喉癌喉咽癌哨位淋巴结的临床初步研究

目的 探讨喉癌喉咽癌哨位淋巴结的检测及其对颈淋巴结转移的预测价值。方法 用手术中注射蓝染料的方法,对29例颈淋巴结NO的喉癌喉咽癌患者进行了哨位淋巴结的临床研究。手术中取蓝染的哨位淋巴结作快速冰冻病理检查,并与HE染色病理检查结果及颈清扫切除的淋巴结病理检查对照,观察哨位淋巴结转移对颈淋巴结转移癌的预测值。结果 29例中28例成功地显示了哨位淋巴结,成功率达96．6％。每例发现蓝染的哨位淋巴结1－4个,平均每例则检出2．5个。有3例患者的哨位淋巴结检测有肿瘤转移,HE染色病理检查及颈清扫切除的淋巴结病理检查均证实颈淋巴结转移。25例哨位淋巴结冰冻病理检查阴性患者,颈淋巴结清扫标本亦未查见淋巴结转移。哨位淋巴结对颈淋巴结转移的阳性正确率和阴性预测率为100％。结论 哨痊淋巴结检测对喉咽癌的淋巴结转移有重要的预测价值。     

改良性颈廓清术在声门上型喉癌患者中的应用

目的 :为提高声门上型喉癌患者的生存率和生存质量 ,总结颈廓清术中保留颈内静脉的临床经验。方法 :88例声门上型喉癌患者中 ,在原发灶切除同时 ,共进行 146侧 (双侧 116例 ,单侧 30例 )颈廓清术 ,其中改良颈廓清 (MND)10 6侧 ,根治颈廓清 (RND) 4 0侧。双颈廓清术 5 8例 ,其中同期双颈廓清 32例 ,18例保留双侧颈内静脉 ,14例保留一侧颈内静脉 ;分期双颈廓清 2 6例 ,第一次均为 RND,第二次均为 MND。 30例行一侧颈廓清术 ,术中均保留颈内静脉。结果 :患者 3年生存率同期双颈廓清 81.5 % (2 2 / 2 7) ,分期双颈廓清 6 0 .9% (14/ 2 3) ,一侧颈廓清 75 % (15 / 2 0 )。5年生存率同期双颈廓清 6 1.5 % (16 / 2 6 ) ,分期双颈廓清 40 .9% (9/ 2 2 ) ,一侧颈廓清 70 .6 % (12 / 17)。 MND最大淋巴结直径≤ 3cm,术后复发率 12 .9% (11/ 85 ) ,>3cm者复发率为 47.6 % (10 / 2 1) ,总复发率为 19.8% (2 1/ 10 6 )。 RND术后颈淋巴结复发率为2 2 .5 % (9/ 40 )。结论 :声门上型喉癌常有双颈淋巴结转移 ,需行双颈廓清术 ,并必须保留一侧颈内静脉。在淋巴结小于3cm ,肉眼观与颈内静脉无粘连时保留颈内静脉 ,不增加淋巴结复发率 ,减少并发症 ,并提高生存质量。     

Management of contralateral N0 neck in pyriform sinus carcinoma

OBJECTIVE: The hypopharynx has a rich lymphatic network that places patients with tumors of the hypopharynx at high risk for early dissemination of the disease into the cervical lymphatics. Therefore, ipsilateral elective neck dissection of clinically N0 neck in lateralized lesions of hypopharyngeal squamous cell carcinomas (SCCs) is widely accepted as a standard treatment. However, the management of the contralateral N0 neck is still controversial. The aim of this study was to evaluate the incidence and predictive factors of contralateral occult lymph node metastasis in pyriform sinus SCC. MATERIALS AND METHODS: We performed a retrospective analysis of 43 patients with N0 to 3 pyriform sinus SCC with contralateral clinically node-negative necks who had also received contralateral elective neck dissections from 1994 to 2003. Surgical treatment was followed by postoperative radiotherapy in 41 patients. The follow-up period ranged from 4 to 135 months (mean, 40 months). The Kaplan-Meier method and log-rank test were used to calculate the disease-specific survival rates and prognostic significance of contralateral occult lymph node metastasis. RESULTS: Contralateral occult lymph node metastases occurred in 16% (seven of 43) of the subjects. Twenty-six percent of the 27 subjects with clinically node-positive ipsilateral neck developed contralateral occult lymph node metastases, whereas 0% of the 16 subjects with N0 ipsilateral necks (P=.035) developed the disease. Moreover, in cases with primary site extension across the midline, the rate of contralateral occult neck metastasis was significantly higher (P=.010). However, there were no statistically significant differences in age, sex, early versus advanced T stage, number of ipsilateral positive nodes, lymph nodes with extracapsular spread, primary subsite of medial versus lateral pyriform sinus, pyriform sinus apex involvement, and growth type. Patients with no evidence of contralateral nodal cancer had significantly improved disease-specific survival over patients with any pathologically positive nodes (5-year disease-specific survival rate, 66% vs. 33%, P<.05). CONCLUSION: The patients with pyriform sinus SCC with clinically ipsilateral N+ neck and/or extension across the midline are at greater risk for contralateral occult neck metastases. Furthermore, patients who present with a contralateral metastatic neck have a worse prognosis than those staged as N0. Therefore, we advocate bilateral neck treatment in patients with pyriform sinus SCC with clinically ipsilateral node metastases and/or extension across the midline.     

下咽癌颈淋巴结转移的颈侧清扫探讨

目的 为了探讨颈侧清扫可否应用于临床Ｎ＋的下咽癌的颈部治疗。方法 对９３例下咽部颈清扫标本的转移性淋巴结在颈部的分布进行了回顾性分析。结果 颌下淋巴结转移占３．２％。Ｎ０,Ｎ１,Ｎ２ａ和Ｎ２ｂ～Ｎ３的颈后三角淋巴结转移率分别为：５．９％,７．０％,３７．５％和３６．０％。病理证实仅有颌下淋巴结转移或上、中颈深淋巴结转移,而无下颈深淋巴结转移时,颈后三角淋巴结转移率为４．０％,有下颈深淋巴结转移时,     

Ⅵ区淋巴结在甲状腺乳头状癌颈淋巴转移中的意义

目的 进一步认识Ⅵ区淋巴结在甲状腺乳头状癌(papillary thyroid carcinoma,PTC)颈转移中的地位及PTC患者颈部转移淋巴结的分布特点,为PTC的颈部淋巴结处理提供依据.方法 回顾性总结2002年1月至2004年12月97例病变局限于一侧腺叶的PTC患者的临床资料:72例术前检查为cNO,25例为cN+;32例原发灶长径≤1 cm,65例原发灶长径＞1 cm.术中常规取Ⅲ、Ⅳ区淋巴结做冰冻病理检查,根据淋巴结病理结果、肿瘤原发灶大小及位置决定颈部淋巴结的清扫范围.Ⅲ、Ⅳ区淋巴转移患者行包括Ⅵ区的改良性颈清扫;伴有肿瘤包膜外侵患者行双侧Ⅵ区清扫;原发灶长径≤1 cm行患侧Ⅵ区清扫;原发灶长径＞1 cm行双侧Ⅵ区清扫.结果 97例患者行Ⅵ区清扫122侧,45.1%(55/122)发生淋巴转移.72例cN0患者45.8%(33/72)发生Ⅵ区淋巴转移,25例cN+患者76.0%(19/25)发生Ⅵ区淋巴转移,差异有统计学意义(x2=6.790,P=0.009).10例原发灶包膜外侵患者的淋巴转移发生率为65.0%(13/20),87例无包膜外侵患者的淋巴转移发生率为41.2%(42/102),差异有统计学意义(x2=3.833,P=0.047).32例原发灶长径≤1 cm的患者行患侧Ⅵ区清扫,43.8%(14/32)发生淋巴转移,65例原发灶长径＞1 cm患者行双侧Ⅵ区清扫,69.2%(45/65)有患侧Ⅵ区转移,23.1%(15/65)有双侧Ⅵ区转移,两组间同侧Ⅵ区转移率的差异有统计学意义(x2=5.843,P=0.016).结论 Ⅵ区为FTC较早发生淋巴转移的区域,伴有原发灶包膜外侵犯者易发生Ⅵ区淋巴转移.原发灶长径≤1 cm的患者可发生同侧Ⅵ区转移;原发灶长径＞1 cm者可发生双侧Ⅵ区转移.PTC颈淋巴转移可单独或同时发生在Ⅵ区或侧颈区的任何一个区域.术中应常规做Ⅲ、Ⅳ区淋巴结冰冻病理检查,淋巴结阳性者行包括Ⅵ区的改良性颈清扫.     

Management of contralateral N0 neck in tonsillar squamous cell carcinoma

OBJECTIVES: It is well established that tonsillar squamous cell carcinomas have a high probability of disseminating to the neck. An ipsilateral neck treatment is mandatory during initial treatment of stages II to IV tonsillar carcinomas. However, as of yet, no consensus exists whether to perform elective contralateral neck management. MATERIALS AND METHODS: A retrospective analysis of 43 N0-3 tonsillar cancer patients with contralateral clinically negative necks from 1992 to 2002 was performed. All patients had a contralateral elective neck dissection. Surgical treatment was followed by postoperative radiotherapy in 33 patients. The follow-up period ranged from 2 to 120 (mean 38) months. The Kaplan-Meier method and log-rank test were used to calculate the disease-specific survival rates and prognostic significance of contralateral occult lymph node metastasis. RESULTS: Clinically negative, but pathologically positive, contralateral lymph nodes occurred in 16% (7 of 43). Of the 33 cases with an ipsilateral node positive neck, contralateral occult lymph node metastases developed in 21% (7 of 33), in contrast with 0% in ipsilateral N0 necks. On the basis of the clinical staging of the tumor, 5% (1 of 22) of the cases showed lymph node metastases in T2 tumors, 36% (5 of 14) in T3, and 25% (1 of 4) in T4. None of the T1 tumors (3 cases) had pathologically positive lymph nodes (T1 + T2 vs. T3 + T4, P < .05). Patients with no evidence of contralateral nodal cancer had significantly improved disease-specific survival over patients with any pathologically positive nodes (5 year disease-specific survival rate 92% vs. 28%, P = < .05). CONCLUSION: The risk of contralateral occult neck involvement in above T3 staged tonsillar squamous cell carcinomas with unilateral metastases was high (approximately 21%), and patients who present with a contralateral metastatic neck have a worse prognosis than those who are staged as N0. Therefore, we advocate an elective contralateral neck treatment in tonsillar squamous cell carcinoma patients with ipsilateral node metastases.     

Incidence and clinical characteristics of prelaryngeal lymph node metastasis in papillary thyroid cancer

There is little data that determine the clinical characteristics of prelaryngeal lymph nodes (PLN) metastasis in patients with papillary thyroid cancer (PTC). The aims of this prospective study were to evaluate the incidence and the clinical characteristics of metastasis to the PLN for PTC patients who underwent total thyroidectomy and prophylactic central neck dissection. Sixty-seven patients who underwent total thyroidectomy and prophylactic bilateral central lymph node neck dissection for PTC were enrolled. Central neck compartment was further divided into prelaryngeal, ipsilateral/contralateral paratracheal, and pretracheal regions. Clinicopathologic factors including age, sex, tumor size and location, extrathyroidal extension, and central and lateral nodal metastasis were evaluated. Of the 67 patients who underwent PLN dissection, 13 (19.4 %) had evidence of PLN metastasis. Tumor size was significantly larger in patients with PLN involvement (2.28 versus 1.12 cm; p = 0.020). Additionally, primary tumors larger than 1 cm, extrathyroidal extension, and isthmus involvement were more prevalent in PLN-positive patients. Patients with positive PLNs were also more frequently found to have lateral lymph node metastasis (23.1 vs. 1.9 %; p = 0.021), pretracheal lymph node metastasis (76.9 vs. 27.8 %; p = 0.003), and bilateral central lymph node metastasis (38.5 vs. 11.1 %; p = 0.031) than PTC patients without PLN involvement. The incidence of PLN metastasis in PTC patients who underwent prophylactic central lymph node neck dissection was 19.4 %. PLN metastasis was associated with tumor size, extrathyroidal extension, isthmus involvement, and other compartment lymph node metastasis.     

Predictors of extracapsular spread in lymph node metastasis

We investigated effect of clinical and pathologic parameters on extracapsular spread (ECS) in patients with lymph node metastasis in laryngeal and hypopharyngeal cancer. About 186 patients and 342 neck dissection were included in this study. Relationship between ECS and tumor location, T stage, pathologic N stage, tumor differentiation, number of metastatic lymph nodes, diameter of metastatic lymph node and impact of presence ECS on contralateral neck metastasis (CNM) were evaluated; 76 of the 186 patients had lymph node metastasis. Of the 76 patients, 31 (40.7%) had ECS. Tumor location, pathologic N stage of the tumor, number of metastatic lymph nodes, diameter of metastatic lymph node and the presence of CNM were significantly associated with ECS (P < 0.05). Only number of (≥3) lymph node metastasis emerged as significant independent predictor of ECS (P < 0.05; OR:11.6). In conclusion, the number of metastatic lymph nodes (≥3) should be used as predictor of ECS. Furthermore, contralateral neck dissection should be performed in patients with ipsilateral lymph node metastasis with ECS. Presented at 6th European Congress of Oto-Rhino-Laryngology Head and Neck Surgery, 30th June–4th July 2007, Vienna, Austria.     

分化型甲状腺癌Ⅵ区与Ⅱ-Ⅴ区淋巴转移的关系及预后

目的探讨分化型甲状腺癌Ⅵ区与颈侧区（Ⅱ-Ⅴ）区颈淋巴转移的特点，为临床选择正确术式提供依据。方法回顾性分析1984年3月至2000年12月，99例甲状腺癌患者在辽宁省肿瘤医院头颈外科进行初次手术，同期行颈清扫术，进行病理检查，术后随访，并对结果进行统计分析。结果99例分化型甲状腺癌中，乳头状甲状腺癌61例（双侧乳头状甲状腺癌1例），乳头滤泡混合型13例，滤泡状甲状腺癌25例。根据2002年UICCTNM分期：Ⅰ期60例，Ⅱ期1例，Ⅲ期5例，Ⅳ期33例。一侧腺叶及峡部切除80例，一侧腺叶及对侧大部或次全切除15例，全甲状腺切除术4例。全部患者同期颈清扫术104侧（双颈清扫5例），其中经典性清扫66例（68侧），改良性清扫33例（36侧）。术后病理检查淋巴结阳性83例（86侧），其中3例双侧淋巴结阳性，颈淋巴转移率为83．8％（83／99）。VI区阳性率37．5％（39／104），颈侧区（Ⅱ-Ⅴ区）阳性率76．9％（80／104），VI区和颈侧区淋巴结阳性率比较，差异有统计学意义（配对X^2检验，X^2=33．01，P〈0．01）。统计分析表明颈侧区淋巴转移和Ⅵ区淋巴转移无相关性（独立X。检验，X^2=2．08，Pearson列联系数C=0．14，P〉0．05）。10年、15年生存率分别为88．3％和84．5％。结论分化型甲状腺癌Ⅵ区与颈侧区（Ⅱ-Ⅴ区）淋巴转移率不同。不能仅从Ⅵ区转移判断颈侧区是否有转移。发生Ⅵ区淋巴转移的患者不比颈侧区（Ⅱ-Ⅴ区）淋巴转移的预后差，经过正确的外科治疗，预后较好。     

头颈部鳞癌颈淋巴结转移诸因素对预后的影响

对382例头颈部原发鳞癌病人颈清扫标本连续切片病理观察结果和临床资料进行回顾性分析，探讨淋巴结转移的各项临床和病理学因素与病人预后的关系。发现总体5年生存率为46.1％，口腔癌、口咽癌、下咽癌和喉癌的5年生存率分别为49．7％，39．7％，35．0％和60．3％。表明颈淋巴结的临床分期、触诊淋巴结大小、病理转移淋巴结情况、颈淋巴解剖分区受累数和最低受累平面与病人5年生存率有密切关系（均P＜0．01），而阳性淋巴的个数对病人预后无明显影响。提示针对影响预后的淋巴结因素应采取相应的治疗措施，以提高病人的5年生存率。     

声门上型喉癌临床颈淋巴结阴性患者颈清扫区域的选择

目的　探讨声门上型喉癌临床诊断N0 (clinicalN0 ,cN0 )患者颈淋巴结转移的特点 ,选择合理的清扫区域。方法　 5 7例声门上型喉癌患者行喉切除术的同时行改良性颈清扫术 ,将颈清扫的淋巴结标本分区域逐一行病理学检查 ,确定转移区域或复发的区域。结果　 5 7例 (6 3侧 )颈清扫标本共获淋巴结 1877枚 ,平均每侧获 2 9 8枚 ,有转移的 4 3枚 ,其中 4 1枚位于Ⅱ、Ⅲ区 ,占 95 4 % (41/ 4 3)。15例 (17侧 )患者有淋巴结转移 ,转移率为 2 6 3% (15 / 5 7)。其中 14例位于Ⅱ、Ⅲ区 ,占转移例数的93 3% (14 / 15 )。颈部复发 3例 ,复发率为 5 3% (3/ 5 7) ,复发部位分别位于Ⅱ、Ⅲ、Ⅳ区。 5年生存率为 80 7% (46 / 5 7)。结论　对声门上型喉癌cN0重点行Ⅱ和Ⅲ区颈淋巴结清扫术 ,Ⅲ区受累时应包括Ⅳ区 ,Ⅰ、Ⅴ区在无明显转移证据时可避免行颈清扫术     

喉癌和下咽癌颈淋巴结转移临床对比分析

目的：探讨喉癌、下咽癌患者颈淋巴结转移的特点和分布规律。方法：对全喉切除术同期及复发后第1次行颈淋巴结清扫的129例喉癌、下咽癌患者的临床资料进行回顾性对比分析，研究不同类型的喉癌、下咽癌患者颈淋巴结的转移情况。结果：声门上型喉癌、下咽癌患者易发生早期淋巴结转移；下咽癌患者的转移淋巴结融合率高，颈静脉下区出现阳性淋巴结的比率高；声门上型喉癌、下咽癌患者原发病灶分化差的比率相对偏高；同期与复发后行颈淋巴结清扫的患者原发病灶分期差异无显著性意义。结论：对T2期及以上的声门上型喉癌及下咽癌患者，尤其当细胞分化比较差时，即使颈淋巴结阳性体征不明显亦应积极考虑颈淋巴结清扫问题，对下咽癌患者行颈淋巴结清扫时应考虑彻底清扫颈静脉下区的淋巴结。     

Malignant cervical epithelial adenopathy from unknown primary source. Apropos of a series of 54 cases]

Fifty four patients with cervical lymph node metastasis from an unknown primary tumor underwent treatment from 1969 to 1988. Fourty five underwent radical neck dissection. 69% had node capsular effraction and 36% perinodal vascular embolism. Thirty four patients underwent postoperative radiotherapy including rhinopharynx, cervical oesophagus and all the bilateral cervical nodes. The primary tumor appeared after treatment in 7 cases. Total survival rate is 36% 5 years after treatment. Vascular embolism aggravates the prognosis. Radiosurgical association allow effective control of loco-regional cancer but does not improve survival rate. Prognosis is aggravated by metastases arising (18%).     

Lymph node status of lateral neck compartment in patients with N1b papillary thyroid carcinoma

Conclusion Loco-regional recurrence-free survival was significantly decreased in the papillary thyroid cancer patients with >?6 metastatic lymph nodes and a lymph node ratio >?0.22. Also, the risk of lung metastasis was significantly increased in cases with bilateral neck node metastases.

Objective This study focused on the metastatic lymph node status of the lateral neck compartment to understand its prognostic significance for loco-regional recurrence and distant metastasis.

Methods Between January 2004 and December 2009, 1040 patients were diagnosed with papillary thyroid cancer and underwent treatment.

Results In a multivariate analysis, sex, the number of metastatic lymph nodes, and the lymph node ratio was significantly associated with loco-regional recurrence. The sensitivity/specificity of >?6 metastatic lymph nodes for predicting recurrence was 64.0%/69.7%. The 5-year loco-regional recurrence-free survival of patients with 0–6 metastatic lymph nodes and >?6 metastatic lymph nodes were 93.4% and 79.2%, respectively. The 5-year loco-regional recurrence-free survival of patients with a lymph node ratio ≤?0.22 and a lymph node ratio >?0.22 were 97.1% and 78.8%, respectively. In the multivariate analysis, only bilateral neck node metastases were significantly associated with lung metastasis.     

颈Ⅱ和Ⅲ区清扫术治疗cNO声门上型喉鳞状细胞癌

目的 研究择区性即ⅡA、ⅡB和Ⅲ区颈淋巴结清扫术(selective neck dissection,SND)治疗临床颈淋巴结阴性(clinical node negative,cN0)的声门上荆喉鳞癌隐匿性颈转移的可行性.方法 回顾性分析2002年10月至2006年3月在哈尔滨医科大学肿瘤医院头颈外科行SND(ⅡA、ⅡB和Ⅲ区)治疗52例cN0声门上型喉癌的治疗结果.结果 52例cNO声门上型喉癌中32例同期行单侧(ⅡA、ⅡB和Ⅲ区),20例行双侧SND.52例颈清扫标本病理检查发现,颈转移阳性者15例(28.9%).3例首次病理检查阴性者在随访中发生未手术侧颈部转移,总的颈隐匿性转移率为34.6%(18/52),单侧、双侧隐匿性颈转移率分别为28.8%和5.8%.72侧颈清标本共获淋巴结1190枚,其中病理阳性30枚,分布于ⅡA区25枚(83.3%)、Ⅲ区5枚(16.7%).术侧颈部复发率为5.8%(3/52).Kaplan-Meier法统计3年累积生存率为84.6%.淋巴结病理阴性和阳性的颈部复发率分别为0(0/34)和16.7%(3/18),差异有统计学意义(Fisher精确检验,P=0.021),有无包膜外侵犯的颈部复发率分别为50%(2/4)和2.1%(1/48),差异有统计学意义(Fisher精确检验,户=0.002).结论 颈SND(ⅡA、ⅡB和Ⅲ区)治疗cNO声门上型喉癌颈隐匿性转移是可行的,该术式能缩短手术时间、减少并发症且不影响肿瘤治疗效果.     

下咽癌颈淋巴结转移的临床病理学特点及其对预后的影响

目的探讨影响下咽癌颈淋巴结转移的临床病理因素和颈淋巴结转移对预后的影响。方法采用X^2检验和Logistic回归分析，对98例下咽癌患者的临床病理学因素与颈淋巴结转移的关系进行回顾性研究。并对颈淋巴结转移状态、转移颈淋巴结大小、转移颈淋巴结数目、转移颈淋巴结累及区域数、转移颈淋巴结最低受累区域等淋巴结病理学因素对生存率的影响，进行Cox回归分析。结果下咽癌患者5年生存率为28．6％。单因素和多因素分析均证实，肿瘤生长方式、肿瘤大小与发生颈淋巴结转移关系密切。而肿瘤突破基底膜达黏膜下层后对下咽癌颈淋巴结转移发生率不再产生进一步影响。Cox回归分析表明，临床N分期、颈淋巴结转移状态、转移颈淋巴结大小、转移颈淋巴结最低受累区域因素影响患者生存率，特别是转移颈淋巴结大小、转移颈淋巴结最低受累区域因素与下咽癌患者生存率明显相关。结论下咽癌颈淋巴结转移是影响患者预后的重要因素，预测下咽癌颈淋巴结，对其作出早期正确诊断，并对影响预后的淋巴结因素采取相应治疗措施是提高下咽癌治疗效果的关键。     

Preserving level IIb lymph nodes in elective supraomohyoid neck dissection for oral cavity squamous cell carcinoma

OBJECTIVE: To determine whether level IIb lymph nodes can be saved in elective supraomohyoid neck dissection (SOHND) as a treatment for patients with squamous cell carcinoma of the oral cavity. DESIGN: Prospective analysis of a case series. SETTING: University hospital. PATIENTS AND INTERVENTIONS: From 1997 to 2001, 74 patients with squamous cell carcinoma of the oral cavity and with no palpable lymph nodes at the neck who underwent an elective SOHND were prospectively studied. MAIN OUTCOME MEASURES: The incidence of pathological metastasis to level IIb lymph nodes and the regional recurrence within this area after elective SOHND was performed were evaluated. RESULTS: Of the 74 patients, 24 (32%) had lymph nodes positive for microscopic metastatic squamous cell carcinoma. Four (5%) of the 74 patients had involvement of level IIb lymph nodes. There was no instance of isolated metastasis to level IIb lymph nodes without involvement of other nodes in the SOHND specimens. There were 6 cases of the ipsilateral neck recurrences, and of these, 2 patients (3% of all patients) developed recurrences in the level II lymph nodes. CONCLUSIONS: Level IIb lymph node metastasis was rare in this study, and nodal recurrence in this area after SOHND in squamous cell carcinoma of the oral cavity was infrequent. Therefore, this region may be preserved in elective SOHND in patients with squamous cell carcinoma of the oral cavity.     

Cervical lymph node metastases from occult squamous cell carcinoma: analysis of 82 cases

PURPOSE: The aim of this study was to analyze the prognostic value of some clinical factors and to compare the survival of different treatment plans in patients with cervical lymph node metastases from occult squamous cell carcinoma (SCC). METHODS: A retrospective review was conducted of patients who were diagnosed as having cervical lymph node metastases from occult SCC. Overall cumulative survival was analyzed using the standard Kaplan-Meier method. Tests of significance were based on log-rank statistics. RESULTS: The 82 patients in the study consisted of 69 males (84.2%) and 13 females (15.8%). The average age at diagnosis was 64.7 years. Fifty patients (60.9%) underwent surgical treatment of cervical metastasis. Radiotherapy was performed in 79 patients. Thirty-two patients (40.5%) received primary fractioned external beam radiotherapy; 47 patients (59.5%) received postoperative fractioned external beam radiotherapy. Ipsilateral radiotherapy was performed on 37 patients (46.8%), bilateral neck plus mucosal irradiation was performed in 42 patients (53.2%). Ten patients (12.2%) developed a primary tumor during the follow-up. The actuarial survival rates of all patients 2, 5 and 10 years after diagnosis were 50.9, 25.3 and 18.5%, respectively. Patients with nodal stage N2b, N2c and N3 had a significantly poorer prognosis than those with nodal stage N1 and N2a (p = 0.0239). The survival in patients with metastatic nodes in the supraclavicular region (level IV) was significantly poorer than that of patients with involvement of the upper-middle jugular lymph nodes (p = 0.0003). We observed a statistically significant better survival in patients receiving bilateral neck plus mucosal irradiation (p = 0.0003). CONCLUSIONS: Initial N-category and metastasis localization were the most important prognostic factors and nodal relapse the major cause of treatment failure, thus optimal management of cervical nodes appears crucial for the success of treatment. Patients receiving bilateral neck plus mucosal irradiation had a higher survival rate than those who received ipsilateral irradiation.     

Level IIb lymph nodes metastasis in elective supraomohyoid neck dissection for oral cavity squamous cell carcinoma: a molecular-based study

OBJECTIVES: To identify the incidence of level IIb lymph nodes metastasis in elective supraomohyoid neck dissection (SOHND) as a treatment for patients with squamous cell carcinoma (SCC) of the oral cavity. STUDY DESIGN: Prospective analysis of a case series. METHODS: Forty-eight patients with SCC of the oral cavity and with no palpable lymph nodes at the neck who underwent an elective SOHND were prospectively studied. The incidence of micrometastasis to level IIb lymph nodes after performing elective SOHND was evaluated by pathologic examination and molecular analysis. RESULTS: Of the 48 patients, 15 (31%) by pathologic analysis and 22 (46%) by molecular analysis had lymph nodes positive for metastatic SCC. By molecular analysis, 5 (10%) of the 48 patients had involvement of level IIb lymph nodes. All patients with metastasis to level IIb lymph nodes have their primary lesions in the tongue and constituted 22% of patients with tongue lesions. There was no instance of isolated metastasis to level IIb lymph nodes without involvement of other nodes in the SOHND specimens. CONCLUSIONS: In this study, level IIb lymph node metastasis was only found in association with tongue carcinoma. Although this region may be preserved in elective SOHND in patients with SCC of the oral cavity, it should be included whenever the tongue is the primary site.     

Level IIb lymph node metastasis in thyroid papillary carcinoma

The objective of the study was to evaluate the incidence of level IIb lymph node metastases in neck dissections for thyroid papillary carcinoma (TPC) patients. 47 neck dissections of 33 patients with TPC were prospectively evaluated. Selective neck dissections (levels II, III, IV, and V) were performed in all cases. If level I lymph node metastasis was suspected during the procedure, level I dissection was also performed. All level IIb specimens were sent separately from the remainder of the neck dissection for the pathological examination. The number of dissected and metastatic lymph nodes in each specimen was recorded. Twenty-two of 47 neck dissections (46.8%) were positive for the lymph node metastasis. Among 47 neck dissection specimens, the incidence of lymph node metastasis at level II was 12.7% (6 of 47) and level IIb was 2.1% (1 of 47). The rate of level IIb lymph node involvement among patients with metastatic cervical lymph nodes was 4.5% (1 of 22). The specimen with metastatic lymph node at level IIb had also metastasis at levels IIa, III, IV, and V. The results of the present study suggested that lymph node metastases in level IIb are rare in patients with TPC undergoing neck dissection.