Indication Of Elective Neck Dissection Research Articles

Nodal metastasis and value of neck dissection in T1/2 oropharyngeal and hypopharyngeal carcinomas

Due to heterogeneous data, the indication for elective neck dissection (END) in patients with squamous cell carcinoma of the hypopharynx and oropharynx (HPSCC and OPSCC) in stages T1/2N0 is somewhat unclear. Therefore, in this multicenter study, we performed detailed analysis of the metastatic behavior of HPSCC and OPSCC. The nodal metastatic patterns of 262 HPSCC and OPSCC patients who had undergone surgery was retrospectively investigated. In addition, recurrence-free and overall survival were recorded. Furthermore, a systematic literature review on the topic was completed. In patients with HPSCC, a discrepancy between clinical and pathologic N status was recorded in 62.1% of patients vs. 52.4% for p16- OPSCC, and 43.6% for p16+ OPSCC. The occult metastasis rate in cT1/2cN0 primary tumors was 38.9% for HPSCC vs. 17.8% (p16- OPSCC) and 11.1% (p16+ OPSCC). Contralateral metastases occurred in 22.2% of cases for HPSCC at stages cT1/2cN0, compared to only 9.1% for p16- OPSCC, and 0% for p16+ OPSCC patients.Patients with p16+ OPSCC had better recurrence-free and overall survival than p16- OPSCC and HPSCC patients. A direct association between patient survival and the extent of neck surgical therapy could not be demonstrated in our patients. Patients with HPSCC are at risk for bilateral neck metastases from stage cT1/2cN0, justifying bilateral END. Patients with T1/2 OPSCC present with occult metastases ipsilaterally in >20% of cases; however, the risk for contralateral occult metastasis is <10%. Hence, in strictly lateralized cT1/2CN0 tumors, omission of contralateral END may be considered.

Indications for elective neck dissection in cT1N0M0 oral cavity cancer according to the AJCC eight edition: A nationwide study

ObjectivesAccording to the NCCN guidelines, there is weak evidence to support the use of elective neck dissection (END) in early-stage oral cavity squamous cell carcinoma (OCSCC). We sought to examine the indications for END in patients with cT1N0M0 OCSCC defined according to the AJCC Staging Manual, Eight Edition. MethodsOf the 3886 patients diagnosed with cT1N0M0 included in the study, 2065 underwent END and 1821 neck observation. ResultsThe 5-year outcomes for patients who received END versus neck observation before and after propensity score matching (n = 1406 each) were as follows: neck control, 96 %/90 % (before matching), p < 0.0001; 96 %/90 % (after matching), p < 0.0001; disease-specific survival (DSS), 93 %/92 % (before matching), p = 0.0227; 93 %/92 % (after matching), p = 0.1436. Multivariable analyses revealed that neck observation, depth of invasion (DOI) > 2.5 mm, and poor differentiation were independent risk factors for 5-year outcomes. Upon the application of a scoring system ranging from 0 (no risk factor) to 3 (presence of the three risk factors), the following 5-year rates were observed: neck control, 98 %/95 %/84 %/85 %; DSS, 96 %/93 %/88 %/85 %; and overall survival, 90 %/86 %/79 %/59 %, respectively (all p < 0.0001). The survival outcomes of patients with scores of 0 and 1 were similar. The occult metastasis rates in the entire study cohort, DOI > 2.5 mm, and poor differentiation were 6.8 %/9.2 %/17.1 %, respectively. ConclusionBecause all patients who received neck observation had a score of 1 or higher, END should be performed when a DOI > 2.5 mm or poorly differentiated tumors are present. Under these circumstances, 48.6 % (1888/3886) of cT1N0M0 patients may avoid END without compromising oncological outcomes.

Influence of Site, Size, Depth of Invasion and Histologic Grading on the Occurrence of Cervical Level IIb Metastasis and Extranodal Extension in Clinically N0 Neck of Patients with OSCC: A Single Center Retrospective Analysis.

Depth of Invasion ≥ 4mm, T stage and primary site with more than 20% chances for occult metastasis are currently the accepted indications for elective neck dissection. Nodal metastasis decreases survival by 50%. ENE further reduces the prognosis. Dissection of level IIb lymph nodes in clinically N0 neck does not improve survival. A total of 320 patients were evaluated. Binary and multiple logistic regression and chi-square test were used for data analysis. ROC curve with Youden's J index was used to set up a cutoff value for DOI. The predictor variables were site, size, grading and depth of invasion of primary tumor. Incidence of level IIb metastasis and ENE were the outcomes. The study revealed a significant association and risk stratification between primary tumor characteristics with the occurrence of ENE. The cutoff value for DOI predicting ENE was 12.5mm. Tumors of the oral tongue were an independent risk factor for level IIb metastasis. Size of primary tumor, DOI, tumors of the mandibular alveolus and poor grading are independent risk factors for ENE. Isolated metastasis to level IIb rarely occurs in the absence of concomitant level IIa metastasis. Size, DOI and grading were significantly associated with level IIb metastasis. However, only tumors of the oral tongue were independent risk factor.

The Indications for Elective Neck Dissection in T1N0M0 Oral Cavity Squamous Cell Carcinoma

The management of the clinically node-negative neck in T1 oral cavity squamous cell carcinoma (SCC) is controversial. The purpose of this study was to investigate tumor characteristics of surgically managed patients with T1N0 oral cavity SCC and determine the possible benefits of elective neck dissection (END). A retrospective cohort study was conducted assessing outcomes for patients with stage I oral SCC at Waikato Hospital, New Zealand, between 2008 and 2018. Clinical staging was based on the American Joint Committee on Cancer Cancer Staging Manual, 8th Edition. Patients with T1N0 SCC either had an END or had the neck observed. These data were used to determine the rate of occult nodal disease, recurrence rate, and survival. Data collected included patient demographics, location, tumor characteristics including differentiation, depth of invasion (DOI), perineural invasion (PNI), lymphovascular invasion, closest histologic margin, management of the neck, the number of pathologic lymph nodes, adjuvant treatment, recurrence, and survival. A total of 70 patients were included in the study (40 male, 30 female; age range 30 to 91; mean age 65years). Twenty-seven (38.6%) patients underwent END, whereas 43 patients (61.4%) were observed. Occult nodal metastases were diagnosed in 6 of 27 (22.2%) patients who underwent END. Regional relapse occurred in 7 of 43 (16.3%) patients who were observed. Risk factors for nodal disease included increasing DOI ≥ 3mm (P=.049), poor tumor differentiation (P=.003), and presence of PNI (P=.002). Negative prognostic factors for overall survival included male gender (P=.02, hr=3.55, CI for HR (1.18, 10.65)), presence of PNI (P=.001, hr=4.52, CI for HR (1.77, 11.57)), and locoregional recurrence (P<.005, hr=6.55, CI for HR (2.69, 15.98)). Six of the 7 tumors that relapsed in the neck after observation had a primary tumor DOI < 3mm. There is little data published for management outcomes of the node-negative neck in stage I oral squamous cell carcinoma. Given salvage neck dissection carries a poorer prognosis, END should be recommended for all T1N0 oral SCC with DOI ≥ 3mm. In cases of DOI < 3mm undergoing primary ablation only, a staging neck dissection as a second procedure should be considered in the presence of poor tumor differentiation or PNI on final histology.

Elective neck dissection in primary parotid carcinomas: A systematic review and meta-analysis.

To estimate the rate of occult cervical lymph node metastases in cN0 patients affected by primary parotid carcinomas and to scrutinize the evidence on the indication and extent of elective neck dissection in these neoplasms. Medline, Embase, Web of Science, Cochrane Library and Scopus were searched until August 31, 2020, to identify studies reporting the use of elective neck dissection in the management of malignant parotid tumours. The PRISMA checklist was used. A single arm meta-analysis was then made to determine the pooled rate of occult lymph node metastases. Risk of bias of the included studies was assessed through the ROBINS-E tool. The initial search returned 20541 articles, of which twelve met the inclusion criteria and were included in the meta-analysis. They comprised 1310 patients with parotid carcinoma, of whom 542 cN0 underwent elective neck dissection, which led to the diagnosis of lymph node metastasis (pN+/cN0) in 113 cases. Meta-analysis of the results of elective neck dissection showed an overall rate of occult metastases of 0.22 (99% CI: 0.14-0.30). Locally advanced or high-grade tumours were the commonest indications for elective neck dissection in the included studies. The most dissected lymph node levels were I-II-III, and level II was the commonest site of occult nodal metastases. An occult metastasis rate of 0.22 (99% CI: 0.14-0.30) represents a not negligible percentage value, which should encourage further research to outline the most appropriate elective neck management in cN0 patients with parotid carcinomas.

Elective neck dissection in patients with radio-recurrent and radio-residual squamous cell carcinoma of the larynx undergoing salvage total laryngectomy: Systematic review and meta-analysis.

Approximately 30% of nonsurgically treated patients with laryngeal squamous cell carcinoma will suffer recurrence, and many will be clinically N0; the indication for elective neck dissection (END) remains uncertain. We aimed to determine whether END is indicated during salvage laryngectomy. Systematic review and meta-analysis. A total of 1141 patients were identified from 17 studies. Occult nodal positivity was 13.7% (106/775) confidence interval (CI) 11.3%-16.1%; higher in supraglottic than glottic disease (17.8%, CI 10.3%-25.3% vs 12%, CI 7.1%-16.9%, P = .18). No significant difference existed between END vs observation in 5-year disease free survival (odds ratio [OR] = 0.76, CI = 0.49-1.17, P = .21, I2 = 10%) and overall survival (OS; OR = 0.96, CI = 0.65-1.41, P = .82, I2 = 54%). No significant survival advantage was found for END vs observation. Individual studies trended towards improved survival with END in supraglottic and locally advanced tumors. These factors should be considered when deciding on END in salvage laryngectomy.

The role of elective neck dissection for cT4aN0 glottic squamous cell carcinoma.

The indication for elective neck dissection for patients with clinically T4aN0 (cT4aN0) glottic cancer is not established. The objective of this study was to evaluate the role of elective neck dissection for patients with cT4aN0 glottic cancer. We assessed patients with cT4aN0 laryngeal squamous cell carcinoma who underwent total laryngectomy between 1998 and 2014 and conducted a retrospective analysis. We considered occult neck metastasis positive when confirmed by histological analysis. When patients with late neck metastases did not undergo therapeutic neck dissection, the presence of occult neck metastasis was judged on the basis of computed tomography. The validity of elective neck dissection for patients with cT4aN0 glottic cancer was assessed from comparisons the rates of occult neck metastases of supraglottic and subglottic cancers, which are generally recommended for elective neck dissection. The distribution of occult neck metastases in glottic cancer is described according to nodal levels. The rate of occult neck metastasis of cT4aN0 laryngeal cancer was 36% (14/39). There were no significant differences among the rates of glottic 7/21 (33%), supraglottic 3/8 (38%) and subglottic 4/10 (40%) cancers. Patients with glottic cancer did not have bilateral Level IIB and ipsilateral Level IV metastasis. One patient had contralateral Level IV metastasis. The metastases rates of ipsilateral Levels IIA, III, and VI were >10%. We think that elective neck dissection is valid for cT4aN0 glottic cancer. Ipsilateral Levels IIA, III and VI should be dissected. The omission of neck dissection for bilateral Levels IIB and IV can be considered when there is a need to avoid complications.

Oral Cancer Treatment: Still an Indication for Elective Neck Dissection?

Introduction: Oral squamous cell carcinoma has a high incidence and, although elective neck dissection is recommended, the removed nodes frequently present without metastasis. This surgical approach causes disabilities and increases possible surgical complications. Objective: To evaluate the possibility of a watchful waiting approach in oral cancer. Methods: We compared 78 patients with clinical and pathological node metastases and their counterparts with pathological node metastases but without evident clinical neck disease. Therefore, we provided a theoretical comparison between the patients who had an elective neck dissection and those who waited until a clinically positive node was evident. Results: The prognostic factor rates were similar between the groups. Their regional recurrence and mortality rates had no statistical differences. Conclusion: A watchful waiting policy could be applied to selected oral cancer patients who can undergo a very close follow-up. This option would be more cost-effective and less harmful than elective neck dissection.

Neck dissection for salivary gland malignancies

Salivary gland carcinomas are diverse, and their biological behavior and surgical management are also variable and somewhat controversial. Cervical lymph node status is an important prognostic variable for salivary gland malignancies. Neck dissection should be undertaken if there is clinical or radiographic evidence of associated nodal metastasis in the neck. However, indications for elective neck dissections in a clinically N0 neck remains a controversial topic. This article describes indications for elective neck dissection in salivary gland malignancies, provides a detailed review of the neck dissection technique, and discusses postoperative management of these patients.

Incidence of occult metastasis in clinically N0 oral tongue squamous cell carcinoma and its association with tumor staging, thickness, and differentiation

Introduction: Oral squamous cell carcinoma (SCC) is the most frequent head and neck cancer. The metastatic dissemination of these tumours usually occurs through the lymphatic system. The presence of occult lymph node metastasis is the most important prognostic factor. The high incidence of occult lymph nodal metastasis is a strong argument for the indication of elective neck dissection. However, there is a high percentage of patients who do not have metastasis in the pathological exam (pN0). Taking a homogenous group of patients all of whom received primary surgical treatment, at the same institution without prior radiotherapy or chemotherapy, applying stringent patient selection criteria, and standard pathological evaluation methods across the group, this study aims to establish predictors of cervical node metastasis in squamous carcinomas of the oral tongue. Result: During the study period, a total of 112 patients (98 males and 14 females; Mean age 49.7 years (range 15-70)) underwent resection of the primary tumor with SOND for N0 lymph node status of neck. A total of 1489 lymph nodes were analyzed in this study. Occult metastasis was found in 26 patients (23.2%). T-stage 4 was found to be a statistically significant predictor of occult lymph node metastasis in a cN0 neck. (95% CI, p-value 0.02). There was no correlation between gender, tumor thickness, and tumor differentiation and occurrence of occult metastasis. Discussion: Controversy exists over management of the neck in patients with cN0 oral SCC. As is evident there is no consistent statistically significant factor that can be attributed as a predictor of occult metastasis in head and neck cancer of the oral cavity. The search to identify reliable and accurate predictor(s) of occult metastases, or approaches to the management of patients with cN0 oral SCC, must continue. In absence of such predictors, keeping the high incidence of occult metastasis in mind, we recommend END in all cases of N0 OSCC.

Head and Neck Cancer Treatment with Sentinel Node Biopsy without Eletive Neck Dissection

Introduction: The elective neck treatment in patients with squamous cell carcinoma of head and neck is suitable when the neck is clinically negative and the probability of lymphatic metastasis is greater than 20%. However, with this criterion, up to 80% of surgical specimens will be histopathologically negative. The absence of a method that can determine which patient really presents lymphatic metastasis does not allow us not to perform elective neck dissection when there is high risk for lymphatic metastasis. The sentinel lymph node biopsy seems to be clinically safe as a staging procedure. Besides, this technique apparently removes all the metastatic lymph nodes, since only 3% to 5% of the necks would present lymphatic metastasis other than sentinel node and neck recurrence seems similar to that after elective neck dissection. Then, this technique could be justified even as therapeutically, without elective neck dissection, when this lymph node is histologically positive. Objective: The objective of this study was to use the sentinel node technique with lymphocintigraphy and “gamma probe” in patients with squamous cell carcinoma of head and neck, therapeutically, as selective surgical treatment of neck, in substitution to elective neck dissection in clinically negative necks. Case: Prospective clinical study was accomplished with 25 patients with squamous cell carcinoma of head and neck, staged as T1 to T3 of oral cavity, orpharynx, larynx and face’s skin, from May, 2005 to march, 2007. All of them were cN0, without previous treatment, with indication of elective neck dissection and radiologically negative at neck CT scan. Sentinel node was located and dissected off with handheld “gamma probe” and 2 was directed for histopathological exam and immuno histochemistry evaluation. In the presence of adverse prognostic factors in the primary tumor or multiple lymphatic metastases, patient was submitted to adjuvant radiation therapy. Subjects were followed after surgery monthly with clinical exam and half-yearly with neck CT scan. Results: The global cervical recurrence rate was 4% (1/25) and in stage IV patients was 25% (1/4). Seven out of 25 patients (28%) were sentinel node positive, six of whom were classified as N1 and one as N2. The average follow up time was eight months, with a range from one to eighteen months. Conclusion: The sentinel node biopsy stays as a promising method in the neck treatment in head and neck tumors. However, more follow up time, with more patients, is imperative to achieve significant results to establish the sentinel node biopsy without mandatory neck dissection as routine care of head and neck cancer patients with clinically negative necks.

Epstein-Barr virus infection is strictly associated with the metastatic spread of sinonasal squamous-cell carcinomas

Sinonasal squamous-cell carcinomas (SNSCC) are relatively rare. Thus, data regarding the rate of lymph node metastases are inconsistent in contrast with well-known high metastasis rates in squamous-cell carcinomas of the head and neck (HNSCC) (oral cavity, pharynx and larynx). Hence, the indication for elective neck dissection is difficult in SNSCC. The aim of this study was to assess common genetic alterations and EBV and HPV status as a function of metastasis in SNSCC and HNSCC. We retrospectively analyzed 44 SNSCC and 65 HNSCC for TP53, EGFR, KRAS, PIK3CA and BRAF mutations using a high-resolution melting analysis followed by Sanger sequencing. EBV and HPV detection was performed using in situ hybridization for virus encoded RNA. Tumor-associated p16(INK4a) expression was visualized by immunohistochemistry and correlated with HPV infection. The mutation data, EBV and HPV status were statistically compared with the clinical data in SNSCC and HNSCC. TP53 mutations were exclusively associated with shorter survival in SNSCC (p=0.048). All the other markers had no effect on the metastasis rate and survival. In total, 20 of 44 SNSCC were EBV-positive. Only these EBV positive tumors developed lymph node or distant metastases (p=0.008). LMP1 was positive in 14/44 patients. When combining both methods significance for a correlation between EBV/LMP1 positive patients and metastases was even higher (p=0.001). In SNSCC, the presence of EBV is strictly associated with metastasis. We recommend an elective neck dissection in patients with EBV-positive SNSCC.

The Value of Sentinel Lymph Node Biopsy in Oral Cavity Cancers.

The aim of this study was to establish the effectiveness of sentinel lymph node biopsy in the detection of metastasis in N0 necks of T1-T2 early-stage oral cavity cancers. Twenty neck dissections were performed in 18 patients diagnosed with T1 and T2 oral cavity cancer, with an indication for elective neck dissection between November 2007 and January 2011. The male to female ratio was 12:8, with a mean age of 54.5 years (range 28-76). Eight of the dissections were performed for lower lip cancer, 7 for tongue cancer, and 5 for floor of the mouth cancer. Sentinel lymph node biopsy was used to detect metastatic lymph nodes. Tc99m radionuclide injection was administered to the periphery of the tumor 24 h before the operation, and a lymphoscintigraphy image was obtained 30 min after the injection. Sentinel lymph nodes were localized and excised on the day of surgery using static lymphoscintigraphy images and a gamma probe. Sentinel lymph nodes were sent for a frozen section examination, and either a selective or a comprehensive neck dissection was performed for each neck according to the results. After the final histopathological examination of the specimens, the negative predictive value, the positive predictive value, the accuracy of the sentinel lymph node biopsy, and frozen section accuracy were found to be 100%. Sentinel lymph node biopsy was found to be an efficient method in the pathological staging and management of the N0 neck in early T-stage oral cavity cancers.

고악성도 이하선암종에서 임상적으로 경부 임파선 전이가 없는 환자의 예방적 경부청소술의 필요성: 예비 연구

Background and Objectives: Lymph node metastases has a high prognostic value in patients with parotid gland carcinoma. However, a consensus regarding the indication of elective neck dissection (END) has not been reached. Most authors have advocated performing a neck dissection based on the histology of the primary parotid carcinoma and the tumor grade. Materials and Methods: A retrospective analysis was undertaken targeting 16 patients who were previously treated for primary carcinoma of the parotid gland with a clinically negative neck at Department of Otorhinolaryngology?Head and Neck Surgery. Eleven patients with high grade parotid carcinoma except two cases of the adenoid cystic carcinoma and three cases of low grade parotid carcinoma were evaluated to identify occult neck metastases. Results: Lymph node metastasis was detected in one (9.1 %) of the 11 patients with high grade parotid carcinoma who underwent elective neck dissection. One case of positive lymph node was squamous cell carcinoma as primary parotid cancer (33.3 %). Conclusions: Elective neck dissection seems to be necessary for the treatment of high grade parotid cancer with squamous cell carcinoma. However, there may be controversy over the cases of high grade parotid cancer except for the squamous cell carcinoma. (J Clinical Otolaryngol 2014;25:44-48)

OP191: Robot-assisted modified radical neck dissection via a retroauricular or modified face lift approach in clinically N+ head and neck cancer: A comparative study with the conventional transcervical neck dissection

Purpose In our feasibility study of robot-assisted neck dissection (RAND), we limited the indication for elective neck dissection (ND) in clinical N0 head and neck cancer. With growing experiences of RAND, we saw potential for therapeutic RAND in positive neck without extracapsular spread (ECS). In this study, we aim to compare the results of therapeutic RAND via a retroauricular (RA) or modified face-lift (MFL) approach with conventional transcervical ND in head and neck cancer. Materials and methods This study involved a total of 53 patients who underwent therapeutic ND for head and neck cancer at the department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea, from May 2010 to July 2012. Patients themselves decided whether the RAND or the conventional open ND would be performed for the treatment of neck metastasis with the information of the advantages and the disadvantages of both procedures. The following variables were assessed: age, gender, body mass index, primary site, TNM stage, operative parameters, pathologic parameters, perioperative complications, and satisfaction of scar. Results The RAND group consisted of 17 males and three females, with a median age of 62.5 years. The conventional ND group consisted of 30 males and three females, with a median age of 63.0 years. The mean operation time for ND of the RAND group was longer than that of the conventional ND group (186 ± 37 vs 150 ± 23) (p = 0.000). The mean number of retrieved lymph nodes in the RAND group (41.60 ± 12.47) showed no significant difference from that in the conventional ND group (44.39 ± 14.35) (p = 0.474). There were no significant differences in the development of postoperative complications between the RAND group and the conventional ND group. The score of satisfaction scar was significantly higher in the RAND group than in the conventional ND group (p = 0.023). The median follow-up periods were 8.0 month in the RAND group and 9.3 month in the conventional ND group. Conclusions Therapeutic RAND via a RA or MFL approach was feasible and successful, with satisfactory aesthetic results in patients with N+ head and neck cancer. This RAND technique via a RA or MFL approach may be applied to the selected cases by an experienced surgeon.

DF3 epitope expression on MUC1 mucin is associated with tumor aggressiveness, subsequent lymph node metastasis, and poor prognosis in patients with oral squamous cell carcinoma

DF3/MUC1 mucin is expressed in various cancer tissues, and many in vitro studies have suggested that it may play a role in the aggressive behavior of malignant tumors. However, to the best of the authors' knowledge, the relation between DF3/MUC1 expression and outcome has not yet been investigated in patients with oral squamous cell carcinoma (OSCC). The objective of the current study was to evaluate the prognostic significance of DF3/MUC1 expression in patients with OSCC. The expression profile of DF3/MUC1 in OSCC tissues from 206 patients was examined using immunohistochemistry. Its prognostic significance in OSCC was statistically analyzed on the basis of detailed clinicopathologic factors. DF3/MUC1 expression was found to be significantly correlated with tumor aggressiveness, such as pathologic lymph node metastasis (P = .002), advanced tumor stage (P = .02), diffuse invasion of cancer cells (P = .03), and vascular invasion (P = .01). Respectively, the overall survival (OS)and disease-free survival (DFS) rates were significantly worse for patients with DF3/MUC1 expression compared with those without DF3/MUC1 expression (P = .001 and P = .0003, respectively). Multivariate analysis demonstrated that DF3/MUC1 expression was an independent prognostic factor for both OS and DFS (P = .04 for both). In addition, DF3/MUC1 expression was found to be an independent risk factor for subsequent regional lymph node metastasis (P = .03). Aberrant expression of DF3/MUC1 is an independent prognostic factor indicating poor prognosis in patients with OSCC. DF3/MUC1 expression is a risk factor for subsequent lymph node metastasis in patients with OSCC and therefore may represent an indication for elective neck dissection. Patients with OSCC demonstrating positive expression of DF3/MUC1 should be followed carefully.

Eosinophils may predict occult lymph node metastasis in early oral cancer

The aim of this study was to investigate whether tumor-associated tissue eosinophilia (TATE) in early oral squamous cell carcinoma (OSCC) would aid in predicting occult lymph node metastasis. Seventy-one patients undergoing elective neck dissection for T1 and T2 OSCC were evaluated for clinical features, prognosis, and TATE. The degree of TATE in OSCC was statistically analyzed in relation to the clinicopathological features, tumor invasion, occult lymph node metastasis, and survival using χ(2) test and Kaplan-Meier method. Statistical analysis revealed that intense TATE was a significant feature (p = 0.004) to predict occult lymph node metastasis in patients with early OSCC. All regional recurrences of the OSCC occurred in patients showing intense TATE. These results suggest that intense TATE can be clinically used as a predictive factor for occult lymph node metastasis. The presence of intense TATE is an adjunctive histopathological marker to reinforce the indication of elective neck dissection of the patients with early OSCC.

Gingival carcinoma: retrospective analysis of 72 patients and indications for elective neck dissection

Gingival squamous cell carcinoma (SCC) is relatively uncommon, and little is known about its metastatic pattern. We retrospectively reviewed 864 consecutive patients with oral SCC who were seen at the University of Maryland Department of Oral and Maxillofacial Surgery (1991–2005), and identified 111 cases of gingival SCC. Inclusion criteria were fulfilled in 72 patients (mean duration of follow up 49 (1–153) months). Mean (range) age was 72 (45–93) years; 41 patients were women and 31 men. Distribution was almost equal: mandible 35 and maxilla 37. Forty (56%) were in the early stages (pI/II) and 32 (44%) in the later stages (pIII/IV). Twenty-nine patients had primary neck dissections, of whom 7/21 had clear, and 6/8 invaded, cervical nodes. The total number of occult nodal metastases was 9/29 (31%) in the mandible and 14/35 in the maxilla (one patient with initially clear nodes had both invaded nodes at neck dissection and a recurrence in the neck). The number of early compared with late stage occult metastases was 4 of 20 patients (20% T1/T2) and 5 of 9 patients (55% T3/T4) in the mandible and 2 of 22 patients (9% T1/T2) and 2 of 13 patients (15% T3/T4) in the maxilla. Two of 9 patients developed occult nodes within T2 maxillary gingival SCC. Bony invasion was identified in 17 patients (24%) occurring in 8 of 19 patients (42%) with invaded nodes compared with 9 of 53 patients (17%) with clear nodes. Overall survival at 2 and 5 years was 53 of 72 patients (74%) and 27 of 72 patients (38%) respectively. Elective neck dissection is indicated for all stages of mandibular gingival tumours and T3/T4 carcinomas of the maxillary gingiva. T2 maxillary SCC should be considered for elective neck dissection. Overall disease-free survival was worse among those with cervical metastases ( p = 0.004) and those who had had marginal resections ( p = 0.04).

Indication for elective neck dissection for N0 carcinoma of the parotid gland: a single institution's 20-year experience

Conclusions: Elective neck dissection (END) may not be necessary in patients with low-grade malignancy. However, currently, END should be performed in all patients with parotid carcinoma because the preoperative diagnosis of lymph node metastasis is limited and the accuracy of preoperative grade diagnosis is low. Objective: Our aim was to examine the indication for END in N0 patients and the extent of dissection by investigating the accuracy of diagnosing the grade and lymph node metastasis of parotid carcinoma. Patients and methods: The subjects were 77 patients with parotid carcinoma. Among N0 patients, modified radical neck dissection (MRND) was conducted in those in whom the histological grade was evaluated as high, and selective neck dissection (SND) in other patients. Results: Lymph node metastasis was detected in 27 of 71 patients who underwent neck dissection. Node metastasis was detected in 19 (61.3%) of 31 patients in whom high-grade malignancy was suggested and in 8 (22.9%) of 35 patients in whom intermediate-grade malignancy was suggested preoperatively. There was no metastasis in any of the five patients in whom low-grade malignancy was suggested. Occult metastasis was noted in 8 of 51 patients. The rate at which the histological grade was accurately diagnosed before surgery was low, especially in patients with low-grade malignancy.

Indication for elective neck dissection for N0 carcinoma of the parotid gland: a single institution's 20-year experience

Indication for elective neck dissection for N0 carcinoma of the parotid gland: a single institution's 20-year experience