ABSTRACT
Context: The pattern of nodal spread in oral cancers is largely predictable and treatment of neck can be tailored with this knowledge. Most studies available on the pattern are from the western world and for early cancers of the tongue and floor of the mouth. Aims: The present study was aimed to evaluate the prevalence and pattern of nodal metastasis in patients with pathologic T4 (pT4) buccal/alveolar cancers. Settings and Design: Medical records of the patients with pT4 primary buccal and alveolar squamous cell carcinomas treated by single-stage resection of primary tumor and neck dissection at Gujarat Cancer and Research Institute (GCRI), Ahmedabad, a regional cancer center in India, during September 2004 to August 2006, were analyzed for nodal involvement. Materials and Methods: The study included 127 patients with pT4 buccal/alveolar cancer. Data pertaining to clinical nodal status, histologic grade, pT and pN status (TNM classification of malignant tumors, UICC, 6th edition, 2002), total number of nodes removed, and those involved by tumor, and levels of nodal involvement were recorded. Statistical analysis was performed using the Chi-square test. Results: Fifty percent of the patients did not have nodal metastasis on final histopathology. Occult metastasis rate was 23%. All of these occurred in levels I to III. Among those with clinically palpable nodes, level V involvement was seen only in 4% of the patients with pT4 buccal cancer and 3% of the patients with alveolar cancer. Conclusions: Elective treatment of the neck in the form of selective neck dissection of levels I to III is needed for T4 cancers of gingivobuccal complex due to a high rate of occult metastasis. Selected patients with clinically involved nodes could be well served by a selective neck dissection incorporating levels I to III or IV.
Subject(s)
Adenocarcinoma, Bronchiolo-Alveolar/pathology , Adenocarcinoma, Bronchiolo-Alveolar/physiopathology , Adenocarcinoma, Bronchiolo-Alveolar/surgery , Adult , Aged , Aged, 80 and over , Female , Humans , India , Lung Neoplasms/epidemiology , Lung Neoplasms/pathology , Lung Neoplasms/physiopathology , Lung Neoplasms/surgery , Lymph Nodes/pathology , Lymph Nodes/surgery , Lymphatic Metastasis , Male , Middle Aged , Mouth Neoplasms/epidemiology , Mouth Neoplasms/pathology , Mouth Neoplasms/physiopathology , Mouth Neoplasms/surgery , Neck Dissection , Neoplasm Staging , Neoplasms, Squamous Cell/epidemiology , Neoplasms, Squamous Cell/pathology , Neoplasms, Squamous Cell/physiopathology , Neoplasms, Squamous Cell/surgery , PrevalenceABSTRACT
Se realizó un estudio descriptivo y prospectivo entre abril y diciembre de 1996 en el cual se hizo biopsia dirigida por colposcopia a las pacientes con citologías reportadas como ASCUS (Células escamosas atípicas de significado indeterminado). De las 65 pacientes, 63 ingresaron al estudio, excluyendo dos por el antecedente de conización por carcinoma in situ. La mayoría eran relativamente jóvenes (media de 35,8 años), con más de un embarazo y más de un parto vaginal. A 60 pacientes se les realizó colposcopia, todas anormales, siendo el epitelio acetoblanco la alteración más frecuente. El diagnóstico colposcópico más comúnmente propuesto fue el de HPV. La histopatología fue normal sólo en una paciente, encontrándose que el 98.4 por ciento demostró alguna anormalidad distribuidas así: cervicitis crónica 28.6 por ciento, HPV 68.3 por ciento, NIC I 14.3 por ciento, NIC III/ carcinoma in situ 7.9 por ciento, carcinoma microinvasor 1.6 por ciento y carcinoma invasor 1.6 por ciento. El diagnóstico de malignidad se encontró en el 11.1 por ciento de los casos