Elective parotidectomy and neck dissection are not beneficial in cutaneous squamous cell carcinoma of the head

Abstract Objective Cutaneous Squamous Cell Carcinoma (cSCC), a tumor with a significantly increasing incidence, is mostly diagnosed in the head region, where tumors have a worse prognosis and a higher risk of metastases. The presence of metastases reduces specific five-year survival from 99% to 50%. As the risk of occult metastases does not exceed 10%, elective dissection of the tributary parotid and neck lymph nodes is not recommended. Methods We retrospectively analyzed a group of 12 patients with cSCC of the head after elective dissections of regional (parotid and cervical) nodes by means of superficial parotidectomy and selective neck dissection. Results We diagnosed occult metastases neither in the cervical nor parotid nodes in any patient. None were diagnosed as a regional recurrence during the follow-up period. Conclucion Our negative opinion on elective parotidectomy and neck dissection in cSCC of the head is in agreement with the majority of published studies. These elective procedures are not indicated even for tumors showing the presence of known (clinical and histological) risk factors for lymphogenic spread, as their positive predictive value is too low. Elective parotidectomy is individually considered as safe deep surgical margin. If elective parotidectomy is planned it should include only the superficial lobe. Completion parotidectomy and elective neck dissection are done in rare cases of histologically confirmed parotid metastasis in the parotid specimen. Preoperatively diagnosed parotid metastases without neck involvement are sent for total parotidectomy and elective selective neck dissection. Cases of clinically evident neck metastasis with no parotid involvement, are referred for comprehensive neck dissection and elective superficial parotidectomy. The treatment of concurrent parotid and cervical metastases includes total conservative parotidectomy and comprehensive neck dissection. Level of evidence How common is the problem? Step 4 (Case-series) Is this diagnostic or monitoring test accurate? (Diagnosis) Step 4 (poor or non-independent reference standard) What will happen if we do not add a therapy? (Prognosis) Step 4 (Case-series) Does this intervention help? (Treatment Benefits) Step 4 (Case-series) What are the COMMON harms? (Treatment Harms) Step 4 (Case-series) What are the RARE harms? (Treatment Harms) Step 4 (Case-series) Is this (early detection) test worthwhile? (Screening) Step 4 (Case-series)

Clinical effects of elective neck dissection on 5-year survival rate of patients with early oral squamous cell carcinoma / 口腔疾病防治

Objective@#To investigate the effect of elective neck dissection on the 5-year survival rate of patients with early oral squamous cell carcinoma.@*Methods@#The data of 100 patients with early oral squamous cell carcinoma (cT1-2N0M0) were retrospectively analyzed. In 61 cases, the primary tumor was subjected to elective neck dissection (END). Neck observation and follow-up (NOF) were performed in 39 cases with enlarged resection of primary lesions. Clinicopathological data such as pT staging, pathology classification,the rate of cervical lymph node metastasis and the 5-year survival rate of the patients were statistically analyzed.@*Results@#The 5-year survival rates of the END and NOF groups were 86.9% and 69.2%, respectively, and the difference was statistically significant (P=0.028). END treatment was significantly better than NOF in controlling cervical lymph node metastasis in early oral squamous cell carcinoma (P=0.009). After stratified analysis of histopathological features, the 5-year survival rate of patients with pathological T2 (pT2) stage OSCC in the END group was significantly higher than that in the NOF group (P=0.020). The 5-year survival rate of patients with moderate and poorly differentiated pathological grade OSCC in the END group was significantly higher than that in the NOF group (P=0.013). @*Conclusion @# END is effective for the management of the cervical lymph node metastasis rate in early OSCC patients. For patients with pT2 stage or low differentiation pathological grade, active END can significantly improve the 5-year survival rate.

Research progresses in occult lymph node metastasis of oral squamous cancer / 口腔疾病防治

@#Oral cancer is a common malignant tumor in head and neck cancers, and the metastasis of cervical lymph nodes directly affects the prognosis of patients with oral cancer. Exploration and study on the detection of occult lymph nodes in patients with negative cervical lymph nodes is of great importance to improve the prognosis of patients with early oral cancer. This article reviews some progresses of occult lymph node metastasis of oral cancer in ultrasound guided fine-needle aspiration cytology (US-FNAC)、 positron emission tomography and single-photon emission computed tomography/computed tomography (SPECT/CT) fusion technology, sentinel lymph node biopsy technique (SLNB) and molecular biological detection、 nanotechnology and quantum dot technology.

Lymph node metastasis: A bearing on prognosis in squamous cell carcinoma.

Nodal status is a significant predictor for survival of patients with oral squamous cell carcinoma (SCC), sentinel lymph node (SLN) biopsy, step sectioning of SLNs, and immunohistochemistry have changed the detection of tumor deposits in lymph nodes (LNs). The extent of LN metastasis is a major determinant for the staging and the prognosis of most human malignancies and often guides therapeutic decisions. Metastasis to regional lymph node (RLN) is a complex process. It is often associated with several clinical and pathological characteristics. The involvement of RLN is often, a harbinger for increased risk of metastasis. New knowledge in this area can enable the clinicians and pathologists to study and treat tumors in a more directed fashion. A molecular approach to factors that predicts the likelihood of RLN metastasis could eliminate the reoccurrence of the tumor in the form of “micrometastasis” and “skip” metastasis. The aim of this review is to discuss different modes of spread of metastasis in SCC.

Sentinel Lymph Node Biopsy in the Oral Cavity Cancer / 한양의대학술지

Elective neck dissection for the clinically node-negative neck is targeted to diagnose and eradicate the occult lymph node metastasis. However, this elective neck dissection gives unnecessary risk of complication and morbidity. Therefore, the extent of the elective neck dissection tends to be reduced to minimize the postoperative morbidity. The sentinel lymph node biopsy has been developed for this purpose. Sentinel lymph node is the first lymph node that gets lymphatic drainage from the tumor. Evaluation of this sentinel lymph node enables the prediction of the presence of occult lymph node metastasis. If the biopsy of the sentinel lymph node shows no metastasis, additional neck dissection can be avoided, which reduces the postoperative morbidity. There have been clinical studies on the sentinel lymph node biopsy for the head and neck squamous cell carcinoma, in which the diagnostic accuracy has been reported to be 95-100%. We started sentinel lymph node biopsy for the clinically node-negative, early-staged oral cavity cancer in December 2002. From 2002 to 2004, we evaluated its diagnostic accuracy. The positive predictive value and the negative predictive value were 100% and 98.5%, respectively. We currently determine the elective neck dissection according to the result of the sentinel lymph node biopsy.

Neck dissection of clinically N0 Neck of oral squamous cell carcinoma & pathologic comparison

Neck node metastasis of oral cancer can be diagnosed by bimanual palpation, CT, MRI and neck sonography and the final diagnosis can be confirmed by pathologic evaluation of the neck nodes after elective neck dissection. When we meet clinically negative neck node (N0 neck) of oral squamous cell carcinoma, the treatment modality of the neck nodes with the primary lesions are so controversial. The usually used methods are various from close observation to elective radiation and elective neck dissection. The methods can be chosen by the primary size of the carcinoma, site of the lesions and the expected percentage of the occult metastasis to the neck. We reviewed the 86 patients from 1996 to 2006 who were diagnosed as oral squamous cell carcinoma, whose necks were diagnosed negative in radiographically and clinically. According to TNM stage, the patients were in the states of N0 and treated by surgery using mass excision and elective neck dissection. We compared the differences between the clinical diagnoses and pathologic reports and would discuss the needs for elective neck dissection.

A clinical study on regional occult metastases for patients with squamous cell carcinoma of buccal mucosa / 实用口腔医学杂志

Objective:To assess regional occult metastases on clinical negative neck node [cN0] in patients with buccal mucosal squamous cell carcinoma. Methods:69 patients (31males and 38 females ) with cN0 buccal mucosa squamous cell carcinoma who underwent a lymph node dissection (at the Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanjing University Medical School) between 1992 and 2004, were retrospectively reviewed. The patients ranged in age from 31 to 79 years with a mean age of 58.2 years. All patients received radical neck dissection(RND), functional neck dissection (FND) or supraomohyoid neck dissection (SOND). Results:The incidence of occult metastases for patients with cN0 buccal mucosa squamous cell carcinoma was 14.49% (10/69).The distribution of the positive nodes was as follows: Level I,10.14%(7/69); Level II, 5.80% (4/69); Level III, 2.90%(2/69). The occult metastasis rate for patients with T1, T2, T3 and T4 was 9.52% (2/21), 15.38%(6/39), 25.00%(1/4), and 20.00%(1/5), respectively. In patients with well differentiated carcinoma,the occult metastasis rate was 14.89%(7/47); moderate differentiated,10.00%(2/20); and poorly differentiated,50.00%(1/2). Conclusion:The assessment of regional occult metastases for patients with cN0 buccal mucosa squamous cell carcinoma may play an important role in deciding treatment approaches of neck.