Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2010

01-02-2010 | Head and Neck Oncology

Evaluation of Clinical and Histomorphological Parameters as Potential Predictors of Occult Metastases in Sentinel Lymph Nodes of Early Squamous Cell Carcinoma of the Oral Cavity

Authors: Mete Goerkem, MD, Julia Braun, MS, Sandro J. Stoeckli, MD

Published in: Annals of Surgical Oncology | Issue 2/2010

Login to get access

Abstract

Background

Sentinel node biopsy (SNB) for cN0 early squamous cell carcinoma (SCC) of the oral cavity has been validated by numerous studies. Around 30% of SNB will detect occult disease. Several clinical and morphological features of the primary tumor have been claimed to be predictive for occult metastasis in elective neck dissections. The aim of this study was to assess these factors in the context of SNB.

Methods

Seventy-eight patients undergoing SNB for T1/2 oral SCC from the years 2000 to 2007 were prospectively included. Primary tumors were reviewed for the following morphological and clinical parameters: grade of differentiation, tumor depth, tumor thickness, perineural invasion, lymphatic invasion, vascular invasion, muscle invasion, lymphoplasmacytic infiltration, and mode of invasion, age, gender, primary tumor site, tumor side, and cT category.

Results

Statistical analysis revealed significance to predict occult metastasis in the SNB for grade of differentiation (P = 0.002), lymphatic invasion (P < 0.001), and mode of invasion (P < 0.001). None of the other factors reached significance. The mean tumor depth was 6.45 mm (range 0.72–15.15 mm) and the mean tumor thickness was 7.2 mm (range 0.72–15.15 mm). None of the cutoff values reached significance for predicting occult disease.

Conclusions

Tumor depth and tumor thickness failed to achieve statistical significance for prediction of occult metastases in the context of SNB. Patients with cN0 early squamous cell carcinoma of the oral cavity should be offered SNB regardless of their tumor depth and thickness. Poorly differentiated carcinomas, carcinomas with lymphangiosis, and carcinomas with a dissolute mode of invasion show a high probability of positive SNB.
Literature
1.
Kalnins IK, Leonard AG, Sako K, Razack MS, Shedd DP. Correlation between prognosis and degree of lymph node involvement in carcinoma of the oral cavity. Am J Surg. 1977;134(4):450–4.CrossRefPubMed
2.
Barrs DM, DeSanto LW, O’Fallon WM. Squamous cell carcinoma of the tonsil and tongue-base region. Arch Otolaryngol. 1979;105(8):479–85.PubMed
3.
Callery CD, Spiro RH, Strong EW. Changing trends in the management of squamous carcinoma of the tongue. Am J Surg. 1984;148(4):449–54.CrossRefPubMed
4.
Grandi C, Alloisio M, Moglia D, Podrecca S, Sala L, Salvatori P, Molinari R. Prognostic significance of lymphatic spread in head and neck carcinomas: therapeutic implications. Head Neck Surg. 1985;8(2):67–73.CrossRefPubMed
5.
Byers RM, Wolf PF, Ballantyne AJ. Rationale for elective modified neck dissection. Head Neck Surg. 1988;10(3):160–7.CrossRefPubMed
6.
van den Brekel MW, van der Waal I, Meijer CJ, Freeman JL, Castelijns JA, Snow GB. The incidence of micrometastases in neck dissection specimens obtained from elective neck dissections. Laryngoscope. 1996;106(8):987–91.CrossRefPubMed
7.
Krag DN, Weaver DL, Alex JC, Fairbank JT. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol. 1993;2(6):335–9.CrossRefPubMed
8.
Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127(4):392–9.PubMed
9.
Stoeckli SJ. Sentinel node biopsy for oral and oropharyngeal squamous cell carcinoma of the head and neck. Laryngoscope. 2007;117(9):1539–51.CrossRefPubMed
10.
Shoaib T, Soutar DS, Prosser JE, Dunaway DJ, Gray HW, McCurrach GM, et al. A suggested method for sentinel node biopsy in squamous cell carcinoma of the head and neck. Head Neck. 1999;21(8):728–33.CrossRefPubMed
11.
Ross GL, Shoaib T, Soutar DS, MacDonald DG, Camilleri IG, Bessent RG, et al. The First International Conference on Sentinel Node Biopsy in Mucosal Head and Neck Cancer and adoption of a multicenter trial protocol. Ann Surg Oncol. 2002;9(4):406–10.CrossRefPubMed
12.
Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG, et al. AJCC cancer staging handbook, 6th ed. New York: Springer; 2002.
13.
Stoeckli SJ, Steinert H, Pfaltz M, Schmid S. Sentinel lymph node evaluation in squamous cell carcinoma of the head and neck. Otolaryngol Head Neck Surg. 2001;125(3):221–6.CrossRefPubMed
14.
Ambrosch P, Kron M, Fischer G, Brinck U. Micrometastases in carcinoma of the upper aerodigestive tract: detection, risk of metastasizing, and prognostic value of depth of invasion. Head Neck. 1995;17(6):473–9.CrossRefPubMed
15.
Kane SV, Gupta M, Kakade AC, D’ Cruz A. Depth of invasion is the most significant histological predictor of subclinical cervical lymph node metastasis in early squamous carcinomas of the oral cavity. Eur J Surg Oncol. 2006;32(7):795–803.CrossRefPubMed
16.
Shingaki S, Suzuki I, Nakajima T, Kawasaki T. Evaluation of histopathologic parameters in predicting cervical lymph node metastasis of oral and oropharyngeal carcinomas. Oral Surg Oral Med Oral Pathol. 1988;66(6):683–8.CrossRefPubMed
17.
Pimenta Amaral TM, Da Silva Freire AR, Carvalho AL, Pinto CA, Kowalski LP. Predictive factors of occult metastasis and prognosis of clinical stages I and II squamous cell carcinoma of the tongue and floor of the mouth. Oral Oncol. 2004;40(8):780–6.CrossRefPubMed
18.
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.CrossRefPubMed
19.
Yamamoto E, Miyakawa A, Kohama G. Mode of invasion and lymph node metastasis in squamous cell carcinoma of the oral cavity. Head Neck Surg. 1984;6(5):938–47.CrossRefPubMed
20.
Kurokawa H, Zhang M, Matsumoto S, Yamashita Y, Tomoyose T, Tanaka T, et al. The high prognostic value of the histologic grade at the deep invasive front of tongue squamous cell carcinoma. J Oral Pathol Med. 2005;34(6):329–33.CrossRefPubMed
21.
Kurokawa H, Yamashita Y, Takeda S, Zhang M, Fukuyama H, Takahashi T. Risk factors for late cervical lymph node metastases in patients with stage I or II carcinoma of the tongue. Head Neck. 2002;24(8):731–6.CrossRefPubMed
22.
Woolgar JA, Scott J. Prediction of cervical lymph node metastasis in squamous cell carcinoma of the tongue/floor of mouth. Head Neck. 1995;17(6):463–72.CrossRefPubMed
23.
Lim SC, Zhang S, Ishii G, Endoh Y, Kodama K, Miyamoto S, et al. Predictive markers for late cervical metastasis in stage I and II invasive squamous cell carcinoma of the oral tongue. Clin Cancer Res. 2004;10(1 Pt 1):166–72.CrossRefPubMed
24.
Brown B, Barnes L, Mazariegos J, Taylor F, Johnson J, Wagner RL. Prognostic factors in mobile tongue and floor of mouth carcinoma. Cancer. 1989;64(6):1195–202.CrossRefPubMed
25.
Fukano H, Matsuura H, Hasegawa Y, Nakamura S. Depth of invasion as a predictive factor for cervical lymph node metastasis in tongue carcinoma. Head Neck. 1997;19(3):205–10.CrossRefPubMed
26.
Okamoto M, Nishimine M, Kishi M, Kirita T, Sugimura M, Nakamura M, et al. Prediction of delayed neck metastasis in patients with stage I/II squamous cell carcinoma of the tongue. J Oral Pathol Med. 2002;31(4):227–33.CrossRefPubMed
27.
Po Wing Yuen A, Lam KY, Lam LK, Ho CM, Wong A, Chow TL, et al. Prognostic factors of clinically stage I and II oral tongue carcinoma-A comparative study of stage, thickness, shape, growth pattern, invasive front malignancy grading, Martinez-Gimeno score, and pathologic features. Head Neck. 2002;24(6):513–20.CrossRefPubMed
28.
Mohit-Tabatabai MA, Sobel HJ, Rush BF, Mashberg A. Relation of thickness of floor of mouth stage I and II cancers to regional metastasis. Am J Surg. 1986;152(4):351–3.CrossRefPubMed
29.
Sparano A, Weinstein G, Chalian A, Yodul M, Weber R. Multivariate predictors of occult neck metastasis in early oral tongue cancer. Otolaryngol Head Neck Surg. 2004;131(4):472–6.CrossRefPubMed
30.
Warburton G, Nikitakis NG, Roberson P, Marinos NJ, Wu T, Sauk JJ Jr, et al. Histopathological and lymphangiogenic parameters in relation to lymph node metastasis in early stage oral squamous cell carcinoma. J Oral Maxillofac Surg. 2007;65(3):475–84.CrossRefPubMed
31.
Asakage T, Yokose T, Mukai K, Tsugane S, Tsubono Y, Asai M, Ebihara S. Tumor thickness predicts cervical metastasis in patients with stage I/II carcinoma of the tongue. Cancer. 1998;82(8):1443–8.CrossRefPubMed
32.
Spiro RH, Huvos AG, Wong GY, Spiro JD, Gnecco CA, Strong EW. Predictive value of tumor thickness in squamous carcinoma confined to the tongue and floor of the mouth. Am J Surg. 1986;152(4):345–50.CrossRefPubMed
33.
Martínez-Gimeno C, Rodríguez EM, Vila CN, Varela CL. Squamous cell carcinoma of the oral cavity: a clinicopathologic scoring system for evaluating risk of cervical lymph node metastasis. Laryngoscope. 1995;105(71):728–33.PubMed
34.
Wenzel S, Sagowski C, Kehrl W, Metternich FU. Retrospective analysis of the prognostic significance of depth of invasion of advanced oral and oropharyngeal squamous cell carcinomas with lymph node metastases. HNO. 2004;52(7):604–10.CrossRefPubMed
35.
Morton RP, Ferguson CM, Lambie NK, Whitlock RM. Tumor thickness in early tongue cancer. Arch Otolaryngol Head Neck Surg. 1994;120(7):717–20.PubMed
36.
Lopes MA, Nikitakis NG, Reynolds MA, Ord RA, Sauk J Jr. Biomarkers predictive of lymph node metastases in oral squamous cell carcinoma. J Oral Maxillofac Surg. 2002;60(2):142–7.CrossRefPubMed
37.
Byers RM, El-Naggar AK, Lee YY, Rao B, Fornage B, Terry NH, et al. Can we detect or predict the presence of occult nodal metastases in patients with squamous carcinoma of the oral tongue? Head Neck. 1998;20(2):138–44.CrossRefPubMed
38.
Chen RB, Suzuki K, Nomura T, Nakajima T. Flow cytometric analysis of squamous cell carcinomas of the oral cavity in relation to lymph node metastasis. J Oral Maxillofac Surg. 1993;51(4):397–401.PubMedCrossRef
39.
Osaki T, Hirota J, Yoneda K, Yamamoto T, Ueta E. Clinical and histopathologic characteristics of tongue and gingiva carcinomas with occult and clinically evident cervical lymph-node metastasis. Int J Oral Maxillofac Surg. 1996;25(4):274–8.CrossRefPubMed
40.
Nagata T, Schmelzeisen R, Mattern D, Schwarzer G, Ohishi M. Application of fuzzy inference to European patients to predict cervical lymph node metastasis in carcinoma of the tongue. Int J Oral Maxillofac Surg. 2005;34(2):138–42.CrossRefPubMed
41.
Okamoto M, Ozeki S, Watanabe T, Iida Y, Tashiro H. Cervical lymph node metastasis in carcinoma of the tongue Correlation between clinical and histopathological findings and metastasis. J Craniomaxillofac Surg. 1988;16(1):31–4.PubMed
42.
Kowalski LP, Bagietto R, Lara JR, Santos RL, Tagawa EK, Santos IR. Factors influencing contralateral lymph node metastasis from oral carcinoma. Head Neck. 1999;21(2):104–10.CrossRefPubMed
43.
Odell EW, Jani P, Sherriff M, Ahluwalia SM, Hibbert J, Levison DA, et al. The prognostic value of individual histologic grading parameters in small lingual squamous cell carcinomas. The importance of the pattern of invasion. Cancer. 1994;74(3):789–94.CrossRefPubMed
44.
Noone RB, Bonner H Jr, Raymond S, Brown AS, Graham WP III, Lehr HB. Lymph node metastases in oral carcinoma. A correlation of histopathology with survival. Plast Reconstr Surg. 1974;53(2):158–66.CrossRefPubMed
45.
Ambrosch P, Brinck U. Detection of nodal micrometastases in head and neck cancer by serial sectioning and immunostaining. Oncology (Williston Park). 1996;10(8):1221–6.
46.
Hermanek P, Hutter RV, Sobin LH, Wittekind C. International Union Against Cancer Classification of isolated tumor cells and micrometastasis. Cancer. 1999;86(12):2668–73.CrossRefPubMed
47.
Bilde A, von Buchwald C, Therkildsen MH, Mortensen J, Kirkegaard J, Charabi B, et al. Need for intensive histopathologic analysis to determine lymph node metastases when using sentinel node biopsy in oral cancer. Laryngoscope. 2008;118(3):408–14.CrossRefPubMed
48.
Alkureishi LW, Ross GL, Shoaib T, Soutar DS, Robertson AG, Sorensen JA, et al. Does tumor depth affect nodal upstaging in squamous cell carcinoma of the head and neck? Laryngoscope. 2008;118(4):629–34.CrossRefPubMed
Metadata
Title
Evaluation of Clinical and Histomorphological Parameters as Potential Predictors of Occult Metastases in Sentinel Lymph Nodes of Early Squamous Cell Carcinoma of the Oral Cavity
Authors
Mete Goerkem, MD
Julia Braun, MS
Sandro J. Stoeckli, MD
Publication date
01-02-2010
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 2/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0755-3

Other articles of this Issue 2/2010

Annals of Surgical Oncology 2/2010 Go to the issue

Gastrointestinal Oncology

Local Excision After Preoperative Chemoradiation Results in an Equivalent Outcome to Total Mesorectal Excision in Selected Patients with T3 Rectal Cancer

Endocrine Tumors

Controversies in Thyroid Pathology: Thyroid Capsule Invasion and Extrathyroidal Extension

Gastrointestinal Oncology

Positive Peritoneal Washing Cytology in Multiple Cavities Can Predict Poor Prognosis of Advanced Gastric Cancer Patients

Colorectal Cancer

Stage III Colorectal Cancer: Molecular Disparity Between Primary Cancers and Lymph Node Metastases

Colorectal Cancer

K-Ras and MSI: Potential Markers of Both Patient Prognosis and Treatment Efficacy

Urologic Oncology

Renal Cell Carcinoma and Prognostic Factors Predictive of Survival