Frequency and therapeutic implications of “skip metastases” in the neck from squamous carcinoma of the oral tongue

Byers, Robert M.; Weber, Randal S.; Andrews, Todd; McGill, D. A. F.; Kare, Ramon Paul; Wolf, Pat

doi:10.1002/(sici)1097-0347(199701)19:1<14::aid-hed3>3.0.co;2-y

Cited by 432 publications

(244 citation statements)

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“…Level II is the first node level in the majority of HNSCC, but other levels are also likely to be the first node level, especially in tumours of the oral cavity (level I) or hypopharynx (level III) (Schauer et al, 2004). As a variable lymphatic drainage in HNSCC can be observed, tumour cells may be missed in unsuspected groups of lymph nodes (Byers et al, 1997). In our study, this variability of lymphatic drainage was observed in five out of 31 patients.…”

Section: Discussionsupporting

confidence: 47%

“…In two of these patients, CK19 mRNA was detected in IIa and IIb lymph node levels that were negative on histopathology. In support of this idea, Mozzillo et al (2001) recently noted a 18% incidence of sentinel nodes outside the expected nodal drainage pattern, and Byers et al (1997) found that 15.8% of 277 patients with squamous cell carcinoma of the oral tongue had skip metastases.…”

Section: Discussionmentioning

confidence: 91%

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Detection of occult carcinomatous diffusion in lymph nodes from head and neck squamous cell carcinoma using real-time RT–PCR detection of cytokeratin 19 mRNA

et al. 2006

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The aim of the present study was to evaluate the occult lymph node carcinomatous diffusion in head and neck squamous cell carcinoma (HNSCC). A total of 1328 lymph nodes from 31 patients treated between 2004 and 2005 were prospectively evaluated by routine haematoxylin -eosin -safran (HES) staining, immunohistochemistry (IHC) and real-time Taqman reverse -transcriptase polymerase chain reaction (real-time RT -PCR) assay. Amplification of cytokeratin 19 (CK19) mRNA transcripts using real-time RT -PCR was used to quantify cervical micrometastatic burden. The cervical lymph node metastatic rates determined by routine HES staining and real-time RT -PCR assay were 16.3 and 36.0%, respectively (Po0.0001). A potential change in the nodal status was observed in 13 (42.0%) of the 31 patients and an atypical pattern of lymphatic spread was identified in four patients (12.9%). Moreover, CK19 mRNA expression values in histologically positive lymph nodes were significantly higher than those observed in histologically negative lymph nodes (Po0.0001). These results indicate that real-time RT -PCR assay for the detection of CK19 mRNA is a sensitive and reliable method for the detection of carcinomatous cells in lymph nodes. This type of method could be used to reassess lymph node status according to occult lymphatic spread in patients with HNSCC.

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Section: Discussionsupporting

confidence: 47%

Section: Discussionmentioning

confidence: 91%

Detection of occult carcinomatous diffusion in lymph nodes from head and neck squamous cell carcinoma using real-time RT–PCR detection of cytokeratin 19 mRNA

et al. 2006

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“…Byers et al have reported finding "skip metastases" to lymph nodes in levels III and/or IV in 15.8% of the patients with cancer of the oral tongue and therefore recommended inclusion of the lymph nodes of level IV whenever an elective neck dissection is to be performed in any patient with cancer of the oral tongue [22]. However, Khafif et al reported that occult metastasis to lymph nodes in level IV from T1-T3N0 oral tongue cancer is very rare with an incidence of 4% and therefore, suggested extension of elective neck dissection to lymph nodes in level IV only when the intraoperative findings of metastases in levels II and III indicate an increased risk of tumor recurrence in the neck [77].…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of the randomized controlled trials on elective neck dissection versus therapeutic neck dissection in oral cavity cancers with clinically node-negative neck

et al. 2011

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“…Of all the patients, five patients (8.75 %) had metastasis at level III or IV without involvement of level I and II (4 at level III and 1 direct skip metastasis at level IV). The incidence of Skip Metastasis at level IV has ranged from 3 to 28 % in different studies [10][11][12]. Level V metastasis was seen in only one patient that too in presence of metastasis at other levels.…”

Section: Discussionmentioning

confidence: 98%

Cervical node metastasis in T1 squamous cell carcinoma of oral tongue- pattern and the predictive factors

Vishak

Rohan

2014

Indian J Surg Oncol

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Background The squamous cell carcinoma (SCC) of the oral tongue is a common cancer in India. Elective lymphadenectomy is generally performed in all patients with T2-T4 tumors. In this study we have tried to analyze the pattern and risk factors associated with lymph node metastasis in T1 tongue cancers. Methods A retrospective review of the records of 57 patients undergoing surgery for treatment of T1 sqamous cell carcinoma of oral tongue was carried out. The clinicopatological features of the tumor, pattern of nodal metastasis and the risk factors associated with lymph node metastasis were studied. Results Totally 57 patients with T1 tumor underwent excision of the primary and modified neck dissection (MND). Lymph node metastasis was found in 36.8 % of the patients. Level I to Level II was the commonest site of metastasis. Skip metastasis at level III and IV was found in 8.5 % of the patients and isolated skip metastasis at level IV in 1.5 % of the patients. The risk factors associated with the lymph node metastasis on univariete analysis were; higher grade, tumor size >1 cm and tumor thickness >3 mm. On multivariate analysis only the tumor thickness was found to be a risk factor for the lymph node metastasis (hazard ratio of 21.59). Conclusions T1 sqamous cell carcinoma of tongue is associated with a high incidence of lymph node metastasis. Elective neck dissection should be considered in all patients with tumors more than 3 mm in thickness

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Frequency and therapeutic implications of “skip metastases” in the neck from squamous carcinoma of the oral tongue

Cited by 432 publications

References 2 publications

Detection of occult carcinomatous diffusion in lymph nodes from head and neck squamous cell carcinoma using real-time RT–PCR detection of cytokeratin 19 mRNA

Detection of occult carcinomatous diffusion in lymph nodes from head and neck squamous cell carcinoma using real-time RT–PCR detection of cytokeratin 19 mRNA

A meta-analysis of the randomized controlled trials on elective neck dissection versus therapeutic neck dissection in oral cavity cancers with clinically node-negative neck

Cervical node metastasis in T1 squamous cell carcinoma of oral tongue- pattern and the predictive factors

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