[Precancerous conditions in the ENT area]. / Prekancerózy v ORL oblasti.

An important part of tumor prevention is early detection, dia-gnosis, treatment and screening of precancerous conditions. Correct detection and screening of premalignant lesions leads to early dia-gnosis of a malignant process which provides a better chance to completely cure the patient and also predicts better quality of life. Precancerous conditions look like whitish, red or mixed mucose lesions (leukoplakia, erytroplakia, erytroleukoplakia) which are visible during clinical examination. Nevertheless, these mucose changes are not absolutely conclusive. Therefore, histological testing is necessary for dia-gnosis and determination of bio-logical potencial of precancerous lesions. Precancerous lesions as a term of histological terminology means dysplasia. The risk of progression of dysplasia into a carcinoma depends on a grade of dysplasia. The conservative or surgical treatment is chosen according to localisation and grade of dysplasia.

[Sentinel lymph node biopsy in oral and oropharyngeal carcinomas]. / Biopsie sentinelové uzliny u pacientu s karcinomem ústní dutiny a orofaryngu.

BACKGROUND: The aim of our study was to assess feasibility and accuracy of sentinel lymph node biopsy in patients with head and neck squamous cell carcinoma with clinically N0 neck. METHODS AND RESULTS: The sentinel lymph node was localised preoperatively by lymphoscintigraphy and intraoperatively by hand-held gamma probe after peritumoral injection of a Tc99m-labeled colloidal human serum albumin. The histology of the sentinel lymph node was compared with the histology of the nodes of the elective neck dissection performed in all patients. 27 patients with oral and oropharyngeal carcinomas accessible to injection in local anaesthesia were enrolled into a prospective trial between July 1993 and December 2005. The sentinel lymph node was localised by preoperative lymphoscintigraphy in 26 of 27 patients. Sentinel lymph node was identified perioperatively by hand-held gamma probe in all 28 necks of 27 patients. Occult metastases were found in 4 sentinel lymph nodes in 4 cases. In one case (3.6 %) the result of sentinel lymph node biopsy was false negative. The sentinel lymph node biopsy correctly predicted the positivity and negativity of the neck in 27 of 28 cases (96.4 %). CONCLUSIONS: Sentinel lymph node biopsy in patients with oral and oropharyngeal carcinomas is feasible and seems to accurately predict the status of the regional lymph nodes.

Surgical treatment strategy for thyroid gland carcinoma nodal metastases.

The authors present their experience with surgical treatment for nodal metastases of thyroid carcinoma based on neck dissections. The specificity of the surgical approach to the lymph nodes was determined by the biologic behavior of each thyroid tumor. Using the available literature on metastases from thyroid tumors, an opinion is supported that surgery for differentiated carcinomas (papillary and follicular neoplasms) can be more conservative and can be safely limited to modified neck dissections. In contrast, a more extended type of selective neck dissection, and only rarely a comprehensive neck dissection, is needed for medullary carcinoma. Because of its rapid spread to distant sites local aggressivity, extirpation of individual lymph nodes or neck dissection is not justified in patients with anaplastic thyroid carcinoma.