Is dissection of level IV absolutely necessary in elective lateral neck dissection for clinically N0 laryngeal carcinoma?

A prospective study of 73 previous untreated consecutive patients with clinically N0 laryngeal squamous cell carcinoma (SCC) from January 1997 to October 2002 was undertaken to determine whether level IV lymph nodes can be saved in elective lateral neck dissection (LND) performed as a treatment for the N0 neck. The incidence of pathological metastases to level IV lymph nodes was evaluated, as were the incidence of regional recurrence after elective LND, and postoperative complications such as chylous leakage and phrenic nerve paralysis. A total of 142 LNDs were enrolled in this prospective study. The mean number of harvested lymph nodes by level was as follows; 13.1 in level II, 7.1 in level III, and 9.2 in level IV. Pathologic examination revealed nodal involvement in 25 neck specimens (17.6%, 25 of 142). Five necks had lymph nodes which were positive for microscopic metastasis in level IV (3.5%, 5 of 142). These necks were all ipsilateral (6.8%, 5 of 73) and none of the 69 contralateral neck specimens had level IV lymph node metastasis (0%, 0 of 69). With regard to T stage, 3.3% (1 of 30) of ipsilateral necks of T2 tumors exhibited occult metastasis in level IV lymph nodes, 5.9% (2 of 34) for T3 tumors, and 33.3% (2 of 6) for T4 tumors. There were no cases of T1 (n = 3). Separate skip metastasis in level IV lymph nodes was observed in two necks (1.4%, 2 of 142). Four cases of regional recurrence (5.5%, 4 of 73) were observed. Postoperative chylous leakage and phrenic nerve paralysis occurred in four cases (5.5%, 4 of 73) and two cases (2.7%, 2 of 73), respectively. The results of the present study demonstrate the rare incidence of level IV occult lymph node metastasis, as well as infrequent nodal recurrence after elective LND in the treatment of clinically N0 laryngeal SCC. Therefore, dissection of level IV lymph node pads, especially in the ipsilateral neck of early T staged tumors or the contralateral neck, may be unnecessary for the treatment of laryngeal SCC patients with a clinically N0 neck.     

99mTc(V)-dimercaptosuccinic acid scintigraphy in detecting neck metastases in oral squamous cell carcinoma with clinically negative necks

This study compares the accuracy of 99mTc(V)-dimercaptosuccinic acid (99mTc(V)-DMSA) Single Photon Emission Computer Tomography (SPECT) by intravenous or local injection in the detection of occult cervical lymph node metastases in clinically N0 squamous cell carcinoma of the oral cavity. Fifty-eight previously untreated patients without clinically detectable cervical metastases were included in the study and were divided into two groups. Twenty-eight patients were in the intravenous injection group and 30 patients were in the local injection (around primary tumors) group. Both groups received 99mTc(V)-DMSA, and 99mTc(V)-DMSA SPECT was performed on all patients. All isolated lymph nodes in neck dissection specimens were stained using H & E. The sensitivity, specificity, and accuracy for intravenous injection of 99mTc(V)-DMSA was 62.5%, 95.0%, and 85.7%, respective, and 84.6%, 82.4%, and 83.3%, respectively, for local injection. SPECT scan of 99mTc(V)-DMSA injected around the tumor is a simple and efficient approach to detecting metastatic lymph nodes in clinically N0 patients with oral cancer.     

The role of supraomohyoid neck dissection in patients of oral cavity carcinoma(small star, filled)

The aim of this study was to evaluate the role of supraomohyoid neck dissection (SOHND) in oral carcinoma patients with clinically negative neck nodes. From July 1993 to June 1998, 140 patients with oral carcinomas and clinically negative lymph nodes in the neck underwent elective SOHND in Chang Gung Memorial Hospital, Taiwan. Thirty-seven patients had postoperative radiotherapy.Thirty-four (24.3%) patients had occult cervical metastases. The overall regional control rates were 93.4% vs. 85.3% for pathologically negative vs positive nodes, respectively, with or without adjuvant radiotherapy. Adjuvant radiotherapy significantly improved ipsilateral regional control (P=0.012) in patients with occult cervical metastases but not in patients with negative neck disease. (P=1.0) SOHND is both a diagnostic and therapeutic procedure in patients with negative neck disease. Its therapeutic role in patients with positive neck disease remains controversial. Postoperative radiotherapy significantly improve ipsilateral neck control in patients with occult cervical metastasis.     

FDG PET in oral and oropharyngeal cancer. Value for confirmation of N0 neck and detection of occult metastases

Treatment of the clinical N0 neck in squamous cell carcinoma (SCC) of oral cavity and oropharynx remains a dilemma. None of the current imaging modalities are able to detect the presence of micrometastases in the lymph nodes of clinical N0 necks reliably. The aim of this study was to determine the diagnostic properties of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) in patients clinically staged as N0. FDG PET results of 38 patients were compared to histologic specimens obtained with neck dissections or to follow-up. FDG PET performance was compared to computed tomography (CT), magnetic resonance imaging (MRI) or ultrasonography-guided fine needle aspiration cytology (USgFNAC). Sensitivity and specificity of FDG PET in detecting occult cervical metastases were 50% and 97% respectively. Although FDG PET performed better than conventional imaging modalities, sensitivity was lower than desired. As a consequence, clinical application of FDG PET in the patient staged as N0 is limited.     

Level IIb lymph node metastasis in elective neck dissection of oropharyngeal squamous cell carcinoma

This study investigated the oncologic safety of preserving level IIb lymph nodes in ipsilateral and/or contralateral elective neck dissection (END) in patients with oropharyngeal squamous cell carcinoma (SCC). Fifty-one oropharyngeal SCC patients who underwent surgery as an initial treatment were reviewed. Twenty-one patients had clinically node negative necks (cN0) while 30 patients had ipsilateral clinically node positive necks (cN+). Of the cN0 patients, bilateral or ipsilateral END was performed in 15 and six patients, respectively. For the cN+ cases, ipsilateral therapeutic neck dissection with contralateral END was performed in 24 of 30 patients. In the cN0 patients, nodal metastasis to level IIb lymph nodes was not observed in any ipsilateral (21) or contralateral necks (15). Of the 24 cN+ patients who underwent contralateral END, two cases (8.3%) showed contralateral occult level IIb lymph node metastasis. Our data suggest that in cN0 oropharyngeal cancer patients, level IIb lymph nodes may be preserved in ipsilateral and contralateral neck dissection. However, caution is advised when preserving contralateral level IIb nodes in ipsilateral cN+ cases.     

cN0甲状腺乳头状癌侧颈淋巴结转移特点及其相关因素

 目的　探讨cN0甲状腺乳头状癌侧颈淋巴结转移特点及其相关危险因素。方法　回顾性分析73例接受同侧预防性颈清扫（Ⅱ～Ⅵ区或Ⅱ～Ⅳ区联合Ⅵ区）的cN0甲状腺乳头状癌患者临床资料,颈清扫淋巴结标本按颈部分区收集并送术后常规病理检查。 结果　73例cN0甲状腺乳头状癌患者中,侧颈淋巴结转移率为16.4 ％（12／73）,其中Ⅱa、Ⅱb、Ⅲ、Ⅳ、Va、Vb和Ⅵ区淋巴结转移率分别为9.6 %、0、13.6 %、9.6 %、0、4.8 ％和42.4 %,多因素分析显示Ⅵ区淋巴结转移是影响cN0甲状腺乳头状癌侧颈淋巴结转移的独立危险因素（OR＝7.3,P＝0.020）。结论　cN0甲状腺乳头状癌侧颈转移以Ⅱa、Ⅲ、Ⅳ区为主,预防性清扫应重点清扫上述三个分区;术中冷冻Ⅵ区阴性时,cN0甲状腺乳头状癌患者无需常规行侧颈预防性清扫。     

The accuracy of head and neck carcinoma sentinel lymph node biopsy in the clinically N0 neck

BACKGROUND: Sentinel lymph node (SLN) biopsy originally was described as a means of identifying lymph node metastases in malignant melanoma and breast carcinoma. The use of SLN biopsy in patients with oral and oropharyngeal squamous cell carcinoma and clinically N0 necks was investigated to determine whether the pathology of the SLN reflected that of the neck. METHODS: Patients undergoing elective neck dissections for head and neck squamous cell carcinoma accessible to injection were enrolled into our study. Sentinel lymph node biopsy was performed after blue dye and radiocolloid injection. Preoperative lymphoscintigraphy and the perioperative use of a gamma probe identified radioactive SLNs; visualization of blue stained lymphatics identified blue SLNs. A neck dissection completed the surgical procedure, and the pathology of the SLN was compared with that of the remaining neck dissection. RESULTS: Sentinel lymph node biopsy was performed on 40 cases with clinically N0 necks. Twenty were pathologically clear of tumor and 20 contained subclinical metastases. SLNs were found in 17 necks with pathologic disease and contained metastases in 16. The sentinel lymph node was the only lymph node containing tumor in 12 of 16. CONCLUSIONS: The SLN, in head and neck carcinomas accessible to injection without anesthesia, is an accurate reflector of the status of the regional lymph nodes, when found in patients with early tumors. Sentinel lymph nodes may be found in clinically unpredictable sites, and SLN biopsy may aid in identifying the clinically N0 patient with early lymph node disease. If SLNs cannot be located in the neck, an elective lymph node dissection should be considered.     

舌鳞癌隐匿性颈淋巴结转移的特点及其对患者预后的影响

背景与目的:舌鳞癌隐匿性颈淋巴结转移有一定的规律性,且影响预后。本研究的目的是分析舌鳞癌隐匿性颈淋巴结转移的特点及其对患者预后的影响,为选择性肩胛舌骨肌上颈清扫提供临床依据。方法:收集1990～1996年间在我院住院行手术治疗的164例舌鳞癌患者的资料,分析舌鳞癌隐匿性颈淋巴结转移的特点及其对患者预后的影响。结果:164例舌鳞癌隐匿性颈淋巴结转移率为25.71%,最常见的转移部位是同侧的Ⅱ区,其次分别为同侧的Ⅰ和Ⅲ区,82.98%隐匿性转移的颈淋巴结位于以上3个区域,大多数隐匿性转移的颈淋巴结在首次手术治疗后2年内(33/36)被发现。经统计学分析,显性颈淋巴结转移和隐匿性颈淋巴结转移与无转移组之间患者的预后有显著性差异(log-rank,P<0.01),而显性转移组与隐匿性转移组患者的预后之间无显著性差异(log-rank,P>0.05)。结论:同侧的Ⅰ～Ⅲ区是舌鳞癌隐匿性颈淋巴结转移的常见区域,对较易发生隐匿性颈淋巴结转移的cN0舌鳞癌患者可行选择性肩胛舌骨肌上颈清扫术。隐匿性颈淋巴结转移影响cN0舌鳞癌患者的预后。     

Considerations in the treatment of the node-negative (N0) neck in glottic carcinomas

Treatment of lymph node negative (N0) glottic carcinoma has raised numerous controversy for decades. Prevention is one of the oldest axioms in medicine. On the other hand, overtreatment can cause unnecessary harm to patients. This retrospective study was performed in 206 patients having glottic cancers with clinically node-negative (N0) necks. The aim of this assessment is to deal with the diagnosis, predictive factors and surgical therapy of occult metastases of squamous cell cancers originating from the glottic region. The examinations were performed in three phases. Preoperative clinical, histological - and in selective cases - imaging were carried out to separate high-risk patients. Intraoperative cases of open surgery after U-shaped skin preparation up to the hyoid bone with direct inspection of jugular lymph node chain (JLNCh) where the neck was staged. The enlarged suspicious nodes were submitted for immediate frozen section. The types of neck dissection were based on the size, shape, number and histological diagnosis of regional nodes. The postoperative additional management was decided according to the results of definitive pathological findings from serial sections of the dissected specimen. Endolaryngeal LASER surgery was carried out in 87 patients based on clinical, histological and imaging criteria. In the course of two years follow-up 2 occult metastases became clinically apparent. At 119 cases open surgery were performed. In 51 patients we could not see enlarged lymph nodes (N< 2 mm) with direct examination, and thus the JLNCh remained intact. In 68 patients elective neck dissections (END) were carried out. In cases of extracapsular spread (ECS) and/or multiple nodal involvements additional radiotherapy was given.     

Radiation therapy for cutaneous squamous cell carcinoma involving the parotid area lymph nodes: dose and volume considerations

PURPOSE: The intraparotid and periparotid lymph nodes are the most commonly involved when skin cancer of the head and neck metastasizes beyond the primary site. We sought to report the clinical outcome of patients treated with radiation therapy for parotid-area metastases from cutaneous squamous cell carcinoma of the head and neck. METHODS AND MATERIALS: The records of 36 patients treated with radiation therapy for cutaneous squamous cell carcinoma involving the parotid-area lymph nodes were reviewed. All patients had clinically N0 necks and were without evidence of distant disease. Thirty patients (83%) were treated postoperatively after gross total tumor resection. Median dose to the parotid area was 60 Gy (range, 50-72 Gy). Treatment of clinically N0 necks consisted of surgical dissection (7 patients), irradiation (15 patients), and observation (14 patients). RESULTS: The 5-year estimate of local (parotid) control was 86% in patients treated using surgery with postoperative therapy and 47% in patients treated using radiation therapy alone. Three of 4 patients with tumors that relapsed locally after surgery and postoperative radiation received a dose of less than 60 Gy. Elective neck irradiation decreased the incidence of subsequent nodal failures from 50% to 0% and significantly improved neck control (p < 0.001). The 5-year overall survival rate was 63%. CONCLUSIONS: Surgery followed by radiation therapy to doses of at least 60 Gy results in effective local control for patients with parotid area metastasis from cutaneous squamous cell carcinoma. Routine irradiation of the clinically N0 neck is recommended.     

Nodal metastases from laryngeal carcinoma and their correlation with certain characteristics of the primary tumor

5O cases of carcinoma larynx were included in a prospective study to detect the incidence and pattern of nodal metastases (both clinical and occult) and to study the influence of certain characteristics of the primary tumor on the incidence of nodal metastases. In our study 66% (33 cases) of the lesions were transglottic as compared to 24% (12 cases) supraglottic and 10% (5 cases) glottic lesions. The most common age group affected in our study was 51-60 years comprising 50% of the cases. The most common symptoms were hoarseness, breathlessness and difficulty in swallowing. The incidence of clinically positive neck at the time of presentation was 42% while the incidence of occult nodal metastases was found to be 27.6%. The most common levels of lymph nodes involved in our study were levels II and III (87.5% cases). Multiple level lymph node involvement was seen in 71.4% of the eases at the time of presentation. A high incidence of cervical nodal metastases was associated with the following characteristics of the primary lesion-extralaryngeal spread, infiltrating or endophytic peripheral growth pattern, poor cellular differentiation and advanced T stage. In view of the high incidence of occult nodal metastases, use of selective lateral neck dissection is advocated in patients with a clinically negative neck at the-time of presentation (early glottic carcinomas being excluded).     

Pathologic analysis of sentinel and nonsentinel lymph nodes in breast carcinoma: a multicenter study

BACKGROUND: Axillary lymph node status is a powerful prognostic factor in breast carcinoma; however, complications after axillary lymph node dissection are common. Sentinel lymph node biopsy is an alternative staging procedure. The sentinel lymph node postulate is that tumor cells migrating from the primary tumor colonize one or a few lymph nodes before colonizing subsequent lymph nodes. To validate this hypothesis, the distribution of occult and nonoccult metastases in sentinel and nonsentinel lymph nodes was evaluated. METHODS: Original pathology material was reviewed from 431 patients enrolled on a multicenter validation study of sentinel lymph node biopsy in breast carcinoma patients. Paraffin embedded tissue blocks of sentinel and nonsentinel lymph nodes were obtained for 214 lymph node negative patients. Additional sections from 100 and 200 microm deeper into the paraffin block were examined for the presence of occult metastatic carcinoma. Both routine and cytokeratin immunohistochemical stains were employed. RESULTS: Metastases were identified in 15.9% of sentinel lymph nodes and 4.2% of nonsentinel lymph nodes (odds ratio [OR] 4.3[ P < 0.001]; 95% confidence interval [95% CI], 3.5-5.4). Occult metastases were identified in 4. 09% of sentinel lymph nodes and 0.35% of nonsentinel lymph nodes (OR 12.3 [P < 0.001]; 95% CI, 5.6-28.6). The overall case conversion rate was 10.3%. All the occult metastases identified were < or = 1 mm in greatest individual dimension. The likelihood (OR) of metastases in nonsentinel lymph nodes was 13.4 times higher for sentinel lymph node positive than for sentinel lymph node negative patients (P < 0. 001; 95% CI, 6.7-28.1). CONCLUSIONS: The distribution of occult and nonoccult metastases in axillary lymph nodes validates the sentinel lymph node hypothesis. In addition, pathology review of cases confirmed the authors' previously reported finding that the sentinel lymph nodes are predictive of the final axillary lymph node status. Occult metastatic disease is more likely to be identified in sentinel lymph nodes, allowing future studies to focus attention on one or a few sentinel lymph nodes. However, the relation between occult metastatic disease in sentinel lymph nodes, disease free survival, and overall survival must be evaluated prior to endorsing the intensive analysis of sentinel lymph nodes in routine practice. [See editorial on pages 971-7, this issue.] Copyright 2000 American Cancer Society.     

Ability of lymphoscintigraphy to direct sentinel node biopsy in the clinically NO check for patients with head and neck squamous cell carcinoma; a prospective study (preliminary results)

Detection of metastasis involvement of lymph nodes is essential for management and prognostic evaluation in most cancer cases. The success of lymphatic mapping depends on identifying the sentinel lymph node(s) draining the primary tumour. In this preliminary study we prospectively evaluated the feasibility of sentinel node radio localisation in head and neck squamous cell carcinoma N0 stage to gain insight as to whether the sentinel lymph node (SLN) could be prognostic of regional metastasis disease or not. In 14 patients with squamous cell carcinoma of the head and neck region preoperative lymphoscintigraphy (LSG) mapping of the tumour was performed after subcutaneous injection of 22 to 30 MBq of Tc99m-labelled sulfur colloid. SLN was detected and localised by LSG in all patients with a gamma camera and a hand-held gamma probe. All the patients underwent surgery SLN and cervical nodes dissection. Six SLNs for five patients revealed occult metastasis disease. No skip metastasis were found in the 9 necks with negative SLN analysis. The results of this preliminary study are encouraging. They showed that SLN in squamous cell carcinoma of the head and neck N0 is accurately feasible and could predict the presence of occult metastasis. Nevertheless, more data are needed to validate these results.     

PET/CT与增强CT诊断头颈肿瘤颈淋巴结转移的对比研究

目的:探讨18F-脱氧葡萄糖(FDG)PET/CT显像与螺旋CT增强扫描检测头颈肿瘤淋巴结转移的临床价值。方法:13个头颈肿瘤病人在颈部手术前,行PET/CT和增强CT检查。术后病理结果作为参考标准,PET/CT与增强CT的发现以左、右颈侧为记录单位进行比较。结果:在21个颈侧清扫(8个双侧,5个单侧)中,共清扫出440个淋巴结,其中的45个颈部淋巴结转移癌分布在14个颈侧。PET/CT检测颈淋巴结转移的敏感性、特异性和准确性分别为86%、100%和90%,增强CT分别为79%、86%和81%,PET/CT诊断的敏感性和准确性均显著高于增强CT(P<0.05)。结论:PET/CT在头颈肿瘤淋巴结转移的诊断中优于增强CT。本文结果为PET/CT在临床和放射影像诊断为颈部淋巴结阴性病人中发现转移的研究提供了可行性依据。     

局部晚期喉鳞癌cN0临床观察

目的：探讨喉癌cN0患者颈部处理的方法，降低颈淋巴结转移癌的复发率。方法：回顾分析87例T3、T4期cNo喉癌患者的临床资料，颈部处理方式为颈改良性清扫术或颈分区清扫术，分析手术组阳性淋巴结的分布情况及病理特点，观察颈清扫术对预后的影响，采用Kaplan—Meier方法计算肿瘤复发及生存趋势。结果：87例颈部淋巴结隐性转移率为36．8％，声门上型喉癌40．4％，声门型喉癌32．5％；淋巴结转移分布为：声门上型喉癌89．5％（17／19）位于Ⅱ和Ⅲ区，声门型喉癌92．3％（12／13）位于Ⅱ和Ⅲ区；5年颈部复发率：隐性淋巴结转移复发率为13．5％，无隐性淋巴结转移复发率6．7％；5年生存率：有淋巴结隐性转移生存率为53．8％，无隐性转移为71．1％。结论：晚期喉癌隐性转移率较高，分区清扫术后，隐性转移复发率与无隐性转移复发率无差别，分区清扫术十分必要，注意双侧Ⅱ、Ⅲ区的淋巴结清扫。     

口腔癌患者对侧颈部淋巴结转移危险因素的多因素分析

目的:探讨口腔癌患者对侧颈淋巴结转移特点及其危险因素。方法:收集同期行双侧颈淋巴结清扫术患者82例,分析对侧颈部淋巴结转移风险因素。结果:对侧转移29例,伴有同侧转移27例（93.10%）。分析结果表明同侧转移与对侧转移关联性有统计学意义。结论:口腔癌同侧颈部转移将增加对侧转移的风险。     

Value of neck dissection in patients with cancer of the parotid gland and a clinical NO neck

Cervical lymph node metastases in patients with parotid gland carcinoma are not rare. Regional metastases have a significant influence on the prognosis of these patients. In spite of the clinical relevance of lymphogenous metastases, the indications for elective treatment of the neck are not well defined. In the present review the controversies and therapeutical strategies of ipsilateral neck lymph nodes and their extension in patients with potential occult lymph node metastases are discussed. On the basis of the published data, in consideration of the direction of lymphogenous metastatic spread of parotid gland carcinomas, an elective neck dissection is recommended in carcinomas with high percentage of lymphatic spread also in the N0 neck. Consideration of additional parameters (> T2, lymphangiosis carcinomatosa) is appropriate to perform also a neck dissection in carcinomas with low risk for lymphogenous metastases. An elective neck dissection should include levels I, II, III and upper V.     

Rotterdam and Brussels CT-based neck nodal delineation compared with the surgical levels as defined by the American Academy of Otolaryngology-Head and Neck Surgery

PURPOSE/OBJECTIVE: Rotterdam and Brussels have independently published guidelines for the definition and delineation of CT-based neck nodal Levels I-VI. This paper first reports on the adequacy of contouring of the Rotterdam delineation protocol. Rotterdam and Brussels differed slightly in translating the original surgical level definitions as proposed by the 2002 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) to CT guidelines. To adapt to the surgical level definitions to come to a unifying concept, adjustments of both CT-based classifications are proposed. METHODS AND MATERIALS: The clinical neck nodal target volumes of patients irradiated in Rotterdam by three-dimensional conformal radiotherapy (3D-CRT) between December 1998 and March 2001 were reviewed. Thirty-four patients with N0 and 27 patients with N+ disease with primary tumors located in the oral cavity (n = 1) oropharynx (n = 24), hypopharynx (n = 7), and larynx (n = 29) were evaluated. Seven patients underwent unilateral (3 N0 patients, 4 N+ patients) and 54 underwent bilateral (31 N0 patients, 23 N+ patients) irradiation of the neck. In 11 N+ patients, 3D-CRT of the neck was followed by unilateral neck dissection. The dose to the primary and nonresected N+ necks was 70 Gy and to the N0 neck was 46 Gy. Neck levels were analyzed for adequacy of contouring, dose distribution, and patterns of relapse. The mean dose and the percentage of the volume receiving a minimum of 95% (V95) or >107% (V107) of the prescribed dose was computed. RESULTS: In 4 patients treated with bilateral 3D-CRT, contouring was not in concordance with the guidelines of the protocol. The V95 and V107 in the 81 adequately contoured N0 necks (63 irradiated N0 necks from 33 N0 patients, 18 irradiated N0 necks from 24 N+ patients) was 95.6% and 6.3%, respectively. For the 26 N+ necks (15 N+ necks from 13 N+ RT-only patients, 11 N+ necks from 11 preoperatively irradiated patients), the V95 and V107 was 94.6% and 6.7%, respectively. With a median follow-up of 29 months, in 4 (8.6%) of 46 patients treated by 3D-CRT only, regional relapse was found. An actuarial regional and locoregional relapse-free survival and disease-free survival rate at 3 years of 90%, 78%, and 68%, respectively, was observed. All regional relapses were observed in the N0 necks of patients with supraglottic laryngeal carcinoma. Taking the surgical 2002 AAO-HNS classification as a reference, adjustments are proposed for the Rotterdam and Brussels delineation protocols to arrive at a unified CT-based neck nodal classification. CONCLUSION: Adequate dose coverage for the Rotterdam CT-based contours of the neck nodal levels was found. In the RT-only patients, only four failures were observed: one regional and three locoregional relapses. As a next step in optimizing the current Rotterdam and Brussels CT-based delineation protocols, adaptations are proposed to resolve the discrepancies compared with the 2002 AAO-HNS surgical classification.     

甲状腺乳头状癌颈部的处理

目的 探讨甲状腺乳头状癌颈部处理的最佳方案。方法 总结１９６５年１月～１９８７年１月４２４例甲状腺乳头状癌的临床资料,根治原发灶的同时,对颈部淋巴结阳性（Ｎ＋）患者进行颈清扫术,对颈部淋巴结阴性（Ｎ０）患者进行观察,待出现颈淋巴结转移后再行治疗性颈清扫术。所有患者均随访１０年以上。结果 ２５８例颈部Ｎ＋患者的５,１０年生存率分别为８４．３％和８０．４％,而１６６例Ｎ０患者的５,１０年生存率分别为９     

Occult primary tumors of the head and neck: lack of benefit from positron emission tomography imaging with 2-[F-18]fluoro-2-deoxy-D-glucose.

BACKGROUND: Patients who present with squamous cell carcinoma metastatic to cervical lymph nodes and no clinically apparent primary site present a therapeutic dilemma. Positron emission tomography imaging with 2-[F-18]fluoro-2-deoxy-D-glucose (FDG-PET) has been shown to be useful for the examination of known primary tumors. This study was undertaken to determine whether FDG-PET imaging improves detection of occult primary tumors in patients with metastatic squamous cell carcinoma in the lymph nodes of the head and neck. METHODS: Thirteen patients with pathology proven cervical lymph node metastases from clinically occult primary squamous cell carcinomas were evaluated prospectively with FDG-PET, in addition to standard clinical and radiographic techniques, as part of their pretreatment diagnostic evaluation. Direct panendoscopy and biopsy were performed on all patients in an attempt to detect primary tumor sites and to characterize them histologically. RESULTS: A primary squamous cell carcinoma was confirmed after panendoscopy and biopsy in 3 of the 13 patients. The site of the primary tumor was correctly identified with FDG-PET in only one of these three patients. The FDG-PET study suggested a primary tumor location where no tumor was found in 6 of 13 patients; for 5 other of the 13 patients, the FDG-PET results were negative and no primary was found. No primary tumor locations were identified by computed tomography, magnetic resonance imaging, or direct panendoscopy. FDG-PET imaging correctly detected the location of the primary tumor in 1 patient (8%) and provided apparent false-positive results for 6 (46%) of the 13 patients. CONCLUSIONS: FDG-PET imaging did not significantly improve detection of unknown primary squamous cell carcinomas in patients with metastases to lymph nodes of the neck. A high percentage of results were apparent false-positive.