Head Lymph Nodes Research Articles

Detection of Cervical Lymph Nodes in Head and Neck Cancer: A Study of the Correlation Between Ultrasonic and Histological Findings in Wales

Detection of Cervical Lymph Nodes in Head and Neck Cancer: A Study of the Correlation Between Ultrasonic and Histological Findings in Wales

Epidemiological Aspects of Head and Neck Cancers in a Group of Iranian Population

Statement of Problem: Head and neck cancers occur in a wide variety of tissue types and sites, resulting in a complex range of malignancies cared by physicians in multiple specialties. Epidemiologic aspects of head and neck cancer in Iran have not been studied adequately. Purpose: The aim of this study was to represent epidemiological aspects of head and neck cancers in Kerman province in Iran. Materials and Method: In this retrospective epidemiological study, a total of 2211 cases of head and neck cancers were diagnosed in period 11-year. Data on all malignant head and neck cancers were included in this study. Information was obtained from the records of the 18 departments of histopathology in Kerman province. Results: The five most common sites were skin of the head and neck (46.81%), lymph nodes of head and neck (13.98%), larynx (13.48%), oral cavity and pharynx (12.21%), and thyroid (6.20%). Paranasal sinuses were the least common. The incidence rate of head and neck cancers was 10.12/100000 cases. Conclusion: Geographical or regional variations in the prevalence of head and neck cancer indicate that the socio-cultural lifestyles of a population play an important role in head and neck carcinogenesis. This study showed that the incidence rate of head and neck cancers was lower than that in many other countries. However, comparison between our findings with some other studies shows a relation consistency.

Head and neck lymph node region delineation with image registration

BackgroundThe success of radiation therapy depends critically on accurately delineating the target volume, which is the region of known or suspected disease in a patient. Methods that can compute a contour set defining a target volume on a set of patient images will contribute greatly to the success of radiation therapy and dramatically reduce the workload of radiation oncologists, who currently draw the target by hand on the images using simple computer drawing tools. The most challenging part of this process is to estimate where there is microscopic spread of disease.MethodsGiven a set of reference CT images with "gold standard" lymph node regions drawn by the experts, we are proposing an image registration based method that could automatically contour the cervical lymph code levels for patients receiving radiation therapy. We are also proposing a method that could help us identify the reference models which could potentially produce the best results.ResultsThe computer generated lymph node regions are evaluated quantitatively and qualitatively.ConclusionsAlthough not conforming to clinical criteria, the results suggest the technique has promise.

Pemphigus vulgaris antigen mRNA quantification for the staging of sentinel lymph nodes in head and neck cancer

Background:Molecular diagnosis has been proposed to enhance the intra-operative diagnosis of sentinel lymph node (SLN) invasion in head and neck squamous cell carcinoma (HNSCC). Although cytokeratin (CK) mRNA quantification with real-time reverse transcriptase-PCR (QRT–PCR) has produced encouraging results, the more discriminating markers remain to be identified.Methods:Pemphigus vulgaris antigen (PVA), squamous cell carcinoma antigen (SCCA), and CK17 mRNA were quantified using QRT–PCR, and the results were compared with an extensive histopathological examination of the entire SLNs on 78 SLNs harvested from 22 patients with HNSCC.Results:SCCA and CK17 quantification showed significantly higher mRNA values for macrometastases (MAs) than for either negative or isolated tumour cell (ITC) SLNs (P<0.01). Pemphigus vulgaris antigen allowed the discrimination of all MAs and micrometastases from both negative and ITC SLNs (P<0.001). For the neck staging of patients, considering metastatic vs non-metastatic status, receiver-operating characteristic curve analysis found areas under the curve of 93.8, 97.9, and 100% for CK17, SCCA, and PVA, respectively. With PVA, a cutoff value of 562 copies per 100 ng of cDNA permitted the correct distinction between patients with positive as opposed to negative neck nodes in all cases.Conclusion:PVA seems to be a highly promising marker for accurate intra-operative SLN staging in HNSCC by QRT–PCR.

Evaluation of fluorodeoxyglucose-position-emission tomography-computer tomography imaging on head and neck squamous cell carcinomas including primary tumors and lymph node metastases

To evaluate (18)F-fluorodeoxyglucose-position-emission tomography-computer tomography imaging ((18)F-FDG-PET-CT) on head and neck squamous cell carcinoma(HNSCCA) and lymph node metastasis. (18)F-FDG-PET-CT imaging of 20 patients with HNSCCA was evaluated retrospectively. All the primary tumors were correctly diagnosed by (18)F-PET-CT imaging and SUV(avg) of the primary tumors was (6.22 +/- 2.20). All the sensitivity, specificity, positive predictive value and the negative predictive value were 100%. In detecting lymph node metastasis, the sensitivity was 51%, specificity 97.7%, false positive rate 2.3%, false negative rate 49%, positive predictive value 82%, and negative predictive value 91.2%. (18)F-FDG-PET-CT imaging was valuable in detecting HNSCCA and lymph node metastasis. SUV was helpful for differential diagnosis between benign or malignant tumors but it needs further study to determine the cutoff SUV for differentiating lymph node metastasis.

Head and Neck Sentinel Lymph Node Biopsy: Current State of the Art

Sentinel node biopsy is an alternative to elective neck dissection for the management of T1/T2 oral and oro-pharyngeal squamous cell carcinomas and is also finding application to head and neck cancer at other sites. The main clinical aim of sentinel node biopsy is to achieve better staging and there is now evidence that the procedure reduces morbidity. Reported detection rates for sentinel neck nodes are greater than 95% and there is also a negative predictive value of 95% for negative sentinel nodes. Current histopathological protocols have been developed for use in the research setting and are designed to identify all micrometastatic disease. However the use of step serial sectioning at 150 micron intervals with pan-cytokeratin immunohistochemistry is currently advised and appears to upstage nodes by approximately 20% over the initial single routine stained section. Adoption of the UICC/TNM definitions is recommended for future sentinel node studies, but further refinements and descriptions are required. The SENT trial has recruited over 300 cases from 10 European centres and a quality control study of the pathological material is in progress. At the first consensus meeting of the SENT pathology group there were excellent levels of agreement on the diagnosis of positive and negative nodes, and a number of potential pitfalls such as non-malignant inclusions and staining artefacts were identified.

Quantitative Analysis of Extracapsular Extension of Metastatic Lymph Nodes and its Significance in Radiotherapy Planning in Head and Neck Squamous Cell Carcinoma

We performed a histopathologic analysis to assess the extent of the extracapsular extension (ECE) beyond the capsule of metastatic lymph nodes (LN) in head and neck cancer to determine appropriate clinical target volume (CTV) expansions. All tumor-positive LN of 98 patients who underwent a neck dissection with evidence of ECE in at least one LN were analyzed by a single pathologist. The largest diameters of all LN, and in the case of ECE, the maximal linear distance, from the capsule to the farthest extent of tumor or tumoral reaction were recorded. A total of 231 LN with ECE and 200 tumor-positive LN without ECE were analyzed. The incidence of ECE was associated with larger LN size (p < 0.001). Of all tumor-positive LN with a diameter of < 10 mm or < 5 mm, 105/220 (48%) nodes or 17/59 (29%) nodes, respectively, showed evidence of ECE. The mean and median extent values of ECE were 2 and 1 mm (range, 1-10 mm) and the ECE was < or = 5 mm in 97% and < or = 3 mm in 91% of the LN, respectively. Overall, the extent of ECE was significantly correlated with larger LN size (Spearman's correlation coefficient = 0.21; p = 0.001). The incidence of ECE is associated with larger LN size. However, ECE is found in a substantial number of LN with a diameter of < 10 mm. The use of 10-mm CTV margins around the gross tumor volume seems appropriate to account for ECE in radiotherapy planning of head and neck cancer.

Positron emission tomography with F-18-FDG: a new tool in the evaluation of patients with head and neck tumors

Positron emission tomography using fluoro-deoxyglucose (PET-FDG) imaging has been shown to be effective in detecting and staging malignancies based on tumor glucose metabolism. The aim of the study was to evaluate the use of PET-FDG for the detection of metastatic lesions as well as early recurrence in patients with head and neck tumors. Eleven patients were examined with PET-FDG to study the reliability of PET in assessing regional nodal status and in identifying distant metastasis (group I) and 37 patients who had previously received curative treatment and who presented differential diagnostic problems were imaged to differentiate between scar and residual or recurrent cancer (group II). PET-FDG studies were compared to results of computed tomography (CT) in 35 patients, magnetic resonance imaging (MRI) in 4 patients and both techniques in 6 patients. All PET-FDG studies were positive in group I, while CT failed to detect metastatic lesions in three patients. In group II PET-FDG accurately detected recurrent disease in 22/25 patients, while CT/MRI were negative in 4 cases and equivocal in 6 cases. However, there was a false positive PET study with equivocal CT in a patient with local infection. PET-FDG was highly effective in detecting metastatic cervical lymph nodes in head and neck tumours. It was most helpful in differentiating residual or recurrent tumour from scar sequelae and it enhanced the diagnostic accuracy when CT and MRI were equivocal due to anatomical distortions.

The prevalence and distribution of Mycobacterium bovis infection in European badgers ( Meles meles) as determined by enhanced post mortem examination and bacteriological culture

The accurate diagnosis of Mycobacterium bovis infection in badgers is key to understanding the epidemiology of tuberculosis in this species and has significant implications for devising strategies to limit spread of the disease. In this study, badgers ( n = 215) in the Republic of Ireland were examined at post mortem and tissues were collected from a range of anatomical locations and pooled into groups for bacterial culture of M. bovis. By assessing confirmed gross visible lesions (VL) alone, infection was detected in 12.1% of badgers. However, by including the results of all culture positive pooled samples, the overall infection prevalence increased significantly to 36.3%. Two-thirds (66.7%) of infected animals had no visible lesions (NVL). While the thoracic cavity (lungs and pulmonary lymph nodes) was found to be the most common site of infection, in a proportion of animals infection was absent from the lungs and draining lymph nodes and was confined to the lymph nodes of the carcase or the head. This may indicate an early extrapulmonary dissemination of infection or alternatively, in the case of the head lymph nodes, a secondary pathogenic pathway involving the lymphoid tissues of the upper respiratory tract (URT).

O152. Evaluation of molecular markers for the assessment of occult metastasis in lymph nodes in head and neck squamous cell carcinoma

O152. Evaluation of molecular markers for the assessment of occult metastasis in lymph nodes in head and neck squamous cell carcinoma

A Simian Immunodeficiency Virus-Infected Macaque Model To Study Viral Reservoirs That Persist during Highly Active Antiretroviral Therapy

The treatment of human immunodeficiency virus type 1 (HIV-1) infection with highly active antiretroviral therapy (HAART), a combination of three or more antiretroviral drugs, suppresses viremia below the clinical limit of detection (50 HIV-1 RNA copies/ml), but latently infected resting CD4(+) T cells serve as lifelong reservoirs, and low-level viremia can be detected with special assays. Recent studies have provided evidence for additional reservoirs that contribute to residual viremia but are not present in circulating cells. Identification of all the sources of residual viremia in humans may be difficult. These discoveries highlight the need for a tractable model system to identify additional viral reservoirs that could represent barriers to eradication. In this study, simian immunodeficiency virus (SIV)-infected pig-tailed macaques (Macaca nemestrina) were treated with four antiretroviral drugs to develop an animal model for viral suppression during effective HAART. Treatment led to a biphasic decay in viremia and a significant rise in levels of circulating CD4(+) T cells. At terminal infection time points, the frequency of circulating resting CD4(+) T cells harboring replication-competent virus was reduced to a low steady-state level similar to that observed for HIV-infected patients on HAART. The frequencies of resting CD4(+) T cells harboring replication-competent virus in the pooled head lymph nodes, gut lymph nodes, spleen, and peripheral blood were reduced relative to those for untreated SIV-infected animals. These observations closely parallel findings for HIV-infected humans on suppressive HAART and demonstrate the value of this animal model to identify and characterize viral reservoirs persisting in the setting of suppressive antiretroviral drugs.

SU‐FF‐T‐107: Selective Extended Field IMRT Can Protect Larynx and Adequately Treat the Lower Neck Lymph Nodes in Head and Neck Cancer

Objectives: Radiation dose to the larynx has been a major concern in the treatment of head and neck cancer. The use of splitting field (SF) IMRT can improve the dose to the larynx but it may result in inadequate tumor coverage and dosimetric uncertainties at the matchline. In this study, we propose a selective extended field (SEF) method to avoid the use of splitting field while reducing the larynx dose and achieving the adequate tumor coverage. Materials and Methods: Five nasopharyngeal patients with the gross tumor volume extended to the lower neck were treated with extended field (EF)‐IMRT. SEF IMRT plans were created by extending only three anterior and anterior oblique beams to the supraclavicular region while the other fields were restricted to the superior of the vocal cord. For comparison, SF‐IMRT plans were also created and matched with the conventional AP field. All plans were compared based on the tumor volume coverage, mean dose to the larynx while meeting other planning requirement in RTOG protocol of 0225. Results: The average doses to 95% (D95) of the pGTVs and pCTV were 67.10 ± 6.56 Gy, 70.65 ± 1.62 Gy, 72.74 ± 1.76 Gy and 55.21 ± 3.41 Gy, 57.17 ± 1.51 Gy, 59.92 ± 1.01 Gy for SF, SEF, and EF‐IMRT plans, respectively. The tumor dose coverage in SF IMRT plans was the worst among three methods. Accordingly, the average mean doses to the larynx were 29.25 ± 5.61 Gy, 29.41 ± 2.99 Gy, 41.87 ± 10.61 Gy, respectively. The mean dose to the larynx in EF‐IMRT plans were the highest among the three methods. Conclusions: The selective extended field IMRT provides adequate tumor dose coverage and protects the larynx with the similar mean dose as the SF method.Research is supported by Siemens Corporation.

Head and neck lymph nodes in children: the spectrum from normal to abnormal

Lymphadenopathy of the head and neck region is a common finding in children and a very common reason to image the craniocervical region. Enlarged lymph nodes are commonly palpated by the pediatrician in the office and commonly imaged by the pediatric radiologist. The difficult task of the clinician is to determine whether the adenopathy is acute (<3 weeks) or chronic (>6 weeks) and when imaging is indicated. In children, radiation is always a consideration when choosing an imaging modality; thus, US is usually the first imaging study at our institution, and CT the second option, usually reserved for the very ill child or for when there is a high index of suspicion for malignancy. We present the normal anatomy of head and neck lymph nodes and the US, CT, and MRI appearances in normal and pathologic states to help clinicians generate a reasonable differential diagnosis and prevent unnecessary procedures.

Therapeutic Value of Lymph Node Dissection in Advanced Gastric Cancer with Macroscopic Duodenum Invasion: Is the Posterior Pancreatic Head Lymph Node Dissection Beneficial?

In advanced gastric cancer (AGC) with duodenum invasion, the posterior pancreatic lymph nodes are susceptible to metastasis because of their proximity to the duodenum. The therapeutic value of lymph node dissection in this area for AGC with macroscopic duodenum invasion remains unclear. Patients who had undergone curative gastrectomy for lower-third AGC from 1970 to 2004 at the Cancer Institute Hospital were recruited for this study. Clinicopathological data were collected retrospectively, and compared between cases of AGC with duodenum invasion (AGC-DI group) and AGC without duodenum invasion (AGC-nDI group). In the AGC-DI group, the therapeutic value of lymph node dissection was evaluated using a therapeutic index (multiplication of the frequency of metastasis to the station by the 5-year survival rate of patients with metastasis to that station). The AGC-DI group generally had tumors of higher pathological stage, which might account for the poorer 5-year survival rate compared with that of the AGC-nDI group (50.1% versus 68.5%; P = 0.0002). The incidence of lymph node metastasis was higher in the AGC-DI group than that in the AGC-nDI group, including nodes in the posterior pancreatic head (23.9% versus 7.0%, P < 0.0001). In the AGC-DI group, posterior pancreatic head lymph node dissection was of therapeutic value (4.19) equivalent to dissection of second-tier lymph nodes. The dissection of posterior pancreatic head lymph nodes might be effective in AGC with macroscopic duodenum invasion since this has therapeutic value equivalent to that of second-tier lymph node dissection and might improve patients' long-term outcomes.

Segmentation of Head and Neck Lymph Node Regions for Radiotherapy Planning Using Active Contour-Based Atlas Registration

<para xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> In this paper, we present the segmentation of the head and neck lymph node regions using a new active contour-based atlas registration model. We propose to segment the lymph node regions without directly including them in the atlas registration process; instead, they are segmented using the dense deformation field computed from the registration of the atlas structures with distinct boundaries. This approach results in robust and accurate segmentation of the lymph node regions even in the presence of significant anatomical variations between the atlas-image and the patient's image to be segmented. We also present a quantitative evaluation of lymph node regions segmentation using various statistical as well as geometrical metrics: sensitivity, specificity, dice similarity coefficient and Hausdorff distance. A comparison of the proposed method with two other state of the art methods is presented. The robustness of the proposed method to the atlas selection, in segmenting the lymph node regions, is also evaluated. </para>

Diagnostic accuracy and additional value of diffusion-weighted imaging for discrimination of malignant cervical lymph nodes in head and neck squamous cell carcinoma

The aim was to determine the diagnostic accuracy and additional value of diffusion-weighted imaging for detection of malignant lymph nodes in head and neck squamous cell carcinoma. Two hundred nineteen lymph nodes, predominantly smaller than 10 mm (95.4%), in 16 consecutive patients were evaluated at 1.5 T. Lymph nodes were evaluated for maximum short axial diameter, morphological criteria, and apparent diffusion coefficient (ADC) values (b = 0 and b = 1,000 s/mm(2)). Sensitivity, specificity, positive and negative predictive values as well as diagnostic odds ratios (DORs) and areas under the curves (AUCs) of ROC curves were calculated for the various magnetic resonance imaging (MRI) criteria individually and in combination. Histological examination of lymph nodes in the neck dissection specimen was the gold standard to determine malignant involvement. The optimal ADC threshold was 1.0 x 10(-3) mm(2)/s. Using this cutoff point, sensitivity and specificity were 92.3% and 83.9%, respectively. When used in combination with size and morphological criteria, ADC value <1.0 x 10(-3) mm(2)/s was the strongest predictor of presence of metastasis (DOR = 97.6). A model which added ADC values to the other MRI criteria performed significantly better than a model without ADC values: AUC = 0.98 versus AUC = 0.91 (p = 0.036). In this study, with predominantly small lymph nodes, the ADC criterion is the strongest independent predictor of presence of metastasis. The use of ADC values in combination with the other MRI criteria significantly improves the discrimination between malignant and benign lymph nodes.

Malignant tumours of childhood in Zaria

The increased prevalence of hitherto uncommon tumours in children in our geographic setting formed the basis for this study. This study aimed to determine the current histopathologic distribution pattern of paediatric malignancies in Zaria. An eight year (2000-2007) consecutive analysis of malignant tumours in children ages 0 to 15 years in a referral University laboratory. All tissue biopsies were fixed in 10% formalin and processed in wax. Tumours were characterised histologically into tissues of origin and categorised into three age groups; <1 year, 1-5 years and 6-15 years. 189 children with malignant tumours were analysed. They showed a male preponderance (M: F; 1.2: 1.0) and their ages ranged from 5 days to 15 years. Tumours of mesenchymal origin were the commonest (115: 60.8%) while epithelial tumours including germ cell tumours accounted for 74 (39.2%) cases. The age group 1-5 years had the highest epithelial tumours while age group 6-15 years had the most tumours with 102 (54%) cases overall. The five commonest tumours over-all were rhabdomyosarcoma, Burkitt lymphoma, retinoblastoma, non-Hodgkin's lymphoma and nephroblastoma. Germ cell tumours affected the ovary predominantly and two of the endodermal sinus tumour cases were seen in the testis of an eighteen month child and sacrococcygeum of a 5 year old girl, respectively. Of the six immature teratoma cases, four were cutaneous in distribution. The vascular tumours included epithelioid haemangioendothelioma, haemangioblastoma and Dabska tumour and they accounted for (5.8%) of all tumours seen. The commonest sites of occurrence of these tumours were the oculo-orbital, jaw, head and neck regions with 82 cases (43.4%) while lymph nodes were involved in 31 (16.4%) cases. The distribution and occurrence of malignant tumours in children is age related. Lymphomas were the commonest tumours overall while retinoblastoma and Burkitt lymphoma were the commonest tumours affecting children below 5 years and 6-10 years old, respectively, in our centre. The head region and lymph nodes were the sites of predilection for majority of these tumours.

Heparanase induces VEGF C and facilitates tumor lymphangiogenesis

Heparanase is an endoglycosidase that specifically cleaves heparan sulfate side chains, a class of glycosaminoglycans abundantly present in the extracellular matrix and on the cell surface. Heparanase activity is strongly implicated in tumor angiogenesis and metastasis attributed to remodeling of the subepithelial and subendothelial basement membranes. We hypothesized that similar to its proangiogenic capacity, heparanase is also engaged in lymphangiogenesis and utilized the D2-40 monoclonal antibody to study lymphangiogenesis in tumor specimens obtained from 65 head and neck carcinoma patients. Lymphatic density was analyzed for association with clinical parameters and heparanase staining. We provide evidence that lymphatic vessel density (LVD) correlates with head and neck lymph node metastasis (N-stage, p = 0.007) and inversely correlates with tumor cell differentiation (p = 0.007). Notably, heparanase staining correlated with LVD (p = 0.04) and, moreover, with VEGF C levels (p = 0.01). We further demonstrate that heparanase overexpression by epidermoid, breast, melanoma and prostate carcinoma cells induces a 3- to 5-fold elevation in VEGF C expression in vitro and facilitates tumor xenograft lymphangiogenesis in vivo, whereas heparanase gene silencing was associated with decreased VEGF C levels. These findings suggest that heparanase plays a unique dual role in tumor metastasis, facilitating tumor cell invasiveness and inducing VEGF C expression, thereby increasing the density of lymphatic vessels that mobilize metastatic cells.

Cervical lymph nodes

The lymph node staging is a very important prognostic parameter for patients with presenting with head neck cancer and is influencing the selection of the different therapeutic strategies including surgery, chemotherapy, radiotherapy or a combination of them. The accuracy of imaging techniques, such as US, MR imaging, and CT, depends on the appropriateness of radiological criteria used for diagnosing lymph node metastases. Size of nodes and evidence of necrosis are still the most important radiological criteria. However, the size shows great variability. A spherical lymph node larger than 10 mm is an indicator for a malignant node, whereas an oval shape and/or a fatty hilus are more benign signs. But there are many limitations and different cut offs published in the literature, indicating that the size of a lymph node is not a reliable criteria for the assessment of lymph nodes in the head and neck region. Today new high-resolution MRI sequences and the development of specific contrast agents are offering new possibilities in the diagnostic work-up of head and neck lymph nodes. Ultrasmall superparamagnetic iron oxide particles (USPIO's) are resulting after intravenous application in a reduction of the T2 relaxation time. This is causing a signal decrease on T2-weighted MR images in benign lymph nodes after administration of USPIO's, whereas malignant lymph nodes do not show a significant signal decrease. Some clinical studies presented already very promising results. Based on the fact, that the size evaluation of lymph nodes in the head and neck has not changed during the last decade, this paper will mainly focus on MRI with new contrast agents and new techniques as diffusion weighted imaging (DWI).

Diffusion-weighted magnetic resonance imaging in neck lymph adenopathy

In patients with head and neck squamous cell carcinoma (SCC), nodal metastases are an adverse prognostic factor compromising long term patient survival. Therefore, accurate detection of regional nodal metastases is required for optimization of treatment. Computed tomography (CT) and magnetic resonance imaging (MRI) remain the primary imaging modalities for locoregional staging of head and neck SCC. Next to evaluation of the primary tumour, both modalities facilitate detection of non-palpable lymph nodes (LN). However, both modalities rely on size-related and morphological criteria to differentiate between benign and malignant lymph nodes, decreasing the sensitivity for detection of small metastases. Diffusion-weighted MRI (DW-MRI) measures differences in tissue microstructure, based on the random displacement of water molecules. The differences in water mobility are quantified using the apparent diffusion coefficient (ADC), which has an inverse relationship with tissue cellularity. As such the technique is able to differentiate between tumoral tissue and normal or necrotic tissue. The added value of DW-MRI to conventional imaging for staging of lymph nodes in head and neck cancer is discussed, before and after treatment. The possible consequences regarding therapeutic management are outlined.