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Sentinel lymph node biopsy as adjunct to selective neck dissection for SCC oral cavity
Otolaryngology– Head and Neck Surgery Volume 131 Number 2
The Value of B-Scan Sonography in Patients with Head and Neck Cancer Petra Lohnstein, MD (presenter); Wolfgang Maier, MD; Jorg Schipper, MD Freiburg Germany; Freiburg Germany; Freiburg Germany
Objectives: Quality assessment to analyze the value of sonographic examination for the indication of a wait-and-see policy regarding the neck in patients with N0 stage. Methods: We performed a follow-up on 121 patients with a pT1 or pT2 carcinoma of the mouth, larynx, or pharynx undergoing R0 transoral laser-microsurgical resection. All patients underwent preoperative regionary staging with Bscan sonography, resulting in N0 stage. Neither neck dissection or radiotherapy were performed but all patients were controlled in a close-meshed clinical and sonographical follow-up of 18 to 36 months that was now analyzed regarding the probability of recurrence and survival. Results: The sonographic follow-up revealed suspicious cervical lymph nodes in 30 patients, indicating potential metachronic metastasis. All these 30 patients underwent a curative neck dissection. The histologic examination proved lymph node metastases in 8 patients, 6 of whom additionally suffered from local recurrence. Thus, only 2 of 121 patients (1.7%) showed metachronic isolated regionary recurrence. Survival was 100% in all tumor entities. The probability of being free from locoregional recurrence was 1.0 for larynx or hypopharynx carcinoma stage I, 0.9 for mouth or oropharynx carcinoma stage I or II, and of larynx stage II, and 0.6 for hypoharynx carcinoma stage II. Conclusion: Sonography is an appropriate method for preoperative evaluation and postoperative follow-up of cervical lymph node stage. Our results are excellent compared to those reported from the literature, underlining indication of a wait-and-see strategy on the neck in patients with stage I or II and a sonographic N0 neck.
P065 Sentinel Lymph Node Biopsy as Adjunct to Selective Neck Dissection for SCC Oral Cavity Barry M Rasgon, MD (presenter); Mark Joseph Bitgood, MD Oakland CA; Oakland CA
Objectives: The current standard of care for managing the clinically negative neck (NO) in patients with squamous cell carcinoma (SCC) of the oral cavity includes a selective neck dissection (SND), levels I-III minimally, with pathological findings determining the need for postoperative radiation. This approach may present several difficulties. Limiting the dissection to levels I-III could potentially miss affected nodes in other nodal basins. If SND includes the appropriate nodal basins, metastatic disease may be missed, and micrometastases could be overlooked with current pathological analysis.
P261
The purpose of this study was to see if SLN biopsy in conjuntion with SND improved diagnostic and therapeutic outcomes. Methods: We retrospectively reviewed 10 patients with SCC of the oral cavity and NO neck undergoing SND. Preoperative and intraoperative lymphatic mapping using low dose Technetium 99 sulfur colloid was used as an adjunct to standard SND Results: Preoperative lymphoscintigraphy showed 1 or more SLNs in all patients. Two patients had SLNs in level IV and 1 patient had a contralateral Level I SLN. All SLNs seen on preoperative lymphoscintigraphy were identified in the SND. No SLNs were left in the nodal basins dissected after SND was completed. Micrometastases were found in SLNs of 3 patients. Conclusion: Combined with standard SND, preoperative and intraoperative SLN mapping may improve our diagnostic and therapeutic outcomes in patients with SCCA of the oral cavity with clinically negative necks. The extent of SND can be more accurately planned, a more thorough neck dissection can be accomplished and a detailed pathological analyses of high risk nodes feasible. P066 Relationship of P53 Mutations in Laryngeal Cancer and Tobacco Smoking Manuel C Pais Clemente, MD PhD (presenter); Laudelina Pais Clemente, MD PhD; Vitor Cardoso, MD; Raquel Seruca, MD; Conceicao Souto-Moura, MD; Paulo Abreu-Dias, MD Porto Portugal; Porto Portugal; Porto Portugal; Porto Portugal; Porto Portugal; Porto Portugal
Objectives: (1) To determine the spectrum of P53 mutations in patients with laryngeal cancer and heavy smokers. (2) To correlate the p53 alterations with the expression of p53 protein. (3) To verify if imunoexpression of p53 can be used as a good method for screening of P53 mutations. Methods: Forty-one patients were enrolled in this study; half were heavy smokers. All surgical specimens obtained were routinely fixed in buffered formalin and processed in paraffin. Diagnosis was performed by light microscopy examination of tissue sections stained with hematoxylin and eosin. Forty patients had squamous cell carcinoma and one had an adenosquamous cell carcinoma of the larynx. Fifteen of the 41 had nodal metastases. The immunohistochemistry study was carried out simultaneously in all cases and in the margins. DNA was isolated from microdissected tumor cells obtained from formalin-fixed, paraffin-embedded tissue sections from 22 cases. Mutations in the p53 gene were analyzed by PCR/SSCP with primers covering exons 5– 8. Aberrant bands were direct sequenced. Results: (1) Twenty-two cases were selected to analyze somatic mutations of P53 between exon 5– 8. From these 22 cases under analysis, 11 (50%) P53 sequence were found. In 3 of the 11 (27.2%) cases, the tumor presented more than one
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P064
Scientific Posters
The Value of B-Scan Sonography in Patients with Head and Neck Cancer Petra Lohnstein, MD (presenter); Wolfgang Maier, MD; Jorg Schipper, MD Freiburg Germany; Freiburg Germany; Freiburg Germany
Objectives: Quality assessment to analyze the value of sonographic examination for the indication of a wait-and-see policy regarding the neck in patients with N0 stage. Methods: We performed a follow-up on 121 patients with a pT1 or pT2 carcinoma of the mouth, larynx, or pharynx undergoing R0 transoral laser-microsurgical resection. All patients underwent preoperative regionary staging with Bscan sonography, resulting in N0 stage. Neither neck dissection or radiotherapy were performed but all patients were controlled in a close-meshed clinical and sonographical follow-up of 18 to 36 months that was now analyzed regarding the probability of recurrence and survival. Results: The sonographic follow-up revealed suspicious cervical lymph nodes in 30 patients, indicating potential metachronic metastasis. All these 30 patients underwent a curative neck dissection. The histologic examination proved lymph node metastases in 8 patients, 6 of whom additionally suffered from local recurrence. Thus, only 2 of 121 patients (1.7%) showed metachronic isolated regionary recurrence. Survival was 100% in all tumor entities. The probability of being free from locoregional recurrence was 1.0 for larynx or hypopharynx carcinoma stage I, 0.9 for mouth or oropharynx carcinoma stage I or II, and of larynx stage II, and 0.6 for hypoharynx carcinoma stage II. Conclusion: Sonography is an appropriate method for preoperative evaluation and postoperative follow-up of cervical lymph node stage. Our results are excellent compared to those reported from the literature, underlining indication of a wait-and-see strategy on the neck in patients with stage I or II and a sonographic N0 neck.
P065 Sentinel Lymph Node Biopsy as Adjunct to Selective Neck Dissection for SCC Oral Cavity Barry M Rasgon, MD (presenter); Mark Joseph Bitgood, MD Oakland CA; Oakland CA
Objectives: The current standard of care for managing the clinically negative neck (NO) in patients with squamous cell carcinoma (SCC) of the oral cavity includes a selective neck dissection (SND), levels I-III minimally, with pathological findings determining the need for postoperative radiation. This approach may present several difficulties. Limiting the dissection to levels I-III could potentially miss affected nodes in other nodal basins. If SND includes the appropriate nodal basins, metastatic disease may be missed, and micrometastases could be overlooked with current pathological analysis.
P261
The purpose of this study was to see if SLN biopsy in conjuntion with SND improved diagnostic and therapeutic outcomes. Methods: We retrospectively reviewed 10 patients with SCC of the oral cavity and NO neck undergoing SND. Preoperative and intraoperative lymphatic mapping using low dose Technetium 99 sulfur colloid was used as an adjunct to standard SND Results: Preoperative lymphoscintigraphy showed 1 or more SLNs in all patients. Two patients had SLNs in level IV and 1 patient had a contralateral Level I SLN. All SLNs seen on preoperative lymphoscintigraphy were identified in the SND. No SLNs were left in the nodal basins dissected after SND was completed. Micrometastases were found in SLNs of 3 patients. Conclusion: Combined with standard SND, preoperative and intraoperative SLN mapping may improve our diagnostic and therapeutic outcomes in patients with SCCA of the oral cavity with clinically negative necks. The extent of SND can be more accurately planned, a more thorough neck dissection can be accomplished and a detailed pathological analyses of high risk nodes feasible. P066 Relationship of P53 Mutations in Laryngeal Cancer and Tobacco Smoking Manuel C Pais Clemente, MD PhD (presenter); Laudelina Pais Clemente, MD PhD; Vitor Cardoso, MD; Raquel Seruca, MD; Conceicao Souto-Moura, MD; Paulo Abreu-Dias, MD Porto Portugal; Porto Portugal; Porto Portugal; Porto Portugal; Porto Portugal; Porto Portugal
Objectives: (1) To determine the spectrum of P53 mutations in patients with laryngeal cancer and heavy smokers. (2) To correlate the p53 alterations with the expression of p53 protein. (3) To verify if imunoexpression of p53 can be used as a good method for screening of P53 mutations. Methods: Forty-one patients were enrolled in this study; half were heavy smokers. All surgical specimens obtained were routinely fixed in buffered formalin and processed in paraffin. Diagnosis was performed by light microscopy examination of tissue sections stained with hematoxylin and eosin. Forty patients had squamous cell carcinoma and one had an adenosquamous cell carcinoma of the larynx. Fifteen of the 41 had nodal metastases. The immunohistochemistry study was carried out simultaneously in all cases and in the margins. DNA was isolated from microdissected tumor cells obtained from formalin-fixed, paraffin-embedded tissue sections from 22 cases. Mutations in the p53 gene were analyzed by PCR/SSCP with primers covering exons 5– 8. Aberrant bands were direct sequenced. Results: (1) Twenty-two cases were selected to analyze somatic mutations of P53 between exon 5– 8. From these 22 cases under analysis, 11 (50%) P53 sequence were found. In 3 of the 11 (27.2%) cases, the tumor presented more than one
POSTERS
P064
Scientific Posters