Elective Neck Dissection Research Articles

Pathologic dural invasion is associated with regional recurrence in olfactory neuroblastoma: A multi-institutional study.

Neck metastases are a poor prognostic factor in olfactory neuroblastoma (ONB). Pathologic dural invasion (pathDI) may increase the risk of neck metastases due to invasion of dural lymphatics. We aim to evaluate the prognostic value of pathDI in predicting rates of neck metastases and recurrence using a large, multicenter database of ONB patients. Retrospective review of a prospective, multicenter database of electronic health records of all patients who presented with ONB between 2005 and 2021 at nine tertiary academic care centers within North America. Clinicopathologic features including modified Kadish staging systems, margin status, treatment modalities, Hyams grading, follow-up time, and survival. Of 258 ONB patients, 189 patients met the inclusion criteria. The 10-year neck recurrence-free survival (neck-RFS) rates were 85.7% (75.6‒97.3) and 61.8% (47.9‒79.8) for patients without and with pathDI, respectively (p=0.018). Time-to-event multivariable regression analysis found pathDI to have an odds ratios of 9.7 (95% confidence interval [CI] 1.2-80.4, p=0.04) for neck-RFS and 9.5 for RFS at any site (95% CI 1.1-83.3, p=0.04). In multivariable analysis, the presence of pathDI appears to be the strongest predictor of neck recurrence and recurrence at any site. Future studies exploring the benefit of elective neck dissection or radiation for patients with pathDI may impact disease management.

Impact of contralateral occult neck metastasis in HPV-associated tonsil cancer: Is elective contralateral neck dissection required?

Background: Contralateral elective neck dissection in human papillomavirus (HPV)- associated tonsil cancer is a matter of debate.Objectives: The aim of this study was to analyze rates of contralateral lymph node (LN) metastasis and their prognostic effects on HPV-associated tonsil cancer. We also assessed the necessity of elective contralateral neck dissection.Methods: To investigate the pathologic incidence of and risk factors for contralateral nodal disease in HPV-associated tonsil cancer treated with upfront primary surgery and bilateral neck dissection, the records of 68 patients were reviewed.Results: Six (8.8%) patients displayed pathologic contralateral nodal disease; four of the patients had LN metastasis confirmed in contralateral level II, one patient had LN metastasis in level III, and one patient had multi-level metastasis in contralateral levels II and III. Contralateral LN metastasis showed a significant association with greater depth of invasion (DOI) in primary tumor (p=0.032), count of positive LN (p=0.008), and positive LN ratio of the ipsilateral neck (p=0.01). Patients with contralateral LN metastasis showed a significantly worse five-year overall survival but no significant difference in disease-free survival.Conclusion: HPV-associated tonsil cancer has exceedingly low rates of occult contralateral LN metastasis. However, in cases of ipsilateral multiple node metastases and higher DOI, it may be worth considering elective contralateral neck dissection based on the risk of occult metastasis.

Treatment strategy for cervical lymph node metastases from early-stage tongue and floor of the mouth squamous cell carcinoma using tumour budding and depth of invasion as predictors.

This study aimed to determine whether elective neck dissection can help improve outcomes in early-stage tongue and floor squamous cell carcinoma (SCC) by statistically analysing the relationship between information obtained from biopsy specimens and the incidence and prognosis of cervical lymph node metastasis (CLM). Biopsy specimens of 103 patients diagnosed with early cT1-T2 cancer of the tongue and floor of the mouth were included. Multivariate analysis showed that the three parameters significantly correlated with CLM, and univariate analyses showed that budding score (BS) ≥ 5 and pathological depth of invasion (pDOI) ≥ 5mm were independent risk factors for CLM. There were significant differences in the 5-year cumulative disease-specific survival between the BS < 5 and BS ≥ 5 groups, the pDOI < 5mm and pDOI ≥ 5mm groups, and the positive and negative budding and depth of invasion (BD) score groups. In early-stage tongue and floor of the mouth cancers with maximum tumour diameter ≤ 20mm, it may be necessary to treat occult CLM during initial surgery based on the following preoperative criteria: pDOI ≥ 5mm or BS ≥ 5 in biopsy specimens and DOI ≥ 8mm on imaging. The BD model exhibited the highest specificity and proved helpful for CLM prediction. pDOI ≥ 5mm and BS ≥ 5 were independent predictors of CLM and prognosis in early-stage tongue and floor of the mouth cancers with a maximum tumour diameter of 20mm.

Nomogram to Predict Nodal Recurrence-Free Survival in Early Oral Squamous Cell Carcinoma.

This study aimed to develop and internally validate a prognostic nomogram for predicting nodal recurrence-free survival (NRFS) in patients with early-stage oral squamous cell carcinoma (OSCC) with clinically negative neck lymph nodes. The management of early-stage oral cancer patients with clinically negative neck lymph nodes (cN0) remains controversial, especially concerning the need for elective neck dissection. Data from a single institution spanning 2010 to 2020 were utilized to develop and evaluate the nomogram. The nomogram was constructed using multivariable Cox regression and LASSO regression analyses to identify independent risk factors for lymph node metastasis. Internal validation was performed using bootstrap resampling to assess the nomogram's predictive accuracy. A total of 930 cN0 patients with T1 and T2 stage OSCC were randomly divided into training and validation cohorts (8:2 ratio). Independent risk factors for lymph node metastasis included tumor pathological grade (well: reference, moderate/poor: OR 1.69), cT (cT1: reference, cT2: OR 2.01), history of drinking (never: reference, current/former: OR 1.72), and depth of invasion (0 mm < DOI ≤ 5 mm: reference, 5 mm < DOI ≤ 10 mm: OR 1.31). The nomogram, incorporating these variables, demonstrated good predictive accuracy with a C-index of 0.67 (95% CI: 0.58-0.76) in the validation set. In both training and validation groups, the nomogram effectively stratified patients into low-risk and high-risk groups for occult cervical nodal metastases (p < 0.05). The nomogram enables risk stratification and improved identification of occult cervical nodal metastases in clinically node-negative OSCC patients by incorporating tumor-specific and patient-specific risk factors.

Depth of Invasion Threshold for Recommending Elective Neck Dissection in T1 or T2 Oral Squamous Cell Carcinoma

BackgroundThere is variability in the literature on the role of the depth of invasion (DOI) for recommending an elective neck dissection (END). PurposeThe purpose of the study is to estimate the DOI threshold for recommending an END. Study Design/Setting/SampleA retrospective cohort study was performed at McGill University Health Centre from 2008-2018 with 5 years of follow-up. The sample was subjects with clinical T1/T2 oral squamous cell carcinoma (OSCC) and clinically negative neck. Subjects with previous head and neck cancer were excluded. Predictor VariableThe primary predictor variable was DOI measured from the basement membrane of the adjacent normal mucosa on final pathology, coded as <4mm or ≥4mm. DOI is a continuous variable converted to a binary variable. Main Outcome VariableThe main outcome variable was time to development of neck disease (RD+) defined as the time from surgery to development of pathologic nodes. Time to RD+ for pathologic nodes discovered from the END was considered 0 months. The secondary outcome variable was overall survival. CovariatesDemographics (age, sex, smoking/alcohol history) and tumor characteristics (tumor location, clinical T, tumor differentiation, perineural invasion, lymphovascular invasion) were analyzed. AnalysesTime to RD+ and survival were analyzed using Cox hazard ratio, Kaplan-Meier curves, and log-rank test. Student T-test and Chi-square test were used for bivariate analyses; p≤0.05 was statistically significant. ResultsThe final sample were 64 subjects (average age 65.25 (SD 13.06) years and 36 (56.2%) males). Twenty-nine subjects had DOI<4mm, and the 5-year RD+ was 3.4% (the 1 occurrence of RD+ was at 5.3 months). Thirty-five subjects had DOI≥4mm, and the 5-year RD+ was 45.7% (15 subjects had RD+ discovered from the END, and 1 subject had RD+ at 7.6 months). DOI≥4mm had significantly higher risk of RD+ than DOI<4mm (HR 17.91; 95% CI 2.37-135.3; p=0.01), which remained significant after adjusting for clinical T, tumor differentiation, perineural invasion, and lymphovascular invasion (HR 9.53; 95% CI 1.12-81.44; p<0.05). The shallowest DOI with >20% risk of RD+ was in the DOI 4-4.9mm group. Conclusions/Relevance: Among patients with OSCC of T1 or T2 and clinically negative necks, END should be considered with DOI≥4mm.

Reconstruction in early squamous cell carcinoma of the oral cavity—Do free flaps improve oncological outcome?

BackgroundOral squamous cell carcinoma (OSCC) ranks on position 14 in global cancer analysis and makes up to 38 % of all head and neck squamous cell carcinomas. While surgery is accepted as first-line treatment of early tumors, the reconstructive approach is not standardized. Therefore, we evaluated the concept of ablative tumor removal and microvascular reconstruction in terms of oncological safety and surgical morbidity for early OSCCs. Methods262 patients received ablative tumor surgery with neck dissection together with microvascular reconstruction between 2010 and 2020. General clinical data was analyzed descriptively with regard to surgery time, duration of tracheotomy and hospitalization. ResultsEstimated 5-year overall and progression-free survival was 85 % and 77 % respectively with no significant difference between stage I or II cancer patients. Tracheotomy was performed in 131 patients (50 %). 19 patients (7.3 %) were temporarily dependent to a gastric feeding tube. Flap loss occurred in 9 patients (3.4 %). DiscussionIn a standardized setting, mean surgery time could be reduced constantly. We propose consistent tumor ablation, combined with elective neck dissection and microvascular reconstruction in early oral squamous cell carcinoma. The presented concept leads to excellent oncological and functional results with acceptable morbidity and short surgery times.

A study on direct metastasis to levels III, IV in oral tongue squamous cell carcinoma

ObjectiveThis study aimed to determine the frequency and specific metastatic patterns of direct metastasis to levels III and IV in oral tongue squamous cell carcinoma (OTSCC) among Japanese individuals. MethodsWe conducted neck dissections on 319 patients at our department from January 2001 to December 2020. Of these, 220 patients with histopathological evidence of lymph node metastasis were included in the study. Lymph node metastases were categorized by level to elucidate the metastatic patterns. Additionally, metastatic sites within level III were identified as either anterior or posterior to the internal jugular vein, and these findings were compared between the direct metastatic group and the non-direct metastatic group. ResultsAmong the patients, 13 experienced direct metastases to level III or IV. Specifically, 12 patients had metastases at level III, and one patient had metastases at both levels III and IV, constituting 5.9% (13/220) of those with cervical lymph node metastasis in OTSCC. No patients exhibited direct metastases solely to level IV. Within level III, the direct metastasis group showed a significantly higher incidence of metastasis anterior to the internal jugular vein (p = 0.03). ConclusionsDirect metastasis to levels III and/or IV occurred in 5.9% of the cases. Although elective neck dissection up to level III is generally sufficient, metastasis to level IV, while infrequent, can occur. Therefore, vigilant follow-up with attention to the lower neck regions is crucial.

Prognostic significance of anatomic site-specific depth of invasion in oral squamous cell carcinoma - An eastern Indian multi-center study

A crucial parameter in determining the prognosis of oral cavity cancer is depth of invasion (DOI). This research aimed to correlate pathological DOI at different intra-oral anatomical sites for oral squamous cell carcinoma (OSCC) with the risk of regional lymph node metastasis (LNM). This study also investigated the correlation of 3-year overall survival (OS) and disease-specific survival (DSS) with tumor depth. DOI measurement of the primary tumor at different intra-oral anatomic sites of clinically node negative patients who underwent curative surgery with elective neck dissection (END) was carried out as per AJCC 8th Edition staging guidelines in 3 DOI groups of ≤5 mm(A), >5 to ≤10 mm(B) and >10 mm(C). Association of groupwise DOI values with histopathological parameters including LNM and 3 years survival was evaluated. Univariate and multivariate logistic regression analysis (Odds ratio (OR) = 1.1 95 % CI: 1.0–1.2, p < 0.05) showed DOI to be a significant predictor for sub-clinical nodal metastasis observed in 136/382 OSCC patients. Receiver operating curve suggested that at 5 mm DOI (4 mm for early-stage OSCC), the risk of occult LNM was >20 % for all intra-oral sites combined. DOI <5 mm group demonstrated a superior 3-year OS (OR = 19.8 % CI: 7.8–49.9) and DSS (OR = 14.7 % CI: 5.9–37.0). Thus, DOI is an independent predictor of nodal metastasis and has significant association with LNM, OS and DSS. Our findings suggest that a DOI of ≥4 mm is an accurate cut-off value for performing END in early-stage OSCC and > 5 mm for advanced cases across all evaluated oral anatomic sites.

Risk factors and impact of occult and skip metastasis in early-stage oral tongue squamous cell carcinoma.

To investigate risk factors associated with occult lymph node metastases (ONM) and skip metastasis in early-stage oral tongue squamous cell carcinoma (OTSCC) patients. Meanwhile, to analyze the contribution of metastatic nodes to survival outcomes. 544 OTSCC patients who were clinically staged T1-T2N0 with pathologic results from May 2018 to January 2024 were enrolled. Those with ONM were divided into subgroups with or without skip metastasis. Clinical, laboratorial, radiological and pathological factors between groups were analyzed by using univariate analysis and multivariate logistic analysis. The association of tumor growth behavior with the metastatic pattern of lymph nodes was summarized. Additionally, disease free survival (DFS) among different groups were compared using Kaplan-Meier analysis. Tumor growth behavior was associated with ONM. Tumor thickness with a threshold of 6.4mm was not inferior to histological depth of invasion in predicting ONM. Only 1.3% of patients had nodal involvement of neck level IV or V. The DFS of patients with ONM were significantly reduced than those without ONM (P<0.001). The DFS between patients with and without skip metastasis exhibited no statistical significance(P = 0.246). The 1-year, 2-year recurrence rates of patients with or without ONM were 31.9%, 37.5%, 10.1% and 14.0%, correspondingly. Tumor thickness with a threshold of 6.4mm could be used as a preoperative predictor for ONM. Elective neck dissection of level I - III might be sufficient for early stage OTSCC patients. OTSCC patients with ONM should be closely observed during the first 2 years after surgery. The risk of ONM in early stage OTSCC patients might be predicted by tumor thickness calculated on MR imaging. Elective neck dissection of level I - III could remove micrometastases timely and effectively.

PREVALENCE OF OCCULT CERVICAL LYMPH NODES METASTASIS IN CN0 IN ORAL SQUAMOUS CELL CARCINOMA (OSCC)

Occult metastasis is not easily detected clinically or radiographically. Various methods have been applied for neck control for clinically N0 via elective neck dissection (END), wait and watch (W&W) and sentinel lymph node biopsy (SLNB). The main aim of this study is to investigate the prevalence of occult cervical lymph nodes metastasis in cN0 in oral squamous cell carcinoma, to investigate and compare the disease-free state and overall survival rate between occult metastasis and the non-occult group that presented at the oral and maxillofacial surgery clinic, Faculty of Dentistry, Universiti Malaya. This is a retrospective study involving 48 patients with complete data from 2008 to 2019. Data collected includes socio-demographic and clinicopathologic factors. Descriptive analysis was performed and Kaplan-Meier analysis was used to compare disease-free status and overall survival period between occult and non-occult metastases groups. The prevalence of occult metastasis in oral squamous cell carcinoma (OSCC) was low at 8.3% but it became 100% on OSCC tongue. The main tumor site for occult metastasis originated from the oral tongue with T2 size. Non-occult group had better overall survival rate comparing to occult metastasis group and the advanced group. Therefore, END is recommended particularly for N0 OSCC tongue.

Microinvasive oral squamous cell carcinoma: A management protocol

Microinvasive oral squamous cell carcinoma (MISCC) is the early stage of oral cancer that shows a breach in the basement membrane, and the depth of invasion of the tumour is limited to 0.5-2mm into the papillary stroma. A review of the available data on MISCC was conducted to formulate a management protocol for MISCC and to assess the association of MISCC with oral potentially malignant disorders. An electronic and manual search of the articles was conducted following the inclusion and exclusion criteria. A total of 14 articles were selected, evaluated, and details were tabulated. Before finalizing the treatment plan, potential diagnostic errors on both the surgeon and pathologist's part and prognostic outcomes should be taken into consideration. An association between oral potentially malignant disorders and MISCC was observed in 12 out of 14 articles. According to the NCCN guidelines, elective neck dissection is only indicated in highly selective cases for a depth of invasion of less than 2mm. However, three out of 14 MISCC cases showed metastasis to lymph nodes during the follow-up period. Multiple recurrences and second primaries in the case of MISCC are also a matter of concern. Management protocol was formulated for MISCC considering the histopathological, clinical, and radiological presentation. Precise management of oral potentially malignant disorders with rigorous follow-up for at least 3 years is advisable to prevent their carcinomatous transformation. A follow-up period of 4-8 years in the case of MISCC is recommended as part of the management protocol.

Transcriptional expression of SLC16A7 as a biomarker of occult lymph node metastases in patients with head and neck squamous cell carcinoma.

Glucose is the main energy substrate of tumor cells. This study aims to assess whether the transcriptional expression of glucose metabolism-related genes is associated with occult lymph node metastases in head and neck squamous cell carcinoma (HNSCC) patients. We examined the transcriptional expression of a panel of glucose metabolism-related genes in a cohort of 53 patients with HNSCC without cervical lymph node involvement at the time of diagnosis (cN0) and subsequently treated with elective neck dissection. Occult lymph node metastases were found in 37.7% (n = 20) of the patients. Among the analyzed genes, SLC16A7 exhibited the strongest association with the presence of occult lymph node metastases. Patients with occult lymph node metastases (cN0/pN +) had significantly lower SLC16A7 expression values (p = 0.001). Patients with low SLC16A7 expression (n = 17, 32.1%) had a frequency of occult lymph node metastases of 76.5%, while for patients with high SLCA16A7 expression (n = 36, 67.9%) it was 19.4% (P = 0.0001). A multivariable analysis showed that patients with low expression of SLC16A7 had a 12.6 times higher risk of developing occult lymph node metastases. cN0 HNSCC patients with low SLC16A7 expression had a higher risk of occult lymph node metastases.

Tumor budding and complete epithelial mesenchymal transition correlate with late nodal metastasis in early-stage tongue squamous cell carcinoma

BackgroundLate nodal metastasis is a poor prognostic factor for early-stage tongue squamous cell carcinoma. However, for most early-stage patients, there is a low risk for late nodal metastasis, which currently lacks a diagnostic marker. Tumor budding is a nodal metastasis risk factor in other human cancers. Here, we evaluated tumor budding by partial or complete epithelial-mesenchymal transition and Ovol2 expression, a transcription factor that directly suppresses epithelial-mesenchymal transition. MethodsSixty-six T1–2N0 patients were enrolled in this retrospective study. Tumor expressions of E-cadherin and vimentin (epithelial-mesenchymal transition markers) and Ovol2 were assessed by immunohistochemistry. Tumor histopathological and immunohistochemical features, mode of invasion, and tumor budding were assessed. Correlations between these potential predictive factors and late nodal metastasis were determined statistically. ResultsUnivariate analysis demonstrated lymphoid infiltrate, perineural invasion, infiltrative growth pattern, tumor budding, vimentin positive, and complete epithelial-mesenchymal transition were significant factors of late nodal metastasis (all P < 0.05), observed in 25.8 % of patients. Multivariate analysis identified tumor budding and vimentin positive were independent prognostic factors (both P < 0.025). Ovol2 expression was significantly decreased in partial and complete epithelial-mesenchymal transition cells (both P < 0.01) compared with normal epithelia. Univariate analysis, but not multivariate analysis, showed Ovol2 correlated with depth of invasion and tumor budding (both P < 0.05). ConclusionTumor budding and vimentin expression are risk factors for late nodal metastasis in T1–2N0 tongue squamous cell carcinoma. Ovol2 might be involved in the early stages of epithelial-mesenchymal transition. Evaluation of these factors might identify patients susceptible to late nodal metastasis who require elective neck dissection.

Clinicopathological Factors Associated with Lymph Node Metastasis in Oral Cavity Squamous Cell Carcinoma: A Retrospective Analysis

Abstract Background: Metastasis to regional cervical lymph nodes is an important prognostic factor for oral-cavity squamous cell carcinomas (OSCC). However, it is difficult to predict nodal metastasis in OSCC. The current study was done with an aim to find the association of various clinicopathological factors to the presence of cervical lymph node metastasis in OSCC. Materials and Methods: A retrospective analysis of hospital records from January 2020 to June 2023 was conducted in a tertiary care center. The records of 65 patients were included as per the inclusion criteria. The data were divided into two groups based on the presence or absence of neck nodal metastasis. Various factors such as tumor size, volume, depth of invasion (DOI), lymphovascular invasion, and perineural invasion were statistically compared between the study groups. Results: The oral tongue was the most common subsite (25, 38.5%), followed by buccal mucosa (18, 27.7%). The mean DOI in the group with cervical lymph node metastasis was 9.83 ± 4.83 mm, and it was significantly higher than the group without cervical lymph node metastasis (6.15 ± 4.20 mm, P = 0.004). Conclusion: DOI assessment is one of the most important preoperative assessments in the clinicoradiological assessment of OSCC cases. Further, it is recommended that in cases with DOI &gt;5 mm, the intraoperative frozen section on the nodes dissected in elective neck dissection is done for further determination of the extent of neck dissection.

A Multimodal Protocol Combining 99mTc-Tilmanocept with Indocyanine Green Fluorescence Lympho-Angiography for Sentinel Lymph Node Biopsy in Early-Stage Oral Cancer: A Case Series.

Sentinel lymph node biopsy (SLNB) is currently considered as a viable alternative to elective neck dissection (END) for the management of cN0 oral cavity squamous cell carcinoma (OCSCC). However, some difficulties were detected in sentinel lymph node (SLN) identification in floor of mouth (FOM) and ventral tongue tumors because of the so-called "shine-through radioactivity" of the injection site, which may mask nodal hotspots in proximity. We assessed the feasibility and the potential strengths of combining 99mTc-Tilmanocept with indocyanine green (ICG) fluorescence lympho-angiography in a dedicated multimodal protocol for SLNB in T1/T2N0 oral cancer to evaluate the synergistic role of each of these two tracers in providing the appropriate sensitivity and ease of learning, even in such a critical anatomical subsite. A detailed, stepwise description of our multimodal protocol is provided, together with the presentation of its application in two cases of early-stage ventral tongue tumors. Radioactive guidance with 99mTc-Tilmanocept was used preoperatively to perform planar lymphoscintigraphy and single-photon emission computed tomography/computed tomography and to define the nodal hotspot(s) and the surgical "roadmap". In addition, it was used intraoperatively to pinpoint the SLN location within each nodal hotspot with high specificity but limited spatial resolution. Optical guidance with ICG injection at the tumor bed and near-infrared fluorescence imaging was then added, providing intuitive intraoperative guidance within each nodal hotspot with high spatial resolution. Our small experience with this protocol is illustrated and future perspectives are highlighted.

A Systematic Review of Occult Contralateral Neck Metastasis in Tonsillar Squamous Cell Carcinoma.

To determine the prevalence of occult contralateral nodal metastasis in tonsillar squamous cell carcinoma (TSCC) in patients who have undergone bilateral neck dissection. A systematic review of English articles identified from PubMed, Embase, and Web of Science databases. Search terms included "oropharynx," "carcinoma," "lymph node," and "neck dissection." Two reviewers independently screened abstracts, reviewed full texts, and extracted data from all studies that presented the prevalence of contralateral occult nodal metastasis in TSCC. The overall prevalence of occult contralateral nodal metastasis was 10%. The prevalence was 8% for cT1/T2 tumors, 19% for cT3/T4, 1% for N0 in the ipsilateral neck, and 12% for N+. Occult contralateral lymph nodes were most frequently found in neck level II (81%) and level III (19%). No metastatic nodes were found in level I. Elective neck dissection of the contralateral neck in TSCC is controversial due the historic morbidity caused by the surgery. A widely accepted recommendation suggests performing an elective neck dissection when the prevalence of occult metastasis is between 15% and 20%. The results of this study suggest that elective contralateral neck dissection will identify occult positivity in 19% of patients with T3/T4 tonsil cancer. In T1/T2 or N0 tumors, the diagnostic yield would be considerably lower at 8% and 1%, respectively. Contralateral nodal sampling could be considered based on patient preference after adequate counseling on the risks/benefits of occult nodal detection. More research is needed on other nodal features to formulate treatment guidelines. Laryngoscope, 2024.

Prediction of nodal disease in oral squamous cell carcinoma of the tongue: histopathological risk assessment with the focus on depth of invasion.

Cervical lymph node metastasis (CLNM) is one of the most relevant influencing factors for the oncological outcome of patients with oral squamous cell carcinoma (OSCC). Several studies showed that the tumors depth of invasion (DOI) influences the risk for CLNM, however varying across the oral subsites. The aim of this study is to investigate the role of DOI and other risk factors in OSCC of the tongue in relation to the occurrence of occult CLNM. In this retrospective study, n = 139 patients with primary OSCC of the tongue, treated by complete surgical resection (R0) with curative intention between 2013 and 2021, were included. For data analysis, epidemiologic data as well as preoperative tumor staging, surgical therapy including neck management, histopathological tumor data and follow-up were considered. Uni- and multivariate logistic regression were used to determine association between histopathological risk factors and the occurrence of occult CLNM. The rate of occult cervical metastasis was 19.4%. T-staging, cervical nodal disease (pN+) and lymphatic invasion were significantly associated with reduced OS and RFS. While DOI had no relevant influence on the OS and RFS (p = 0.88 and p = 0.91 respectively), there was significant correlation between DOI and the occurrence of occult CLNM (OR: 1.17, 95%CI: 1.05-1.30; p < 0.01). The optimal cutoff in predicting occult CLNM was 6mm (Sensitivity: 84.2%, Specificity: 73.5%, AUC: 0.75). The DOI is a helpful risk parameter to predict the occurrence of occult nodal disease in OSCC of the tongue. Given the critical decision cutoff between 2 and 4mm DOI for performing elective neck dissection in the current guidelines, our data suggests that in these cases, surgical de-escalation could be feasible with close follow-up. This study highlights the relevance of DOI as a risk parameter in the prediction of CLNM with the aim to specify the individual patient risk and to deescalate surgical therapy in order to decrease comorbidities while improving the oncological prognosis.

Addressing the Neck: An NCDB Study of Clinically Node-Negative Supraglottic Squamous Cell Carcinoma.

Identify the proportion of patients undergoing elective neck dissection (END) in surgically managed supraglottic squamous cell carcinoma (SCCa), assess associations between patient, tumor, and treatment factors with END, and assess associations between neck management and overall survival (OS). Retrospective study. National Cancer Database (NCDB) 2019 Participant User File. Patients with previously untreated, clinically node-negative (cN0) supraglottic SCCa treated with partial laryngectomy were queried from NCDB. Patients without known neck management and who underwent total laryngectomy were excluded. Patient and tumor factors associated with END were evaluated by logistic regression analysis. Univariable Cox proportional hazard analysis was used to examine associations between patient factors and OS, and factors with P < .05 were included on multivariable analysis. A total of 1352 patients met eligibility criteria. Eight hundred eleven (60%) patients had END performed with occult nodal metastasis identified in 177 (22%) patients. END was more likely to be performed at academic centers than nonacademic centers (odds ratio: [1.66], 95% confidence interval [CI]: 1.32-2.09, P < .001). On multivariable analysis, patients who underwent adjuvant radiation had worse OS (hazard ratio [HR]: 1.45, 95% CI: 1.13-3.29, P = .017). END was associated with improved OS overall on univariable analysis (HR: 0.83, 95% CI: 0.69-0.98, P = .026), but not on multivariable analysis. In this NCDB study, 22% of cN0 supraglottic SCCa patients had occult nodal metastatic disease. Despite this, 40% of patients do not receive END at the time of primary resection. Patients who receive END for supraglottic SCCa are more likely to avoid adjuvant radiation without impacting OS.

Radiologic findings of occult nodal metastasis during clinically-N0 salvage total laryngectomy.

Occult nodal disease (OND) during clinically-N0 salvage total laryngectomy (TL) can be detected with the Neck-Imaging-Reporting-and-Data-Systems (NI-RADS). However, some patients will still have OND revealed on final pathology. A retrospective study on all patients who had OND during salvage TL with elective neck dissection (END) between 2009 and 2021 was performed. Repeat CT and PET scan interpretation was performed to evaluate their preoperative imaging for suspicious features. Among 81 salvage TL patients undergoing END, 12 (16%) had OND and a total of 26 occult nodes were identified. On pathology, the average node length [SD] was 0.6 cm [0.3]. On CT, 31% (8 of 26) had rounded morphology. On PET, most had SUVmax below blood pool. One patient scored NI-RADS 2; the rest scored 1. On re-review of preoperative imaging, occult nodes were subtle and challenging to identify. Despite no clear impact on survival, performing an END may provide prognostic information.

Sentinel lymph node biopsy in early-stage oral squamous cell carcinoma: A retrospective single-center analysis

Sentinel lymph node biopsy (SLNB) is increasingly incorporated in European national guidelines for the management of the clinically node-negative neck (cN0) in early-stage oral squamous cell carcinoma (OSCC). In Germany, SLNB in OSCCs is not yet routinely performed. This study aimed to evaluate the clinical outcome of SLNB in a German cohort.Patients with primary early-stage OSCC who underwent tumor resection and SLNB were retrospectively analyzed. Clinical-pathological characteristics were documented. Primary endpoints were sensitivity and the negative predictive value (NPV).A total of 46 patients with a mean age of 62.3 (±14.5) years met the inclusion criteria. Most tumors were located in the tongue (63.0%). Bilateral drainage from a lateral tumor was observed in three cases (6.5%), and sentinel lymph node metastasis was detected in three patients (6.5%). Mean follow-up for all patients was 13.8 months (±9.6). One patient developed regional recurrence following a negative SLNB during the observation period, leading to an NPV of 0.98 and a sensitivity of 75.0%. The 2-year neck-specific relapse-free survival was 92.8%.SLNB in early-stage OSCC is a reliable diagnostic tool of the cN0 neck, ensuring a high NPV and RFS. SLNB can be advantageous in comparison to elective neck dissection due to the detection of contralateral lymph drainage.