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Clinical study of the diagnostic standards for cervical lymph node metastasis using contrast-enhanced CT
021-B2 Diagnosis of neoplasm 021-B2 Diagnosis of neoplasm 1. Diagnosis and Management of Lingual Lymph Node Metastases
Omura, K., Yanai, C., Yamashita, T., Okumura, K. Department of Head and Neck Surgery, Chiba Cancer Center Hospital, Chiba, Japan
The lingual lymph nodes are small, inconstant, interrupting nodules placed deeply above the suprahyoid region along the course of the lymphatic vessels draining the tongue and floor of the mouth. They are divided into two groups: lateral and median nodes. The presence of lingual lymph nodes and their significance in diagnosis and metastatic involvement have received little attention in the literature. It has been difficult to detect the metastatic lingual node preoperatively because of its small size and close proximity to the primary lesion. But now it can be detected and delineated by CT scan or MRI. Out of 472 patients with carcinoma of the tongue (n=385) or floor of the mouth (n = 87) treated at Chiba Cancer Center between 1973 and 1996, lingual node metastasis was histologically proven in 9 patients (1.9%). The primary site in these patients was the tongue in 7 patients and floor of the mouth in 2 patients. Eight of 9 patients had associated cervical lymph node metastases. The metastatic disease was located in the lateral node in 8 patients, and in both median and lateral nodes in one patient. Lingual node metastasis was preoperatively diagnosed in 4 patients by CT or MRI. Eight patients had a pull-through operation, one patient had neck dissection followed by radiation therapy. Eight of 10 involved lingual nodes revealed extracapsular spread of the tumor. Seven patients are alive with no evidence of disease, and two patients have died of neck failure. Both median and lateral lingual nodes are situated outside the limits of the standard neck dissection. The metastatic lingual nodes, which frequently show extracapsular spread, including the lymphatic vessels between the primary lesion and cervical lymph nodes should be dissected by pullthrough operation in combination with postoperative radiation therapy.
2. Early Detection of Oral Cancer
Sassi, L. M. *, Oliveira, B. V., Ramos, G. H. A., Ramos. C., Minari-Sassi, C. L. Erasto Gaertner Hospital (LPCC/CEPEP) ; Curitiba Gakusseis Union (UGC), Curitiba, Parana, Brazil Early detection of oral cancer is of paramount importance if one wants to make progress in the treatment of oral cancer. One way of achieving this goad is to educate the people about oral pathology and to learn them to examen their own mouth.
45
A project was set up in Parana in 1989, aiming at patients over 30 years old, of both gender. Counseling the people consisted of educational pictures and self-examinations cards, showing them the particulars of the various lesions such as leukoplakia, erythroplakia and ulcerative lesions. It was found that little awareness was present among the people counseled, while there was a relatively high incidence of premalignant lesions.
3. Clinical Study of the Diagnostic Standards for Cervical Lymph Node Metastasis Using Contrast-Enhanced CT
Nakanishi, H., Hayashi, E., Nagayama, 3/1.1, Takahashi, A. 2 alst Department of Oral and Maxillofacial Surgery, 2Oral and Maxillofacial Radiology, School of Dentistry, Tokushima Univ., Tokushima, Japan
Cervical lymph node metastasis is a critical factor affecting treatment and prognosis of patients with cancer in the head and neck. To detect lymph node metastasis, a contrast-enhanced CT is usually used in addition to clinical examination. Since diagnostic accuracy depends on a diagnostic standard which considers lymph node metastasis, we studied the findings of lymph nodes imaged in CT, which were examined clinically or histologically, and set a standard to acquire a more accurate diagnosis. CT examinations were performed in 60 cases on oral squamous cell carcinoma patients, from these CT images we detected 251 lymph nodes which were more than 5 mm in diameter. In 33 cases, neck dissection or lymph node extirpation was performed, and histological metastatic lymph nodes were found in 51 out of 122. When we compared the metastatic diagnostic rate with the lymph node size of more than 10 mm in maximum diameter or minimum diameter, the latter standard gave a higher value. After categorizing the lymph nodes according to their internal appearance: flat, non-flat or ring enhanced, ring enhancement was recommended as a standard. In the false negative cases, we found more than three lymph nodes together, even when they were less than 10 mm in minimum diameter. Using the set standards for metastasis derived as above, a lymph node with a minimum diameter more than 10mm, ring enhancement and in a group of more than three lymph nodes, the metastatic diagnostic rate showed high values and an accuracy of 90.4%. We concluded that these standards might be useful for the diagnosis of cervical lymph node metastasis.
Omura, K., Yanai, C., Yamashita, T., Okumura, K. Department of Head and Neck Surgery, Chiba Cancer Center Hospital, Chiba, Japan
The lingual lymph nodes are small, inconstant, interrupting nodules placed deeply above the suprahyoid region along the course of the lymphatic vessels draining the tongue and floor of the mouth. They are divided into two groups: lateral and median nodes. The presence of lingual lymph nodes and their significance in diagnosis and metastatic involvement have received little attention in the literature. It has been difficult to detect the metastatic lingual node preoperatively because of its small size and close proximity to the primary lesion. But now it can be detected and delineated by CT scan or MRI. Out of 472 patients with carcinoma of the tongue (n=385) or floor of the mouth (n = 87) treated at Chiba Cancer Center between 1973 and 1996, lingual node metastasis was histologically proven in 9 patients (1.9%). The primary site in these patients was the tongue in 7 patients and floor of the mouth in 2 patients. Eight of 9 patients had associated cervical lymph node metastases. The metastatic disease was located in the lateral node in 8 patients, and in both median and lateral nodes in one patient. Lingual node metastasis was preoperatively diagnosed in 4 patients by CT or MRI. Eight patients had a pull-through operation, one patient had neck dissection followed by radiation therapy. Eight of 10 involved lingual nodes revealed extracapsular spread of the tumor. Seven patients are alive with no evidence of disease, and two patients have died of neck failure. Both median and lateral lingual nodes are situated outside the limits of the standard neck dissection. The metastatic lingual nodes, which frequently show extracapsular spread, including the lymphatic vessels between the primary lesion and cervical lymph nodes should be dissected by pullthrough operation in combination with postoperative radiation therapy.
2. Early Detection of Oral Cancer
Sassi, L. M. *, Oliveira, B. V., Ramos, G. H. A., Ramos. C., Minari-Sassi, C. L. Erasto Gaertner Hospital (LPCC/CEPEP) ; Curitiba Gakusseis Union (UGC), Curitiba, Parana, Brazil Early detection of oral cancer is of paramount importance if one wants to make progress in the treatment of oral cancer. One way of achieving this goad is to educate the people about oral pathology and to learn them to examen their own mouth.
45
A project was set up in Parana in 1989, aiming at patients over 30 years old, of both gender. Counseling the people consisted of educational pictures and self-examinations cards, showing them the particulars of the various lesions such as leukoplakia, erythroplakia and ulcerative lesions. It was found that little awareness was present among the people counseled, while there was a relatively high incidence of premalignant lesions.
3. Clinical Study of the Diagnostic Standards for Cervical Lymph Node Metastasis Using Contrast-Enhanced CT
Nakanishi, H., Hayashi, E., Nagayama, 3/1.1, Takahashi, A. 2 alst Department of Oral and Maxillofacial Surgery, 2Oral and Maxillofacial Radiology, School of Dentistry, Tokushima Univ., Tokushima, Japan
Cervical lymph node metastasis is a critical factor affecting treatment and prognosis of patients with cancer in the head and neck. To detect lymph node metastasis, a contrast-enhanced CT is usually used in addition to clinical examination. Since diagnostic accuracy depends on a diagnostic standard which considers lymph node metastasis, we studied the findings of lymph nodes imaged in CT, which were examined clinically or histologically, and set a standard to acquire a more accurate diagnosis. CT examinations were performed in 60 cases on oral squamous cell carcinoma patients, from these CT images we detected 251 lymph nodes which were more than 5 mm in diameter. In 33 cases, neck dissection or lymph node extirpation was performed, and histological metastatic lymph nodes were found in 51 out of 122. When we compared the metastatic diagnostic rate with the lymph node size of more than 10 mm in maximum diameter or minimum diameter, the latter standard gave a higher value. After categorizing the lymph nodes according to their internal appearance: flat, non-flat or ring enhanced, ring enhancement was recommended as a standard. In the false negative cases, we found more than three lymph nodes together, even when they were less than 10 mm in minimum diameter. Using the set standards for metastasis derived as above, a lymph node with a minimum diameter more than 10mm, ring enhancement and in a group of more than three lymph nodes, the metastatic diagnostic rate showed high values and an accuracy of 90.4%. We concluded that these standards might be useful for the diagnosis of cervical lymph node metastasis.