No abstract

The past two decades have brought an enormous widening of interest in and knowledge about swallowing disorders. The most frequently used technique for swallow evaluation is X-ray videofluoroscopy. Most interventions are based on this examination. Only a few studies assessing interobserver reliability of videofluoroscopy have been published. The aim of our study was to assess the interobserver reliability of videofluoroscopy for swallow evaluation. Fifty-one consecutive dysphagic patients referred for videofluoroscopy were entered into the study regardless of their underlying disorder. The first swallow (5 ml of a semisolid radio-opague contrast media) of each patient was assessed in the lateral projection by 9 independent, experienced observers from different international swallow centers. All studies were evaluated according to a standardized protocol sheet and the interobserver reliability was calculated. The interobserver reliabilities assessed as kappa coefficient for parameters of the oral and pharyngeal phase, for the temporal occurrence of penetration/aspiration, and for the location of bolus residue ranged from 0.01 to 0.56. High reliability with an intraclass coefficient of 0.80 was achieved only with the well defined penetration/aspiration score. Our study underlines the need for exact definitions of the parameters assessed by videofluoroscopy, in order to raise interobserver reliability. To date, only aspiration is evaluated with high reliability by videofluoroscopy, whereas the reliability of all other parameters of oropharyngeal swallow is poor.

SNB is associated with significantly less postoperative morbidity and better shoulder function than elective neck dissection. This supports our opinion that patients with nodal negative early SCC of the oral cavity should be offered SNB.

SNB is technically feasible and reproducible with a high sentinel node detection rate. Validation against elective neck dissection revealed a negative predictive value of 100%. Application of the SNB concept in clinical practice was very successful. The recurrence rate within the neck was very low and the morbidity and cost of an elective neck dissection could be spared to 60% of the patients.

Involvement of the cervical lymph nodes is the most important prognostic factor for patients with oral/ oropharyngeal squamous cell carcinoma (OSCC), and the decision whether to electively treat patients with clinically negative necks remains a controversial topic. Sentinel node biopsy (SNB) provides a minimally invasive method of determining the disease status of the cervical node basin, without the need for a formal neck dissection. This technique potentially improves the accuracy of histological nodal staging and avoids over-treating three-quarters of this patient population, minimizing associated morbidity. The technique has been validated for patients with OSCC, and larger-scale studies are in progress to determine its exact role in the management of this patient population. This article was designed to outline the current best practice guidelines for the provision of SNB in patients with early-stage OSCC, and to provide a framework for the currently evolving recommendations for its use. These guidelines were prepared by a multidisciplinary surgical/nuclear medicine/pathology expert panel under the joint auspices of the European Association of Nuclear Medicine (EANM) Oncology Committee and the Sentinel European Node Trial Committee.

SLN evaluation in N0 neck in squamous cell carcinoma of the head and neck is accurately feasible and seems to adequately predict the presence of occult metastasis.

Salvage surgery in laryngeal cancer achieves good results, especially for small recurrences. Because of tumor progression, larynx preservation is seldom possible at the time of salvage. Salvage surgery in hypopharyngeal cancer shows poor survival regardless of tumor stage and despite radical surgical procedures, and can be recommended only for carefully selected patients. Arch Otolaryngol Head Neck Surg. 2000;126:1473-1477

In patients with early head and neck squamous cell carcinoma (HNSCC), occult lymph node metastasis is difficult to predict by clinical or pathological parameters. However, such parameters are necessary to select patients either for elective neck dissection or the sentinel lymph node (SLN) procedure. The membrane glycoprotein podoplanin is normally expressed in lymphatic endothelial cells. Recently, expression of podoplanin by cancer cells was demonstrated to promote tumor cell motility and tumor lymphangiogenesis in vitro. The value of cancer cell-expressed podoplanin was to be determined as a predictive marker for SLN metastasis in early HNSCC of the oral cavity and oropharynx. One hundred twenty patients with HNSCC of the oral cavity and oropharynx undergoing a SLN biopsy were enrolled in this prospective clinical trial of SLN biopsy. Cancer cell-expressed podoplanin was determined by immunohistochemistry using tissue microarrays. Podoplanin expression was quantified by the intensity reactivity score and categorized into expression and nonexpression. SLN examination revealed occult metastasis in 45 patients (37.5%). Twenty-nine of 120 (24.2%) primary HNSCC showed podoplanin expression. Podoplanin expression correlated significantly with SLN metastasis (p 5 0.029) and remained a significant predictor for lymph node status even after controlling for tumor stage (p 5 0.028). As a predictive marker for SLN metastasis, however, podoplanin expression reached a sensitivity of a mere 36% and a specificity of 83%. Podoplanin expression is associated with metastasis to lymph nodes in vivo. Podoplanin immunohistochemistry in early HNSCC of the oral cavity and oropharynx may help to select patients for the SLN procedure and to identify patients with increased risk for presence of occult lymph node metastasis in the neck.Head and neck squamous cell carcinoma (HNSCC) is the fifth most common malignancy worldwide and responsible for more than 7,800 deaths per year in the United States alone. 1 Despite improvements in surgical treatment and radiation technology over the last decades, survival has not significantly improved. A chief feature of malignant behavior is the capability of tumor cells to metastasize to other organs. Metastasis of many human cancers, including HNSCC, occurs primarily through the lymphatic system. The cellular mechanisms responsible for the acquisition of a metastatic phenotype include the adaptation to potential hostile environment (blood stream, lymph nodes and organ of metastasis). In addition, the ''tumor cell-to-tumor cell'' and ''tumor cell-to-stromal environment'' cross talk is recognized as an important condition for invasion and metastasis.Very recently, expression of the 38-kDa Type 1 transmembrane glycoprotein podoplanin has been shown to induce tumor lymphangiogenesis and enhance metastasis to lymph nodes. 2,3 Human podoplanin is expressed in various normal human tissues. Podoplanin is highly and specifically expressed in lymphatic endothelial cells, but not in blood vessel endothelium. 4,5...