Histological study on pN upgrading of oral cancer

Abstract

The International Union Against Cancer (UICC) does not define the number of sections required from each regional lymph node to record pTNM classification. This study was designed to clarify the incidence of occult metastasis and to assess the pN upgrading of patients with oral cancer. Ultimately, this study led to a proposal for appropriate semiserial sectioning guidelines. Five hundred fifty-four nonmetastatic cervical lymph nodes taken from 73 patients with oral cancer were subjected to hematoxylin-eosin (HE) staining and keratin immunohistochemistry. Micrometastases, defined as foci ≤3 mm, were detected in 29 sites of 23 lymph nodes (4.2%) of 16 patients (21.9%). In 9 patients (12.3%) pN upgrading was needed: in 6 from pN0 to pN1, in 1 from pN0 to pN2b, and in 2 from pN1 to pN2b. The remaining 13 lymph nodes with occult metastasis were found in 5 pN2b and 2 pN2c patients, resulting in no pN upgrading. Occult metastasis was also detected in 6 small lymph nodes ≤5 mm in diameter. The average minor axis of the micrometastasis was 1.36±0.85 mm. We propose that the lymph nodes should be cut and examined at 1-mm intervals to detect micrometastatic foci and to evaluate the pN classification accurately.

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

“…This method has the advantage of preserving cellular and tissue morphological features, but is expensive and time-consuming, and therefore cannot be used for most routine applications . However, it has been demonstrated that it does not allow a significantly higher detection rate than histopathologic examination of HE-stained sections (Woolgar, 1999;Hamakawa et al, 2000b). In our study, immunodetection of carcinomatous cells of the 203 nodes that were HES negative and real-time RT -PCR positive was negative.…”

“…As histopathologic analysis of neck dissection specimens is usually performed on several 3 -4 mm sections from each lymph node, and as micrometastases represent tumour deposits measuring less than 2 mm in diameter, they can be easily missed on routine light microscopy (Hermanek et al, 1999;Genden et al, 2003). For example, it has been reported that 21.9% of patients with cancer of the oral cavity have micrometastases with an average diameter of 1.36 mm (Hamakawa et al, 2000b).…”

“…Previous studies using such markers in HNSCC have suggested a low specificity (Kawamata et al, 1999;Hamakawa et al, 2000a), particularly because of false-positive results associated with benign epithelial rests in lymph nodes found in 1.6% of cervical nodes, but only in lymph nodes from level I (Gnepp, 2000;Hamakawa et al, 2000b). The assay used in the present study, that is, RT -PCR detection of CK19 mRNA, has been developed in our laboratory for the detection of occult carcinomatous cells in mediastinal lymph nodes in non-small-cell lung carcinoma (Saintigny et al, 2005) and by other teams in various carcinomas (Van Trappen et al, 2001;Inokuchi et al, 2003;Favia et al, 2004).…”

Can Early Dissection of Cervical Lymph Nodes Improve Prognosis in Squamous Cell Carcinomas of the Hard Palate

“…Advances in molecular biology have improved diagnostics that were previously based on immunohistochemical procedures with a sensitivity of only 5-58% (average = 19.6%) [20]. Micrometastases are not infrequent with head and neck SCCs [19], and their reported occurrence in the oral cavity is 21.9% [22]. There is no consensus on the relevance of micrometastases to survival, but our recent studies indicate that prognosis is worse when micrometastases are present [23].…”

Immunohistochemistry, A Valuable Tool in Detection of Cervical Lymph Node Micrometastases in Head and Neck Squamous Cell Carcinoma: A Prospective Study

“…Barrera et al [25] reported the upstaging of 29 % of N 0 cases by IHC. Rhee et al [28] observed cervical micrometastasis in half of their patients with clinically N 0 head and neck cancer and Hamakawa et al [29] found micrometastasis in 15.9 % of N 0 necks, in oral cancer patients. Yoshida et al [30] had even better upstaging to report.…”