopharyngeal SCC patients, PET-CT and CT/MRI may be helpful in identifying patients at high risk of contralateral neck metastasis. Elective contralateral neck treatment is not necessary in hypopharyngeal SCC patients who do not show evidence of ipsilateral neck metastasis on preoperative imaging studies.

Recurrence pattern after conservative surgery for papillary thyroid carcinoma.

Risk-based treatment represents the optimal management strategy for papillary thyroid carcinoma; however, the optimal extent of thyroidectomy and neck dissection remains controversial. This study aims to clarify the pattern of recurrence after conservative surgery in patients with papillary thyroid carcinoma. We retrospectively reviewed 93 patients with papillary thyroid carcinoma treated with conservative surgery. We analyzed recurrence rate, recurrence pattern, risk factors for recurrence, salvage treatment, and disease-free survival (DFS) in patients stratified according to risk. The recurrence rate was significantly lower in the low-risk group compared with the high-risk group (14% vs 34%; p<0.01). The recurrence pattern also differed between the two groups, with ipsilateral lateral neck recurrence being more common in the low-risk group (9%), while contralateral lateral neck recurrence was more common in the high-risk group (18%). Patients with contralateral thyroid lobe metastasis and/or direct contralateral thyroid lobe invasion showed a significantly higher rate of contralateral lateral neck metastasis than patients negative for both these features. The overall 5-year DFS was 81% in all patients. Advanced T and N classification, large primary tumor (≥4cm), extrathyroidal invasion, and high-risk group were significantly associated with poorer 5-year DFS in univariate analysis. Conservative surgery may represent a good treatment option for patients with low-risk papillary thyroid carcinoma. Tumor recurrence patterns differ between risk groups, with contralateral thyroid lobe lesions and direct contralateral lobe invasion being risk factors for contralateral lateral neck recurrence.

The clinical predictive factors for subsequent distant metastasis in patients with locoregionally advanced oral squamous cell carcinoma

Only a small portion of the patients with locoregionally advanced oral squamous cell carcinoma (OSCC) experience subsequent distant metastasis. This study is to evaluate the occurrence of distant metastasis after curative treatment and to explore the predictive factors for subsequent distant metastasis in patients with locoregionally advanced OSCC. The medical records of all patients with locoregionally advanced OSCC without distant metastasis at the time of diagnosis (AJCC stage III, IV but not IVC) who underwent curative surgery with or without adjuvant radiation between 2004 and 2009 were retrospectively reviewed. A total of 628 patients were enrolled, including 562 male and 66 female patients. The 5-year distant metastasis rate was 13.2%. The 5-year disease-free and overall survival rates were 57.0% and 60.3%, respectively. Multivariate analyses revealed that poorly differentiated tumors (HR=2.3 (1.16-4.53), p=0.02) and contralateral neck metastasis (HR=7.55 (3.20-17.83), p<0.001) were independent adverse factors for distant metastasis-free survival. The 5-year distant metastasis rates of 447 patients with well-differentiated tumors, 140 patients with moderately differentiated tumors and 41 patients with poorly differentiated tumors were 12.1%, 18.2%, and 34.1%, respectively. The 5-year distant metastasis rates of 227 patients without neck metastasis, 350 patients with ipsilateral neck metastasis and 51 patients with contralateral neck metastasis were 6.7%, 15.1%, and 55.3%, respectively. Poorly differentiated tumors and contralateral neck metastasis were independent factors for subsequent distant metastasis in patients with locoregionally advanced OSCC.