ABSTRACT
Pilot study evaluating the diagnostic value of magnetic resonance lymphography (MRL) compared with conventional imaging techniques in the preoperative staging of the clinically (palpable) negative neck (cN0) in squamous cell carcinoma of the oral cavity (SCCOC). Patients with SCCOC without clinical evidence of lymph node metastasis and scheduled for surgery underwent MRL in combination with ultrasound with or without fine needle aspiration cytology and multi-detector computer tomography. MRL images were interpreted by 2 independent radiologists. All patients were planned for resection of the primary tumor and a selective neck dissection of levels I-III. Histopathologic results were evaluated as the gold standard and compared with preoperative findings. One of nine evaluated patients had a metastatic node on histopathologic analysis. In all but 1 patient, MRL showed possible metastatic spread in at least 1 node. On a node-to-node basis, negative predictive value (NPV) and sensitivity reached 100% for 1.5- en 3Tesla (T) MRL, specificity reached 92% at 1.5T and 93% at 3T MRL, and positive predictive value (PPV) was 8% at 1.5T MRL, for both radiologists. PPV at 3T MRL was 10% and 9%, for radiologists I and II, respectively. This pilot study shows that MRL has a high NPV based on a node-to-node analysis. However, its PPV was only 10%, and therefore its use as a single imaging technique in the preoperative staging of the cN0 neck in SCCOC seems to be limited. Further studies are needed to confirm these data.
Subject(s)
Carcinoma, Squamous Cell/diagnosis , Mouth Neoplasms/diagnosis , Female , Humans , Lymph Node Excision , Lymphatic Metastasis/diagnosis , Lymphography/methods , Magnetic Resonance Spectroscopy/methods , Male , Neck/surgery , Pilot Projects , Prospective Studies , Sensitivity and SpecificityABSTRACT
Estimating the value of our preoperative workup in the treatment of patients with clinically N0 (cN0) squamous cell carcinoma of the oral cavity. Retrospective analysis. Results of preoperative palpation, ultrasound (US) and ultrasound-guided fine needle aspiration cytology (FNAC) were compared to the histological findings after unilateral or bilateral elective selective neck dissection of level I-III (SND I-III) in patients with cN0 squamous cell carcinoma of the oral cavity. Occult metastases were detected by in 50 (22%) out of the 224 cN0 patients. No metastases were found beyond level III in extended neck dissections. T1N0M0 tumors and T2N0M0 tumors metastasized in 8 out of 77 cases (10%) and 32 out of 112 (29%) cases, respectively. Staging of the cN0 neck by palpation and US (+/-ultrasound-guided FNAC) missed occult lymph node metastases in 22% of the patients with oral cavity squamous cell carcinoma. The use of SND I-III therefore still is warranted. Frozen section sampling seemed to be redundant in this selected group of patients, because no additional metastases were found in extended neck dissection specimens. It might not be necessary to perform elective neck dissection in patients with T1 tumors.
Subject(s)
Carcinoma, Squamous Cell/diagnostic imaging , Head and Neck Neoplasms/diagnostic imaging , Lymph Nodes/diagnostic imaging , Neck Dissection , Preoperative Care/standards , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/secondary , Carcinoma, Squamous Cell/surgery , Elective Surgical Procedures/methods , Female , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/surgery , Humans , Lymph Nodes/pathology , Lymph Nodes/surgery , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Staging , Palpation , Retrospective Studies , UltrasonographyABSTRACT
Most of the Epstein-Barr virus genome in latently infected cells is in a standard nucleosomal structure, but the region encompassing oriP and the Epstein-Barr virus-encoded small RNA (EBER) genes shows a distinctive pattern when digested with micrococcal nuclease. This pattern corresponds to a previously mapped nuclear matrix attachment region. Although the EBER genes are adjacent to oriP, there is only a two- to fourfold effect of oriP on EBER expression. However, sequences containing a consensus ATF site upstream of EBER1 are important for EBER1 expression.
Subject(s)
Chromatin/chemistry , DNA Replication , Gene Expression Regulation, Viral , Herpesvirus 4, Human/genetics , RNA, Viral/genetics , DNA, Viral/metabolism , Promoter Regions, Genetic , Transcription, GeneticABSTRACT
Epstein-Barr virus (EBV) efficiently induces growth of human B cells and prevents cell death. Considerable progress has been made in understanding these processes, the role of EBV in human cancer cells and the relationship of viral gene expression to virus persistence and cancer.
Subject(s)
Burkitt Lymphoma/virology , Cell Death , Cell Division , Herpesvirus 4, Human/physiology , Animals , Burkitt Lymphoma/physiopathology , Chick Embryo , Gene Expression Regulation, Viral , Herpesvirus 4, Human/genetics , Hodgkin Disease/physiopathology , Hodgkin Disease/virology , Humans , Nasopharyngeal Neoplasms/physiopathology , Nasopharyngeal Neoplasms/virologyABSTRACT
Infection of human B cells with Epstein-Barr virus (EBV) results in activation of the cell cycle and cell growth. To interpret the mechanisms by which EBV activates the cell, we have assayed many proteins involved in control of the G0 and G1 phases of the cell cycle and regulation of apoptosis. In EBV infection most of the changes, including the early induction of cyclin D2, are dependent on expression of EBV genes, but an alteration in the E2F-4 profile was partly independent of viral gene expression, presumably occurring in response to signal transduction activated when the virus binds to its receptor, CD21. By comparing the expression of genes controlling apoptosis, including those encoding several members of the BCL-2 family of proteins, the known relative resistance of EBV-immortalized B-cell lines to apoptosis induced by low serum was found to correlate with expression of both BCL-2 and A20. A20 can be regulated by the NF-kappaB transcription factor, which is known to be activated by the EBV LMP-1 protein. Quantitative assays demonstrated a direct temporal relationship between LMP-1 protein levels and active NF-kappaB during the time course of infection.
