Incidence Of Cervical Metastasis Research Articles

Can Submandibular Gland be Preserved During Neck Disscetion in Oral Cavity Squamous Cell Carcinoma?

Submandibular gland is commonly removed as an integral part of level I neck dissection for oral cavity squamous cell carcinoma. However, it is unclear whether lymph nodes are present within the submandibular gland which may form the basis of lymphatic spread and gland removal. So, this study investigated the incidence of submandibular gland involvement in oral cavity squamous cell carcinoma to determine the possible feasibility of submandibular gland sparing neck dissection. The medical records of 83 patients diagnosed with oral cavity squamous cell carcinoma were reviewed retrospectively to determine frequency of intraglandular lymph nodes in submandibular gland [submandibular gland metastasis] and incidence and mechanism of submandibular gland involvement by oral cavity squamous cell carcinoma. The overall incidence of cervical metastasis was 56.4%, of whom majority had level I metastasis. Submandibular gland involvement via direct invasion from the anatomical proximity of T4a tumors or extra nodal extension from level 1b node was evident in 6 patients. Despite the high incidence of level I metastasis, lymphatic metastases to submandibular gland itself are unlikely based on absence of intraglandular lymph nodes. The results suggest the feasibility of preserving the submandibular gland in early-stage oral cavity carcinoma unless the tumor extends level 1b with extra nodal extension.

A retrospective study of correlation of tumour thickness with nodal spread in anterior tongue cancer

Background: Squamous cell carcinoma (SCC) of the oral tongue is characterized by a high propensity for cervical nodal metastasis, which affects the probability of regional control and survival. Many histopathologic parameters in tongue squamous cell carcinoma have been identified as predictive factors for cervical metastasis. Several studies focused on tumor thickness, and the depth of invasion was suggested to have a relationship to the occurrence of cervical metastasis.Methods: The medical records of 134 primary tongue carcinomas operated without any preoperative therapy. Author conducted a retrospective study of anterior tongue cancer cases operated at the institute in the department of surgery between April 2012 till March 2017 and studied the correlation between tumour thickness and nodal spread. Each patient's tumor type, tumor location, tumor size, invasion mode, depth of invasion, intralymphatic tumor emboli, and perineural invasion were evaluated.Results: The overall cervical metastatic rate was 56.71%. In the group in which tumor depth exceeded 5mm, the metastatic rate was 77.77% (70/90). In contrast, when the depth of invasion was less than 5mm, the incidence of cervical metastasis was 13.63% (6/44). Clinically negative necks turned out pathologically positive in 28.39%.Conclusions: It was observed that there is a discerning point at 5mm of tumor depth at which cervical metastasis is probable. Elective neck therapy (surgery or irradiation) is strongly indicated for tumors exceeding 5mm invasion.

Controversies on Tumor Thickness Versus Nodal Metastasis in Oral Squamous Cell Carcinomas Revealed: A Histopathologist’s Perspective

Abstract Background: Cervical metastasis has a tremendous impact on prognosis in patients with head and neck squamous cell carcinomas (HNSCCs). However, to date management of clinically negative neck in HNSCC is still a controversial subject. Tumor thickness (TT) is a strong predictor for lymph node involvement in oral squamous cell carcinomas (SCCs). However, controversy exists about the optimal TT cutoff point for a clinically relevant risk to the neck. Aim and Objectives: The aim is to evaluate the relationship between TT and the risk of cervical lymph node involvement and to determine optimal TT cutoff point for prompting prophylactic neck management. Materials and Methods: The clinical files and histological sections of 35 SCC (T1/T2) at buccal mucosa site from clinically determined N0 patients were retrospectively analyzed who underwent surgical treatment of their primary lesion with simultaneous neck dissection. An ocular micrometer was used to measure the TT both in exophytic and ulcerated lesions. Chi-square contingency tables were used to correlate TT and other clinicopathological parameters with metastasis in the neck. Results: Clinically, negative necks turned out pathologically positive in 42.8% (n = 15/35). In the group in which tumor depth exceeded 1.5 mm, the metastatic rate was 86.7% (13/15). In contrast, when the depth of invasion was <1.5 mm, the incidence of cervical metastasis was 13.3% (2/15) irrespective of the 2 stages. Conclusion: TT is a highly significant, objectively measurable prognostic factor in early stage oral cancers and elective neck therapy is indicated for tumors exceeding 1.5 mm invasion.

Incidence of intraglandular lymph nodes within submandibular gland, and involvement by floor of mouth cancer.

Resection of the submandibular gland is generally undertaken as an integral component of level I neck dissection for oral cancer. However, it is unclear whether lymph nodes are present within the submandibular gland which may form the basis of lymphatic spread. Our purpose was to investigate the frequency of lymph nodes within the submandibular gland, and the incidence and mechanism of submandibular gland involvement in floor of mouth cancer. Retrospective review of 177 patients with oral cancer undergoing neck dissection. Original pathology slides of floor of mouth cases were re-reviewed by two pathologists to determine frequency of intraglandular lymph nodes, and incidence and mechanism of submandibular gland involvement by cancer. The overall incidence of cervical metastases was 36.4%, of whom 44% had level I metastases. Level I metastases were significantly more common in floor of mouth than tongue cancers (p=0.004). Among 50 patients with floor of mouth cancer undergoing re-review of pathology slides, intraglandular lymph nodes were not found in any of 69 submandibular glands. Submandibular gland involvement by cancer was present in two patients, representing 1% of all oral cancers, and 4% FOM cases. Mechanisms of involvement were direct extension, and by an apparent novel mechanism of carcinoma growing along bilateral Wharton's ducts. Despite the high incidence of level I metastasis in floor of mouth, lymphatic metastases to submandibular gland are unlikely based on absence of intraglandular lymph nodes. We describe a previously unreported mechanism of submandibular gland involvement.

Recurrence rate and shift in histopathological differentiation of oral squamous cell carcinoma – A long-term retrospective study over a period of 13.5 years

ObjectiveLittle information is available as to whether recurrences of oral squamous cell carcinoma (OSCC) show different histopathological grades than the primary tumor and whether postoperative radiotherapy (PORT) influences the grade of differentiation in the case of recurrence. The objective of this study was the evaluation of recurrence rates and change in differentiation. Material and methodsThis retrospective, single-institution cohort study included surgically treated OSCC patients over a 13-year period (2000–2013). The relationship among tumor size, lymph node metastases, and recurrence rate of OSCC was investigated. Primary tumor differentiation was compared with differentiation of recurrence. ResultsA total of 429 patients (277 men and 152 women) were included in this study. Of these, 124 (28.9%) received PORT. The incidence of primary cervical metastases increased significantly with tumor size (p < 0.001). Recurrence developed in 82 patients (19.1%). Stage T1/T2 showed a significantly lower recurrence rate than stage T3/T4 (16.3% vs. 30.2%) (p < 0.01). A total of 23 (30.7%) patients with recurrence showed a change in differentiation. ConclusionIncreasing primary tumor size correlates with incidence of cervical metastases and recurrence rate. Initial cervical metastases show no effect on recurrence rates. Differentiation of primary tumor does not correlate with the recurrence rate. The majority of recurrences show consistent histopathological grading.

PP123: Neck dissection in squamous-cell carcinoma of the maxillary gingiva, alveolus, and hard palate. A multicentre Italian study of 65 cases

The occurrence of occult cervical metastases due to squamous-cell carcinoma of the hard palate and maxillary alveolar ridge has not been studied systematically. We have observed that many patients return with a delayed cervical metastasis following resection of a primary cancer at these sites. Some of these patients have died as a result of a regional or distant metastasis, despite control of the primary cancer. The literature contains few recommendations to guide the treatment of maxillary squamous-cell carcinoma; prospective studies are difficult due to the rarità of such tumours. The aim of this study is to define the incidence of cervical metastasis and to investigate whether elective neck dissection is justified. We present a retrospective multicentre study of 65 patients with squamous-cell carcinomas of the maxillary alveolar ridge and hard palate. The overall incidence of cervical metastases was 21%. We evaluated the significance of primary site tumours as indicator of regional disease. The maxillary squamous-cell carcinoma exhibited aggressive regional metastatic behaviour, comparable with that of carcinomas of the tongue, mouth floor, and mandibular gingiva. Based on our findings, we recommend selective neck dissection in clinically negative necks as a primary management strategy for patients with maxillary squamous-cell carcinomas involving the palate, maxillary gingiva, or maxillary alveolus.

Neurological and Survival Outcomes After Surgical Management of Subaxial Cervical Spine Metastases

A clinical retrospective study. To investigate the clinical outcomes of surgery for cervical spine metastasis and identify factors affecting survival and neurological result. Metastatic disease in the cervical spine is known to be a poorer prognosis than in thoracic and lumbar regions. Few reports focused on cervical spine metastasis are available. A retrospective analysis of medical records and radiological data was performed on 46 patients who underwent surgical treatment due to cervical spine metastasis from 2000 to 2010. The incidence of cervical metastasis, overall survival, progression-free survival, and neurological and pain outcomes were analyzed. In addition, factors affecting survival, local recurrence, and neurological and pain outcomes among the 46 study subjects were analyzed. These factors included; age, sex, primary tumor growth rate, preoperative disease-progression status (expressed with Tomita score), irradiation, timing of irradiation, postoperative adjuvant therapy, time of diagnosis of spinal metastasis, cord compression or foraminal invasion on magnetic resonance image, preoperative neurological status, and preoperative pain level. The incidence of cervical metastasis was 17.3%. Mean postoperative overall survival was 16.89 months, the recurrence rate was 39.1%, and mean progression free survival was 11.82 months. Factors related to prolonged survival were slow primary tumor growth, low Tomita score, irradiation of the lesion, and postoperative adjuvant therapy. Postoperative adjuvant therapy was also found to be effective for preventing recurrence. Patients with high preoperative Japanese Orthopaedic Association Score achieved better neurological outcomes. Foraminal invasion was found to be negatively correlated with postoperative pain outcome. Surgical management for subaxial cervical spinal metastasis was found to be effective in terms of neurological recovery and pain control. Furthermore, surgical treatment plus adjuvant therapy was found to achieve sufficient local control during postoperative follow-up.

Is preoperative ultrasonography accurate in measuring tumor thickness and predicting the incidence of cervical metastasis in oral cancer?

Is preoperative ultrasonography accurate in measuring tumor thickness and predicting the incidence of cervical metastasis in oral cancer?

Incidence of cervical metastasis in maxillary oral squamous cell carcinoma: a retrospective review

Current management of squamous cell carcinoma (SCC) originating in the oral mucosa of the maxilla with no evidence of cervical node metastasis (cN0) involves no elective therapy to the neck, unless the neck is to be entered for vascular access.

P2.52. Incidence of cervical metastasis in maxillary oral squamous cell carcinoma – A retrospective review

P2.52. Incidence of cervical metastasis in maxillary oral squamous cell carcinoma – A retrospective review

Cervical Metastasis From Squamous Cell Carcinoma of the Maxillary Alveolus and Hard Palate

Squamous cell carcinoma has a predilection for regional lymphatic metastasis. The occurrence of occult cervical metastases from squamous cell carcinoma of the hard palate and maxillary alveolar ridge has not been studied systematically. We have observed many patients who have returned after resection of a primary cancer in these sites with a delayed cervical metastasis. Some of these patients have died of regional or distant metastasis despite control of their primary cancer. We have studied 26 patients with squamous cell carcinoma of the maxillary alveolar ridge and hard palate to define incidence of cervical metastasis. Overall incidence of cervical metastasis was: clinical 2 of 26 (7.6%) and occult 7 of 26 (27%) for a total of 9 of 26 (34.6%). The 5-year disease-specific survival was 13 of 22 (59%). Surgery for regional failure was successful in 66% (6 of 9). Radiation was administered after surgery in eight of nine patients. Cervical metastasis from cancer of the palate and alveolar ridge is significant. Regional surgery for recurrent disease usually requires radical or modified radical neck dissection. Selective elective neck dissection should be offered to patients with cancer of the hard palate and alveolar ridge. It affords the patient and the treatment team valuable histologic information, which may help to guide therapy and reduce the potential need for future hospitalization, chemoradiation, and more radical surgery.

Distribucija cervikalnih metastaza karcinoma cervikofacijalne regije

The primary goal in the therapy of patients with cervico-facial cancers has been always the control of loco-regional disease. It is more difficult to control metastasis than primary tumor. According to numerous authors, metastases to cervical lymphonodus reduce the survival of patients with planocellular cancer of the upper aero-digestive pathways for about 50%. Precise classification of primary tumor and regional lymphonodus is highly significant for adequate and timely treatment of patients with cancers of cervico-facial region. The objective of our study was to make clinical classification of cervico-facial tumors and to establish the distribution of nodes according to node groups and cervical levels. In our series of 319 subjects, T2 category of primary tumors was most prevalent accounting for 40.44%. Clinically palpable lymphonodes were found in 87.15%, with most prevalent N1 category accounting for 42.95%. The incidence of clinically negative cervical nodus (N0) was reported in 12.85%. The nodes of the upper, medium and lower jugular group were most frequent in cancers of the larynx and pharynx. In cancer of the oral cavity, submental and submandibular nodes were the most commonly involved. In distribution of nodes based on oncological cervical levels, 45.86% of nodes at level II of the neck were found in laryngeal cancer, while 40% the neck level I was involved in the cancer of the oral cavity. In epipharyngeal cancer, 3.15% of cervical metastases were detected in the posterior triangle of the neck. The incidence of cervical metastases in specific primary localizations has a significant role for indications of one of the dissections of the neck.

舌へん平上皮癌Ｎ０症例における頚部後発転移の予測

To predict indicators of occult neck metastasis, we evaluated clinico-pathological findings in N O cases of squamous cell carcinoma of the tongue by the quantification theory type II. The number of N O cases without local failure from 1974 through 1995 was 88. Biopsy specimens were evaluated pathologically after treatment of the primary lesion alone. Cervical lymph node metastasis subsequently developed in 18 cases. Data analysis, in which occult neck metastasis was considered a dependent variate and clinico-pathological findings as an independent variate, indicated that the invasion pattern was the most significant predictor of cervical lymph node metastasis. The presence or absence of occult cervical lymph node metastasis was correctly predicted in 76.1% of the cases.On analysis by the Anneroth classification, the contribution of morphologic variables to metastasis diminished in the following order: mode of invasion, number of mitoses, degree of keratinization, stage of invasion, lymph-plasmocytic infiltration, and nuclear polymorphism. On analysis of the total score derived from the correlation coefficients, occult neck metastasis was not found in patients with a score of 9 or less. The higher the total score, the higher was the incidence of cervical metastasis.

A comparison of results after radiotherapy and surgery for stage I squamous cell carcinoma of the lower lip

Abstract Background Controversy still exists as to whether radiotherapy or surgery is the preferable therapeutic modality for stage I squamous cell carcinoma of the lower lip. Therefore, a retrospective study was undertaken to compare the results of both treatment modalities. Methods The results of 90 patients who received radiotherapy and 166 patients who underwent surgery as the primary form of treatment for their stage I primary squamous cell carcinoma of the lower lip were evaluated. Tumor size and histological grade of differentiation were assessed. Results Local control rates were the same with radiotherapy or surgery. Overall survival rates for both groups of patients were similar as well. Disease-free survival rates in the patients who underwent radiotherapy were significantly lower compared with the surgically treated group. This was due to a higher occurrence of regional metastases in the patients who received radiotherapy. Univariate analysis showed that irradiated patients had a statistically significant greater tumor size. The difference of histological differentiation between the groups was also statistically significant, the poorly differentiated being more common in the irradiated group. Multivariate analysis showed that only tumor size carried significant independent prognostic information. Conclusions The cure rates of stage I squamous cell carcinoma of the lower lip are favorable whether treated by radiotherapy or surgery, and local control rates are similar. The radiotherapeutic treated group showed an increased incidence of cervical metastases, which was due to the more advanced tumor size in these patients. © 1999 John Wiley & Sons, Inc. Head Neck 21: 526–530, 1999.

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

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

Depth of invasion as a predictive factor for cervical lymph node metastasis in tongue carcinoma.

Many histopathologic parameters in head and neck squamous cell carcinoma have been identified as predictive factors for cervical metastasis. Several studies focused on tumor thickness, and the depth of invasion was suggested to have a relationship to the occurrence of cervical metastasis. Nonetheless, the criterium for elective neck therapy in terms of tumor depth is still inconclusive. Therefore, a retrospective study was undertaken to substantiate the differing results in the literature with our own findings concerning the interrelationship between tumor thickness and clinically suspicious neck, as well as occult neck disease. In addition, the study attempted to identify further predictive factors for cervical metastasis in squamous cell carcinoma of the tongue. The medical records of 34 primary tongue carcinomas operated without any preoperative therapy between 1980 and 1991 were reviewed. Each patient's tumor type, tumor location, tumor size, invasion mode, depth of invasion, intralymphatic tumor emboli, and perineural invasion were evaluated. Chi-square contingency tables were used to correlate clinical or histopathologic parameters with metastasis in the neck. The overall cervical metastatic rate was 35.3% (n = 12/34). In univariate analysis, invasion mode and depth of invasion were statistically significant predictors of regional metastasis at p = 0.0019 and p = 0.0003, respectively. In the group in which tumor depth exceeded 5 mm, the metastatic rate was 64.7% (11/17). In contrast, when the depth of invasion was less than 5 mm, the incidence of cervical metastasis was 5.9% (1/17). Clinically negative necks turned out pathologically positive in 30.0% (n = 9/30). The tumor depth exceeded 5 mm in 43.4% (13/30) of the N0 necks. In the conversion (N0-->N1) group, tumor depth exceeding 5 mm was noted in 88.9% (n = 8/9). We suggest that there is a discerning point at 5 mm of tumor depth at which cervical metastasis is probable. Electric neck therapy (surgery or irradiation) is strongly indicated for tumors exceeding 5 mm invasion. Tumor invasion mode and tumor size also bear an impact on the indication for therapy.

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

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

Nodal patterns in carcinoma larynx and hypopharynx

The therapeutic choice for a malignant neoplasm is usually governed by the probability and location of lymph mode metastases. In the present study 47 cases of carcinoma larynx and 44 cases of carcinoma hypopharynx were throughly investigated and reviewed. Among the laryngeal malignancies supra glottic and transglottic tumours were equally frequent (46.8%). Among the hypopharyngeal malignancies, pyriform fossae were most frequently invloved (90.9%). In laryngeal malignancies (51.06%) as well as hypopharangeal malignancies (77.27%) T4 tumour were more common. Overall incidence of cervical metastases was (63.83%) in laryngeal carcinoma and (45.45%) in hypopharyngeal carcinoma respectively.

Incidence of cervical metastasis from uveal melanoma: implications for treatment.

Although the literature has focused on the propensity of uveal melanoma to metastasize to the liver, little attention has been directed to its spread in regional, cervical lymph nodes. We reviewed records of 77 patients who underwent primary resection of uveal melanoma during a 15-year period at our institution. A total of only 6.5% of patients developed cervical metastasis. Factors such as age, race, sex, tumor location, and histology were not influential in identifying these patients. Tumor size and local orbital recurrence were, however, associated with a higher risk of cervical lymphadenopathy (p < 0.05). Cervical metastases were also associated with the presence of distant metastatic disease. Neck dissection should be reserved for patients with clinically demonstrable lymphadenopathy only after distant disease has been excluded.

Squamous cell carcinoma of the lower lip

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