Sentinel Lymph Node Biopsy in Oral and Oropharyngeal Squamous Cell Carcinoma: Statistical Validation and Impact of Micrometastasis Involvement on the Neck Dissection Decision.

PURPOSE: To evaluate the effectiveness of sentinel lymph node biopsy (SLNB) as an optimal staging method in oral and oropharyngeal squamous cell carcinoma (OOSCC) and the impact of the extent of SLN involvement on the decision for neck dissection (ND). MATERIALS AND METHODS: A prospective cohort study was performed in 96 consecutive patients with stage T1 to T4N0M0 OOSCC (mean follow-up, 62.9 months). SLN localization was determined using cervical lymphoscintigraphy and single-photon emission computed tomography. Patients underwent SLNB examination and ND. The ND specimen was investigated by hematoxylin and eosin (H&E) staining and the SLNs were investigated using H&E staining and step-serial sectioning and cytokeratin antibodies AE1 and AE3. The statistical study calculated the sensitivity and negative predictive value (NPV). The sample size of 96 patients was calculated for a 95% confidence interval with an accuracy of ±2% and an estimated a priori sensitivity of 99% compared with the benchmark. The impact of extent of SLN involvement on the decision for ND was analyzed by χ(2) test. A logistic regression model was used to assess the association of predictor variables with SLN involvement and neck disease. RESULTS: The diagnostic accuracy, sensitivity, NPV, and negative likelihood ratio were 95%, 88%, 94%, and 0.06. The statistical comparison between the extent of metastatic involvement of the SLN and neck disease was important for SLN macrometastasis (odds ratio = 11.9), but not for SLN micrometastasis (odds ratio = 0.93). CONCLUSIONS: SLNB examination is an excellent staging method in OOSCC. The present data indicate a very small risk of additional lymph node metastasis with SLN micrometastasis.

Telemedicine as an effective tool for the management of temporomandibular joint disorders.

PURPOSE: To evaluate the effectiveness of a store-and-forward telemedicine system (SFTMS) as an optimal method for the selection, diagnosis and treatment of patients with TMJ disorders (TMJD) referred from primary care sites to the Maxillofacial Surgery Unit (hospital-based). MATERIALS AND METHODS: A multicenter, analytical, quasi-experimental, non-randomized clinical study of a SFTMS aimed towards the management of patients with TMJD was conducted at the Oral and Maxillofacial Surgery Unit of the Virgen Macarena University Hospital (Seville, Spain) and 10 primary care areas of the North area of Seville located between 15 and 180 km from the hospital. The study was carried out between January 2008 and February 2010 including a non-random sample consisting of all patients with TMJD treated at primary care sites during the study period. We describe the development and effectiveness of this method based on the rates of diagnosis of myofascial syndrome and/or internal deragement Wilkes Stages I-II-III, internal deragement Wilkes Stages IV-V, other arthropathies, resolved teleconsultations, second teleconsultations, referrals to hospital, mean treatment delay, lost hours working/patient and complaints. The same variables were also described for the TMJD conventional consultation system at hospital (standard system). Descriptive statistics (frequency tables, means and medians, and dispersion measures), T-Student test was used to compare the differences in the average quantitative variables (time) and Chi2 test was used to compare the differences in the average qualitative variables. RESULTS: Over a 24-month period, 710 patients with TMJD were assisted at hospital by conventional consultation from 1-1-2008 to 2-25-2010, of which 587 (82.7%) were women and 123 (17.3%) were men with a mean age of 41.08 years. The mean time elapsed until treatment onset was 78.6 days, with a mean cost of 32 lost working hours per patient. In this period, 342 patients with TMJD were assisted by teleconsultation, of which 276 (80.7%) were women and 66 (19.2%) were men with a mean age of 38.3 years. Only 35 (10%) patients presented some other TMJ pathology that required maxillofacial surgery. The remaining 307 (89.7%) received non-surgical treatment in the primary care center (high resolutive consultations) in a mean time of 2.3 days (p<0.05), and a mean cost of 16 lost working hours/patient (p<0.05). CONCLUSIONS: Telemedicine allows a correct diagnosis and an adequate treatment for the majority of TMJD from primary care sites and shortens the delay in treatment onset, preventing displacement and unnecessary costs for these patients.

Quality of life in long-term oral cancer survivors: a comparison with Spanish general population norms.

PURPOSE: Health-related quality-of-life (HRQOL) data are becoming an important supplement to information pertaining to treatment outcomes for cancer patients. The purpose of this study was to evaluate the HRQOL of patients undergoing primary surgery for oral squamous cell carcinoma > or =5 years after treatment compared with the Spanish general population norms. MATERIALS AND METHODS: A total of 50 oral cancer patients (mean age 55.78 years, 80% male) with cancer-free survival of > or =5 years after surgery were enrolled. HRQOL was assessed with a standardized questionnaire: the Medical Outcomes Study Short Form 36-Item Health Survey. RESULTS: The Medical Outcomes Study Short Form 36-Item Health Survey scores of the oral cancer patients did not differ significantly from those of an age- and gender-matched sample from the Spanish normative population, except for the pain and social functioning domains. The patients had significantly better results compared with the population norms (Wilcoxon test, P < .05) in the physical function, general health, and vitality domains. CONCLUSIONS: These results provide patient-reported evidence that oral cancer survivors have a similar HRQOL compared with the general Spanish population. We also believe that it would be necessary to analyze the quality of life > or =5 years after treatment or from the moment the patient was discharged.