The potential risk of vessel infiltration and cervical lymph node metastasis in hypopharyngeal superficial squamous cell carcinoma: a retrospective observational study

Conclusion: The depth of hypopharyngeal superficial cancer may predict vessel infiltration and potential risk of cervical lymph node metastasis. Objectives: To elucidate the histopathological predictors of vessel infiltration and the risk of regional lymph node metastasis in hypopharyngeal superficial cancer. Methods: This study included 31 lesions from 30 patients who had undergone transoral en bloc resection in the hospital. Patients with intraepithelial neoplasia or muscular invasion were excluded. Patient characteristics, nodal status, state of vessel infiltration, state of perineural invasion, histopathological parameters, and post-operative cervical lymph node recurrence were retrospectively examined. The histopathological parameters measured were tumor diameter and the following three parameters: tumor thickness, depth from the mucosal surface, and depth from the basement membrane. Correlations between histopathological parameters and state of vessel infiltration were statistically analyzed. Results: Of the 31 lesions examined, four had vessel infiltration. Three of the four lesions with vessel infiltration had regional lymph node metastasis as well as subsequent lymph node metastasis. Lesions with vessel infiltration were significantly deeper than those without. In contrast, there was no significant difference in lesion diameters. In addition, there was no correlation between the depth and the diameter of the lesion.     

The impact of paratracheal lymph node metastasis in squamous cell carcinoma of the hypopharynx

The aim of this study was to analyze the prevalence and prognostic importance of paratracheal lymph nodes in squamous cell carcinoma of the hypopharynx. A retrospective review of 64 previously untreated patients with squamous cell carcinoma (SCC) of the hypopharynx that underwent surgery was performed. Ipsilateral paratracheal lymph node metastases occurred in 22% (14 out of 64) and the mean number of paratracheal lymph nodes dissected per side was 2.3 (range 1–6). Contralateral paratracheal lymph node metastases were present in 2% (1 out of 42). Sixty-seven percent with postcricoid SCC and 22% with pyriform sinus SCC developed clinical node-positive ipsilateral paratracheal lymph node metastases, whereas 11% with posterior pharyngeal wall SCC developed paratracheal metastases. There was a significant correlation between paratracheal lymph node metastasis and cervical metastasis (p = 0.005), and the primary tumor site (postcricoid, 57.1%; pyriform sinus, 20.0%; posterior pharyngeal wall, 8.3%) (p = 0.039). Patients with no evidence of paratracheal lymph node metastasis may have a survival benefit (5-year disease-specific survival rate, 60 vs. 29%). However, this result did not reach statistical significance (p = 0.071). The patients with SCC of the postcricoid and/or pyriform sinus were at risk for ipsilateral paratracheal lymph node metastasis; furthermore, patients with paratracheal node metastasis had a high frequency of cervical metastasis and a poorer prognosis. Therefore, routine ipsilateral paratracheal node dissection is recommended during the surgical treatment of patients with SCC of the postcricoid and/or pyriform sinus with clinical node metastases.     

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.     

喉鳞状细胞癌患者发生隐匿性淋巴结转移风险预测模型的开发和验证

目的 对比分析喉鳞状细胞癌患者有隐匿性淋巴结转移和无隐匿性淋巴结转移患者之间的差异,开发和验证发生隐匿性淋巴结转移风险的预测模型。方法 采取病例对照研究方法,回顾性收集2005—2018年来山西医科大学第一医院耳鼻咽喉科就诊的喉癌患者的临床资料,所有患者在术中均进行了功能性或根治性颈部淋巴结清扫术,将符合条件的136例纳入本研究中,按是否发生隐匿性淋巴结转移分为有隐匿性淋巴结转移组（46例）和无隐匿性淋巴结转移组（90例）,比较分析两组患者的年龄、病理分级、临床分期、肿瘤大小、浸润深度、切缘阴阳性、喉癌分型、会厌前间隙是否受侵、软骨是否受侵、前联合是否受侵等危险因素,将差异具有统计学意义（P<0.05）的危险因素进一步行二元Logistic回归分析,并由此建立一个可以预测其发生风险的预测模型。预测模型公式为：Logit （P）=0.262+1.010×X1+1.624×X2+1.205×X3-1.153×X4-2.270×X5（X1=前联合受侵,X2=肿瘤大小>4~6 cm,X3=肿瘤大小>2~4 cm,X4=中分化,X5=高分化）;计算工作特征（ROC）曲线下面积（AUC）评价模型准确度;利用bootstrap方法对模型进行内验证,用AUC评价模型的区分度,用校准图评价模型的一致性。结果 前联合受侵、病理分级低分化、肿瘤大小（>2~4 cm）是发生隐匿性淋巴结转移的独立危险因素（P<0.05）,AUC为0.767,95%CI为（0.679,0.854）,予以bootstrap法内验证：AUC为0.757,95%CI为（0.661,0.841）,校准曲线与理想曲线较接近,可认为预测结果与实际结果较一致。结论 前联合受侵、肿瘤大小（>2~4 cm）、病理分级低分化是发生隐匿性淋巴结转移的独立危险因素,经评价和验证后,得知此风险预测模型对预测是否发生隐匿性淋巴结转移的准确性较高。     

Distribution and impact of lymph node metastases in oropharyngeal cancer

Conclusions. In the treatment of oropharyngeal cancers, possible metastases to retropharyngeal lymph nodes (RPLNs) should be taken into account, especially in tumors arising in the lateral wall and/or posterior wall. Patients with multiple positive neck nodes must have intensified adjuvant therapy, especially when they have extracapsular spread (ECS). Objective. To develop optimal treatment strategies for oropharyngeal cancers, we retrospectively analyzed the lymph node metastases of oropharyngeal squamous cell carcinoma. Patients and methods. Between 1988 and 2003, 77 patients with previously untreated oropharyngeal squamous cell carcinoma underwent neck dissections. Results. Among the patients with tumor arising in the lateral wall or posterior wall, retropharyngeal nodes were involved in 29% (11/38), while RPLN metastasis was not observed in patients with tumors arising in the superior wall or anterior wall. The survival rate of patients with two or fewer positive lymph nodes was significantly better than that of patients with three or more positive lymph nodes (p<0.05). The survival rate of the patients who had ECS was significantly worse than that of the patients who had lymph node metastases but not ECS (p<0.05). There was no significant difference between the survival rates of the patients with and without RPLN metastases.     

甲状腺微小乳头状癌颈部淋巴结转移危险因素分析

目的 回顾性研究甲状腺微小乳头状癌(PTMC)颈部淋巴结转移的危险因素.方法 收集2010年1月-2020年3月西安交通大学第一附属医院耳鼻咽喉头颈外科收治的1363例PTMC患者的临床资料,分析其性别、年龄、肿瘤直径、多灶性、腺外侵犯(ETE)、肿瘤侧别、颈淋巴结转移、BRAFV600E突变与颈淋巴结转移的关系.结果...     

Clinicopathological factors related to cervical lymph node metastasis in a patient with carcinoma of the oral floor

CONCLUSION: Tumors developing into the muscle layer and tumor thickness > or =5 mm are the most important risk factors associated with nodal metastasis. OBJECTIVE: It is necessary to identify the risk factors associated with cervical metastasis in patients with oral floor cancer to reveal the role of elective neck dissection for oral floor cancer. PATIENTS AND METHODS: Forty-eight patients with oral floor cancer were retrospectively analyzed for a correlation between clinicopathologic factors and cervical lymph node metastasis using Fisher's exact test and a logistic regression test. RESULTS: Univariate analysis showed significantly positive correlations for growth type, mitosis, perineural invasion, vascular invasion, lymphatic invasion, depth, thickness, and infiltration growth ratio. Multivariate analysis had a significantly positive correlation with nest formation and depth in all patients, and with thickness in patients with T1 or T2. In patients with bilateral cervical lymph node metastasis, lymph node metastasis was significantly positively correlated with perineural invasion.     

Histopathological predictors of occult lymph node metastases in supraglottic squamous cell carcinomas

Lymph node metastasis appears to be the most important factor determining survival in patients with squamous cell carcinoma of the larynx. Supraglottic laryngeal carcinomas have a known tendency to metastasize to cervical lymph nodes because of the extensive lymphatic network present. This retrospective cohort study was conducted to define possible histopathological parameters affecting cervical lymph node metastasis and then using these parameters to create a scale to predict occult lymph node metastasis in supraglottic squamous cell carcinoma. The pathological slides of 61 operated patients were reevaluated for tumor grade, lymphatic-vascular invasion, invasion pattern of tumor margins, perineural invasion and lymphocytic infiltration. Grade (P < 0.001), lymphatic-vascular invasion (P < 0.001) and tumor margins (P = 0.007) were found to be closely associated with neck metastasis. To define the risk factors for occult metastasis, a grading scale was created by using grade (G), lymphatic-vascular invasion (L) and tumor margin (M) findings of patients. None of the patients with a GLM value of zero developed occult metastasis. On the other hand occult metastasis was found in 58.8% of N0 patients with a GLM value that was more than zero. These findings indicate that patients with high-grade tumors having infiltrating borders and lymphatic-vascular invasion have a high risk for occult metastasis so that elective treatment of the neck either by neck dissection or radiotherapy should be added to therapy. Serial sections of specimens are needed to avoid missing metastatic loci of disease. Received: 19 February 1999 / Accepted: 30 December 1999     

The effects of tumor size, degree of differentiation, and depth of invasion on the risk of neck node metastasis in squamous cell carcinoma of the oral cavity

Cervical lymph node metastasis is the most important prognostic factor in patients with head and neck carcinoma. We retrospectively analyzed the effects of three different variables-tumor size, degree of differentiation, and depth of invasion-on the risk of neck node metastasis in 50 adults who had been treated with surgery for primary squamous cell carcinoma of the oral cavity. Primary tumor depth and other pathologic features were determined by reviewing the pathology specimens. Preoperatively, 36 of the 50 patients were clinically N0; however, occult lymph node metastasis was found in 13 of these patients (36.1%). The prevalence of neck node metastasis in patients with T1/T2 and T3/T4 category tumors was 51.5 and 58.8%, respectively. The associations between the prevalence of neck node metastasis and both the degree of differentiation and the depth of invasion were statistically significant, but there was no significant association between neck node metastasis and tumor size. We conclude that the prevalence of neck lymph node metastasis in patients with squamous cell carcinoma of the oral cavity increases as the tumor depth increases and as the degree of tumor differentiation decreases from well to poor, as has been shown in previous studies. It is interesting that tumor size, which is the most important component of the TNM system, was not significantly associated with neck node involvement.     

Relationships between Tumor Volume and Lymphatic Metastasis and Prognosis in Early Oral Tongue Cancer

Objectives

Although T stage is an important prognostic tool for oral tongue cancer, it fails to define the depth of invasion and true three-dimensional volume of primary tumors. The purpose of this paper is to determine the relations between tumor volume and lymph node metastasis and survival in early oral tongue cancer.

Methods

Forty-seven patients with T1-2 tongue cancer were included. Tumor volumes were measured by the computerized segmentation of T2-weighted magnetic resonance imaging.

Results

The overall average tumor volume was 27.7 cm³ (range, 1.4 to 60.1 cm³). A significant positive correlation was found between tumor volume and pathological T stage, depth of invasion, and cervical lymph node metastasis (P<0.001, P<0.001, and P=0.002, respectively). When the tumor volume exceeded 20 cm³, the cervical metastasis rate increased to 69.2%. The overall 5-year disease specific survival rate was 80%. There was a statistically significant association between large tumor volume (≥20 cm³) and the 5-year disease-specific survival (P=0.046).

Conclusion

Tumor volume larger than 20 cm³ was associated with greater risk cervical lymph node metastasis and poor 5-year disease-specific survival rate in early oral tongue cancer patients.     

A clinical study on the cervical lymph node metastasis of maxillary sinus carcinoma

Objective: to improve the management of maxillary sinus carcinoma, we retrospectively investigated the significance of cervical lymph node metastasis in our treated cases and discussed how to deal with the cervical lymph node metastasis as a prognostic factor. Methods: medical records of 118 patients with maxillary sinus carcinoma diagnosed and treated in our institute from 1982 to 1997 were retrospectively reviewed. Tumors were staged according to UICC classification 1987. The cumulative survival was analyzed by the Kaplan–Meier method. Generally, the patients had undergone preoperative radiotherapy and surgery. We examined the cervical lymph node metastasis detected at the first examination and the subsequent cervical lymph node metastasis in relation to the prognoses. Results: the incidence of cervical lymph node metastasis at the initial diagnosis was 7.9% (n=9), and that of secondary cervical lymph node metastasis without recurrence at the primary site after the first treatment was 8.3% (n=9). In most cases, we observed metastasis to the lymph nodes in the submandibular region and in the jugular chain. The result of treatment of cervical lymph node metastasis was grave. Among the patients with cervical lymph node metastasis detected at the first examination, four patients developed local recurrence and three patients developed distant metastasis. On the other hand, among those with secondary cervical metastasis, three patients developed neck recurrence and three patients developed distant metastasis, but no local recurrence. Conclusions: in the cervical metastasis of maxillary sinus carcinoma, it is important to treat the primary lesion completely. In addition to it, we should control cervical metastasis and careful neck dissection is required. For the patients with cervical lymph node metastasis, it is necessary to consider the further treatment of distant metastasis.     

Prognostic Significance of Depth of Invasion in Cancer of the Larynx

To determine the prognostic significance of depth of invasion in laryngeal cancer, the depth of invasion of tumor was measured with an ocular micrometer on the laryngectomy specimens of 94 surgically treated patients with T1, T2, and T3 laryngeal cancer and was expressed in millimeters. There was a significant negative correlation between the depth of invasion and disease-free survival. The tumors with no clinical involvement of regional lymph nodes in neck (N0 neck) had significantly less depth of invasion than those with involvement (N+ neck). The tumors with pathologically confirmed cervical lymph node metastasis had significantly more depth of invasion than those without metastasis. For tumors with a depth of invasion equal to or greater than 3.25 mm, the rate of cervical metastasis in this study has always been significantly higher than for those with a depth of invasion less than 3.25 mm (P < .05). The mean depths of invasion for cases with and without recurrence were not significantly different. According to the multivariate analysis, depth of invasion (P = .047) and patient age (P = .113) significantly affected the disease-free survival independently. The depth of invasion did not significantly affect the recurrence and the interval between surgery and the development of recurrence (P > .15). The depth of invasion should be measured in every laryngectomy specimen. The depth of invasion influences the cervical metastasis and disease-free survival significantly but does not affect the recurrence rate. The depth of invasion plays an independent role in determining the disease-free survival.     

下咽癌颈淋巴转移相关因素的研究

目的研究下咽癌颈淋巴转移的特点、规律及对预后的影响。方法收集1985-2000年住院治疗下咽癌患者108例，均经手术治疗，且术前未行放疗和化疗。根据1992年国际抗癌联合会（UICC）分期标准进行分期分级。手术后将下咽癌及颈淋巴结标本进行病理观察，确定肿瘤主体所在原发部位及发生转移的颈淋巴结分布区域。按照病理学将肿瘤的病理分化程度确定为高、中、低分化。通过颈淋巴结病理检查和随访观察确定颈淋巴转移情况，用Kaplan-Meier方法对3、5年生存率进行非参数分析。结果病例中T1、T2淋巴结转移率为45．8％，T3、T4淋巴结转移率为79．8％，总的淋巴结转移率为75．0％（81／108），（P〈0．05）。梨状窝癌为100例，占全部病例的92．6％（100／108），梨状窝及下咽后壁癌的颈淋巴转移率分别为74．0％和87．5％（P〉0．05）。病理高、中、低分化型3组，其颈淋巴转移率分别为72．2％、67．6％、85．7％（P〉0．05）。患者3、5年累积生存率分为67．53％及29．87％。Ⅱ、Ⅲ区颈淋巴转移率为76．5％，Ⅴ、Ⅵ区颈淋巴转移率为8．6％。结论下咽癌颈淋巴转移率高。下咽癌颈淋巴转移是影响下咽癌的预后主要因素，随着颈淋巴转移程度的增加，患者3、5年生存率逐渐降低。     

CD44和转移抑制基因在声门上型喉癌及下咽癌原发灶及转移淋巴结的表达

目的比较声门上型喉癌及下咽癌原发灶与淋巴结转移癌细胞CD44和nm23-H1蛋白表达情况,进一步了解其转移特性。方法应用免疫组织化学方法和流式细胞检测方法观察了22例无淋巴转移的非转移组和41例病理证实有淋巴转移的声门上型喉癌、下咽癌患者的原发灶与淋巴转移灶中的CD44和nm23-H1表达情况。结果喉癌淋巴转移组CD44蛋白表达高于非转移组,nm23-H1,蛋白表达低于非转移组(P值均<0.05)。CD44、nm23-H1蛋白表达与声门上型喉癌、下咽癌的临床分期有关,和病理分级无关。原发灶肿瘤与淋巴转移灶肿瘤CD44和nm23-H1的表达阳性率分别为75.6%(31/41)、85.4%(35/41)和34.1%(14/41)、26.8%(11/41),差异无统计学意义(P>0.05)。原发灶肿瘤与淋巴转移灶肿瘤CD44和nm23-H1的平均荧光指数分别为(x-±s)1.27±0.18、1.33±0.16和1.11±0.19、1.08±0.15,差异无统计学意义(P>0.05)。结论声门上型喉癌及下咽癌原发灶与其转移淋巴结CD44、nm23-H1蛋白表达无明显差异,未能证明原发灶与其淋巴结转移灶肿瘤细胞转移潜能的差异,原发灶及其转移淋巴结的转移潜能比较还应从多靶点深入探讨。     

Regional metastatic pattern of papillary thyroid carcinoma

The objective of the present study was to determine the pattern of lymphatic spread in papillary thyroid carcinoma with clinically positive nodes. Between 1999 and 2008, a total of 48 consecutive patients with clinical evidence of cervical lymph node metastasis of papillary thyroid carcinoma underwent 61 modified radical neck dissections (13 being bilateral) including levels II–VI. All neck dissection specimens were separated during surgery into levels and analysis was done with respect to the levels of neck. T value of tumor and demographic parameters were compared with the number of metastatic nodes with univariate analysis. The median number of pathologic nodes in neck dissection specimen was 7.0. The predominant site of metastasis was level VI (77%), followed by level III (69%), level IV (66%), and level II (46%). Level V showed 34% of nodal metastasis. Seven patients had level VII, and five patients had parapharyngeal lymph node dissections because of lymphatic involvement at these sites. There was no statistically significant correlation between T value, age, sex and the number of histologically positive lymph nodes (P = 0.39, P = 0.91 and P = 0.84, respectively). It was concluded that the high incidence of metastatic disease in levels II through VI supports the recommendation for level II through level VI neck dissection in patient with clinically positive neck disease.     

The role of CSE1L expression in cervical lymph node metastasis of larynx tumors

IntroductionAccording to international reports, 30–40% of all head and neck cancers are larynx cancers, comprising 1–2.5% of all cancer types. Cervical nodal involvement has been reported to be 40% and 65% in T3 and T4 cases, respectively. Five-year survival in patients with cervical lymph node metastasis has been demonstrated to be 50% lower compared to patients with no metastasis. Chromosome segregation like 1 protein; is a DNA fragment isolated by Brinkmann et al. in 1995 that corresponds to yeast chromosome segregation protein. Studies on the effect of chromosome segregation like 1 protein expression in head and neck tumors are rare and it has been shown that nuclear chromosome segregation like 1 protein is over-expressed in these studies where gastrointestinal and breast tumors over-expressed cytoplasmic chromosome segregation like 1 protein.ObjectiveChromosome segregation like 1 protein may regulate the proliferation and metastasis of T3–T4 glottic larynx cancer. The aim of this study is to show the relationship between chromosome segregation like 1 protein expression and cervical lymph node metastasis of T3–T4 glottic larynx cancer.MethodsA total of 57 male patients who were operated for T3–T4 glottic cancer in a tertiary referral hospital was included in this study. There were 28 patients with cervical lymph node metastasis and 29 patients without lymph node metastasis. Immunohistochemistry was carried out on formalin-fixed, paraffin-embedded archival glottic larynx tumour tissue. According to the percentage of immunoreactive cells, chromosome segregation like 1 protein status was analyzed.ResultsAmong the patients, who had no cervical lymph node metastasis, 15 patients showed weak nuclear staining, 12 patients showed moderate nuclear staining and only 2 patients showed high nuclear staining for chromosome segregation like 1 protein. Among the patients who had cervical lymph node metastasis, 18 patients showed high nuclear staining, 9 patients showed moderate staining and only one patient showed weak staining for chromosome segregation like 1 protein. None of the metastatic patients showed cytoplasmic staining and only one patient in the non-metastatic group showed cytoplasmic staining for chromosome segregation like 1 protein. There was a positive correlation between nuclear chromosome segregation like 1 protein expression and cervical lymph node metastasis (r = 0,668) and it was statistically significant (p < 0,001).ConclusionChromosome segregation like 1 protein expression is correlated with lymph node metastasis in T3–T4 glottic cancers. This may change the approach to cervical node treatment in patients with glottic cancers in future.     

The association of lymph node volume with cervical metastatic lesions in head and neck cancer patients

The aim of this study was to determine if volume of cervical lymph node measured via computed tomography (CT) could differentiate metastatic from benign lesions in head and neck cancer patients. We conducted a retrospective review of chart and images in a tertiary referring center in Taiwan. Patients with head and neck cancers underwent radical, modified radical or functional neck dissection were enrolled. The CT images before operation were reassessed by a radiologist and were compared with the results of pathological examination. A total of 102 patients were included for final analyses. Most patients were male (n = 96, 94%) and average age was 50.1 years. Although the average nodal volume in patients with cervical metastases was higher than those of patients without cervical metastases, it was not an independent factor associated with cervical metastasis after controlling for other variables; however, central nodal necrosis on enhanced CT image [odds ratio (OR) 18.95, P = 0.008) and minimal axial diameter >7.5 mm (OR 6.868, P = 0.001) were independent factors correlated with cervical metastasis. Therefore, the volume of cervical lymph node measured from CT images cannot predict cervical metastases in head and neck cancer patients. Measurement of minimal axial diameter of the largest lymph node is a simple and more accurate way to predict cervical metastasis instead.     

头颈部鳞癌颈淋巴结隐匿性转移

目的 探讨头颈部鳞癌隐匿性颈淋巴结转移的特点和规律。方法 对111例头颈部鳞癌N_0M_0患者的颈淋巴结清扫标本进行切片观察。结果 隐匿性转移总体发生率为26.12％(29/111)。其中口腔癌18.75％(15/80),口咽癌25.00％(1/4),下咽癌54.54％(6/11),喉癌43.75％(7/16)。原发癌临床分期、肿瘤细胞分化程度是影响颈淋巴结隐匿性转移的重要因素。111例N_0M_0患者5年生存率为66.7％,其中pN~-为74.39％(61/82),pN~ 为44.82％(13/29)。结论 对临床T_3和T_4期、癌组织分化程度低和深度浸润的cN_0头颈部鳞癌应行选择性颈清扫术以治疗颈淋巴结隐匿性转移并提高患者的生存率。     

Efficacy of endoscopic ultrasonography in evaluating tumor thickness in patients with superficial pharyngeal carcinoma: A pilot study

ObjectivesA histopathological tumor thickness of ≥1000 μm has been reported as one of many risk factors for recurrent lymph node metastasis in superficial pharyngeal cancer (SPC). However, methods for assessing this risk factor preoperatively have not yet been established. Hence, the current study aimed to evaluate the efficacy of endoscopic ultrasonography (EUS) in measuring tumor thickness preoperatively in patients with SPC.MethodsThis single-center retrospective study included 44 consecutive patients with 47 lesions who underwent endoscopic submucosal dissection (ESD). Prior to surgery, EUS examination was performed while under general anesthesia. Further, microvascular irregularity in the target lesion was evaluated using the Japan Esophageal Society (JES) magnification endoscopic classification system.ResultsA significant correlation was noted between histopathological and EUS tumor thickness (Spearman's correlation r == 0.879, p < 0.001). In tumors ≥1000 µm thick on histopathology, the cutoff value for EUS tumor thickness was 2.6 mm, and the following values were obtained: sensitivity, 100%; specificity, 81.8%; positive predictive value (PPV), 70%; negative predictive value (NPV), 100%; and accuracy, 87.2%. In B2 lesions ≥1000-μm thick, the following values were obtained: sensitivity, 85.7%; specificity, 90.9%; PPV, 80%; NPV, 93.8%; and accuracy, 89.4%. The diagnostic accuracy rate of combined EUS and the JES magnifying endoscopic classification system was 95.7%.ConclusionsTumor thickness assessed using EUS was effective in diagnosing histopathological tumor thickness of ≥1000 μm. The combined use of EUS and the JES magnifying endoscopic classification system may be useful for assessing preoperative risk factors for lymph node metastasis in SPC.     

An examination of the cutoff value of the depth of invasion for prophylactic neck dissection in stage I/II tongue cancer

Abstract

Background: In stage-I/stage-II oral tongue cancer, the cutoff value of depth of invasion (DOI) for prophylactic neck dissection is controversial.

Objectives: To examine the relationship between the DOI and the rate of occult lymph node metastasis. In addition, to examine the relationship between the DOI evaluated by magnetic resonance imaging (MRI) and pathological DOI.

Materials and methods: In this retrospective study, 95 patients with clinical T1-2/N0M0 oral tongue cancer were enrolled. The rate of occult lymph node metastasis per DOI between 2 and 11?mm was calculated from the total pathological lymph node metastasis and delayed neck metastasis cases. We measured DOI using MRI and compared DOI obtained from pathology.

Results: The total rate of occult lymph node metastasis was 23.9%. In the rate of occult lymph node metastasis per DOI, there were two peaks at point of 5 to 6?mm and 9 to 10?mm. And there was a significant correlation between the DOI evaluated by MRI and the pathological DOI (Pearson’s correlation coefficient was 0.87).

Conclusions and significance: There was no consistent increase in the rate of occult lymph node metastasis per DOI. MRI was a useful modality to measure the DOI.