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II squamous cell carcinoma of the tongue
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108
Oral abstracts / Oral Oncology Supplement 3 (2009) 56–122
were present for ±6.4 months. Histopathologic analysis revealed mostly moderately differentiated (71.9%) tumors with ±1.09 cm of thickness. Perineural invasion was absent in 55% of the cases, and most were pattern of invasion 4 and 5 (59.4%). 15 (46.8%) patients showed nodal metastasis. None of these variables revealed statistically significant associations with nodal metastasis, but there was a trend towards tumor in clinical stage II (p = .057) and with thickness greater than 1 cm (p = .057) presenting nodal metastasis after pathologic analysis. Discussion: Due to the high number of occult metastasis in initial TFSCC, elective neck dissection should be indicated in this group of lesions. Unfortunately, evaluation of tumor size only (T from TNM) is not enough to determine need for neck dissection. Histopathology analysis is essential and molecular studies could aid on how to reach this information before lymph nodes removal. Financial support: CNPq, FAPERJ, INCA/HCI.
doi:10.1016/j.oos.2009.06.241
Discussion: We found that the growth pattern and greatest dimension of the tumor can be used to predict subclinical regional LNM in SCCOT of the endophytic type. In contrast, no association between tumor depth, greatest dimension and LNM was identified for exophytic- or superficial-type tumors. Combination analysis of tumor growth pattern and greatest dimension may predict LNM of SCCOT. Recently, the potential to detect LNM has increased the use of sentinel lymph node (SLN) biopsy. SLN biopsy may have a role in staging procedures and its diagnostic accuracy in the clinically negative neck in SCCOT should be improved immunohistochemical study and/or Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) examination. However, not all cases of SCCOT with a clinically negative neck require SLN examination. We revealed that the growth pattern of stage I/II SCCOT is of clinical value in predicting subclinical regional LNM. Our findings may represent suitable criteria for the selection of cases requiring SLN examination. Assessment of clinical criteria will facilitate the worldwide exchange of information, and encourage future institutional collaboration in the investigation of SCCOT.
Further reading doi:10.1016/j.oos.2009.06.242 1. Dias FL, Lima RA, Kligerman J, Farias TP, Soares JR, Manfro G, et al.. Relevance of skip metastases for squamous cell carcinoma of the oral tongue and the floor of the mouth. Otolaryngol Head Neck Surg 2006;134(3):460–5. 2. Dias FL, Kligerman J, Matos de Sa G, Arcuri RA, Freitas EQ, Farias T, et al.. Elective neck dissection versus observation in stage I squamous cell carcinomas of the tongue and floor of the mouth. Otolaryngol Head Neck Surg 2001;125(1):23–9. 3. Barnes L, Eveson JW, Reichert P, Sidransky D. World health organization classification of tumours. Pathology and genetics of head and neck tumours. Lyon: IARC Press; 2005. 4. Brandwein-Gensler M, Teixeira MS, Lewis CM, Lee B, Rolnitzky L, Hille JJ, et al.. Oral squamous cell carcinoma: histologic risk assessment, but not margin status, is strongly predictive of local disease-free and overall survival. Am J Surg Pathol 2005;29(2):167–78. 5. Woolgar JA. Salvage neck dissections in oral and oropharyngeal squamous cell carcinoma: histological features in relation to disease category. Int J Oral Maxillofac Surg 2006;35(10):907–12.
O157. Prediction of subclinical regional lymph node metastasis in stage I/II squamous cell carcinoma of the tongue K. Nakamoi *, A. Miyazaki, Y. Sogabe, T. Imai, T. Yamamoto Department of Oral Surgery, Sapporo Medical University School of Medicine, Japan Introduction: Although tumor depth appears to be a powerful predictor of regional lymph node metastasis (LNM) in squamous cell carcinoma of the tongue (SCCOT), measurement is usually based on histological findings following surgical resection. The predictive value of clinical findings on lymph node metastasis in the absence of surgical intervention is unclear. Methods: We retrospectively evaluated 94 previously untreated cases of stage I/II SCCOT to analyze the relationship between greatest dimension, growth pattern (exophytic, superficial and endophytic type), depth of tumor and regional LNM. Results: Regional LNM was recognized in 15 of 94 cases. A positive correlation between greatest dimension and tumor depth was seen for endophytic-type tumors only. Logistic regression analysis revealed that growth pattern was an independent predictor of LNM (p = 0.0014).
O158. Improving the pN staging accuracy with sentinel node biopsy in T1–T2 N0 oral and oropharyngeal squamous cell carcinoma R. Garrel a,*, V. Costes b, J.L. Faillie c, Q. Gardiner d, C. Cartier a, M. Zanca e a
Head and Neck Surgery Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, France b Pathology Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, France c Medical Statistics Department, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, France d Department of Otolaryngology, Ninewells Hospital and Medical School, Dundee, United Kingdom e Nuclear Medicine Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, France Background: One of the issues of sentinel lymph node (SN) biopsy in head and neck squamous cell carcinoma may be the neck staging accuracy improvement. In the present study we compared the neck staging with SN biopsy and with systematic neck dissection as the gold standard. Methods: Fifty-three consecutive patients with oral and oropharyngeal T1–T2 N0 cancer were prospectively studied. Systematic modified radical neck dissection with routine histopathology established the pN stage and SN biopsy analyzed with serial sectioning with immunohistochemistry (SS-IHC) established the pN(SN) stage. Results: One hundred and forty-eight SN were harvested from 50 patients and total of 68 MRND, collected 1056 non-sentinel nodes. The sensitivity and negative predictive value of SN staging were 100%. Five patients were upstaged from pN0 to pN1 or 2(SN). Seven patients were upstaged from pN1 to pN2(SN) i.e. in total 24% were upstaged. Two upstaged patients pN0–pN(SN)+ died of relapsed neck disease. Conclusion: SN biopsy has allowed significant progress in the diagnosis of nodal micrometastases. The pN(SN) stage may have prognostic significance. doi:10.1016/j.oos.2009.06.243
108
Oral abstracts / Oral Oncology Supplement 3 (2009) 56–122
were present for ±6.4 months. Histopathologic analysis revealed mostly moderately differentiated (71.9%) tumors with ±1.09 cm of thickness. Perineural invasion was absent in 55% of the cases, and most were pattern of invasion 4 and 5 (59.4%). 15 (46.8%) patients showed nodal metastasis. None of these variables revealed statistically significant associations with nodal metastasis, but there was a trend towards tumor in clinical stage II (p = .057) and with thickness greater than 1 cm (p = .057) presenting nodal metastasis after pathologic analysis. Discussion: Due to the high number of occult metastasis in initial TFSCC, elective neck dissection should be indicated in this group of lesions. Unfortunately, evaluation of tumor size only (T from TNM) is not enough to determine need for neck dissection. Histopathology analysis is essential and molecular studies could aid on how to reach this information before lymph nodes removal. Financial support: CNPq, FAPERJ, INCA/HCI.
doi:10.1016/j.oos.2009.06.241
Discussion: We found that the growth pattern and greatest dimension of the tumor can be used to predict subclinical regional LNM in SCCOT of the endophytic type. In contrast, no association between tumor depth, greatest dimension and LNM was identified for exophytic- or superficial-type tumors. Combination analysis of tumor growth pattern and greatest dimension may predict LNM of SCCOT. Recently, the potential to detect LNM has increased the use of sentinel lymph node (SLN) biopsy. SLN biopsy may have a role in staging procedures and its diagnostic accuracy in the clinically negative neck in SCCOT should be improved immunohistochemical study and/or Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) examination. However, not all cases of SCCOT with a clinically negative neck require SLN examination. We revealed that the growth pattern of stage I/II SCCOT is of clinical value in predicting subclinical regional LNM. Our findings may represent suitable criteria for the selection of cases requiring SLN examination. Assessment of clinical criteria will facilitate the worldwide exchange of information, and encourage future institutional collaboration in the investigation of SCCOT.
Further reading doi:10.1016/j.oos.2009.06.242 1. Dias FL, Lima RA, Kligerman J, Farias TP, Soares JR, Manfro G, et al.. Relevance of skip metastases for squamous cell carcinoma of the oral tongue and the floor of the mouth. Otolaryngol Head Neck Surg 2006;134(3):460–5. 2. Dias FL, Kligerman J, Matos de Sa G, Arcuri RA, Freitas EQ, Farias T, et al.. Elective neck dissection versus observation in stage I squamous cell carcinomas of the tongue and floor of the mouth. Otolaryngol Head Neck Surg 2001;125(1):23–9. 3. Barnes L, Eveson JW, Reichert P, Sidransky D. World health organization classification of tumours. Pathology and genetics of head and neck tumours. Lyon: IARC Press; 2005. 4. Brandwein-Gensler M, Teixeira MS, Lewis CM, Lee B, Rolnitzky L, Hille JJ, et al.. Oral squamous cell carcinoma: histologic risk assessment, but not margin status, is strongly predictive of local disease-free and overall survival. Am J Surg Pathol 2005;29(2):167–78. 5. Woolgar JA. Salvage neck dissections in oral and oropharyngeal squamous cell carcinoma: histological features in relation to disease category. Int J Oral Maxillofac Surg 2006;35(10):907–12.
O157. Prediction of subclinical regional lymph node metastasis in stage I/II squamous cell carcinoma of the tongue K. Nakamoi *, A. Miyazaki, Y. Sogabe, T. Imai, T. Yamamoto Department of Oral Surgery, Sapporo Medical University School of Medicine, Japan Introduction: Although tumor depth appears to be a powerful predictor of regional lymph node metastasis (LNM) in squamous cell carcinoma of the tongue (SCCOT), measurement is usually based on histological findings following surgical resection. The predictive value of clinical findings on lymph node metastasis in the absence of surgical intervention is unclear. Methods: We retrospectively evaluated 94 previously untreated cases of stage I/II SCCOT to analyze the relationship between greatest dimension, growth pattern (exophytic, superficial and endophytic type), depth of tumor and regional LNM. Results: Regional LNM was recognized in 15 of 94 cases. A positive correlation between greatest dimension and tumor depth was seen for endophytic-type tumors only. Logistic regression analysis revealed that growth pattern was an independent predictor of LNM (p = 0.0014).
O158. Improving the pN staging accuracy with sentinel node biopsy in T1–T2 N0 oral and oropharyngeal squamous cell carcinoma R. Garrel a,*, V. Costes b, J.L. Faillie c, Q. Gardiner d, C. Cartier a, M. Zanca e a
Head and Neck Surgery Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, France b Pathology Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, France c Medical Statistics Department, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, France d Department of Otolaryngology, Ninewells Hospital and Medical School, Dundee, United Kingdom e Nuclear Medicine Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, France Background: One of the issues of sentinel lymph node (SN) biopsy in head and neck squamous cell carcinoma may be the neck staging accuracy improvement. In the present study we compared the neck staging with SN biopsy and with systematic neck dissection as the gold standard. Methods: Fifty-three consecutive patients with oral and oropharyngeal T1–T2 N0 cancer were prospectively studied. Systematic modified radical neck dissection with routine histopathology established the pN stage and SN biopsy analyzed with serial sectioning with immunohistochemistry (SS-IHC) established the pN(SN) stage. Results: One hundred and forty-eight SN were harvested from 50 patients and total of 68 MRND, collected 1056 non-sentinel nodes. The sensitivity and negative predictive value of SN staging were 100%. Five patients were upstaged from pN0 to pN1 or 2(SN). Seven patients were upstaged from pN1 to pN2(SN) i.e. in total 24% were upstaged. Two upstaged patients pN0–pN(SN)+ died of relapsed neck disease. Conclusion: SN biopsy has allowed significant progress in the diagnosis of nodal micrometastases. The pN(SN) stage may have prognostic significance. doi:10.1016/j.oos.2009.06.243