Lymph node yield in treatment naïve cases of head and neck squamous cell carcinoma: en bloc lymphadenectomy versus level-by-level dissection

Devaraja, K; Pujary, Kailesh; Ramaswamy, Balakrishnan; Nayak, Dipak Ranjan; Kumar, Naveena A. N.; Nayak, Deepak M

doi:10.1017/s0022215121000621

Cited by 5 publications

(4 citation statements)

References 52 publications

(90 reference statements)

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“…However, we have excluded lymph nodes only visible in one transverse MRI slice, lymph nodes with a transverse diameter < 2 mm and lymph nodes suspect of containing metastases. Also the pathological determination of lymph node yield in neck dissections cannot be considered the gold standard as the lymph node yield is affected by the dissection technique ( 17 ) and the person who is performing the dissection (pathologist vs. technician) ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

MRI visibility and displacement of elective lymph nodes during radiotherapy in head and neck cancer patients

et al. 2022

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Background and purposeTo decrease the impact of radiotherapy to healthy tissues in the head and neck region, we propose to restrict the elective neck irradiation to elective lymph nodes at risk of containing micro metastases instead of the larger lymph node volumes. To assess whether this new concept is achievable in the clinic, we determined the number, volume changes and displacement of elective lymph nodes during the course of radiotherapy.Materials and methodsMRI scans of 10 head and neck cancer (HNC) patients were acquired before radiotherapy and in week 2, 3, 4 and 5 during radiotherapy. The weekly delineations of elective lymph nodes inside the lymph node levels (Ib/II/III/IVa/V) were rigidly registered and analyzed regarding number and volume. The displacement of elective lymph nodes was determined by center of mass (COM) distances, vector-based analysis and the isotropic contour expansion of the lymph nodes of the pre-treatment scan or the scan of the previous week in order to geographically cover 95% of the lymph nodes in the scans of the other weeks.ResultsOn average, 31 elective lymph nodes in levels Ib-V on each side of the neck were determined. This number remained constant throughout radiotherapy in most lymph node levels. The volume of the elective lymph nodes reduced significantly in all weeks, up to 50% in week 5, compared to the pre-treatment scan. The largest median COM displacements were seen in level V, for example 5.2 mm in week 5 compared to the pre-treatment scan. The displacement of elective lymph nodes was mainly in cranial direction. Geographical coverage was obtained when the lymph node volumes were expanded with 7 mm in case the pre-treatment scan was used and 6.5 mm in case the scan of the previous week was used.ConclusionElective lymph nodes of HNC patients remained visible on MRI and decreased in size during radiotherapy. The displacement of elective lymph nodes differ per lymph node level and were mainly directed cranially. Weekly adaptation does not seem to improve coverage of elective lymph nodes. Based on our findings we expect elective lymph node irradiation is achievable in the clinic.

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Section: Discussionmentioning

confidence: 99%

MRI visibility and displacement of elective lymph nodes during radiotherapy in head and neck cancer patients

et al. 2022

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“…The horizontal neck dissection using standard fascia unwrapping technique was associated with a significantly superior nodal yield in levels I, II, III, and IV, and in overall nodal yield than the vertical neck dissection in the control group [24]. Level-by-level neck dissection resulted in a statistically significant higher LNY than en bloc or monoblock neck dissection in both selective neck dissection and individual neck levels [32]. Surgical experience influences not only LNY in neck dissections but also oncological outcomes with more recurrences occurring with less-experienced surgeons [25].…”

Section: Factors Influencing Lnymentioning

confidence: 85%

“…Moreover, the current literature has moved towards superselective neck dissection, adding more difficulty. For this reason, separating neck dissection specimens into the individual neck levels before being sent for the histopathological examination should be recommended in the future guidelines to establish standard LNY values in different neck levels and, therefore, to assess the adequacy of neck dissection [30,32].…”

Section: Variations In Lnymentioning

confidence: 99%

Lymph Node Yield and Ratio during Surgery for Advanced Laryngeal Carcinoma

S. Elhamshary,

I. Ammar,

Farid Abu Shady

et al. 2023

Lymphatic System - From Human Anatomy to Clinical Practice

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Lymph node metastasis represents one of the most important prognostic factors in patients with head and neck squamous cell carcinomas (HNSCC). Lymph node yield (LNY) is the term used to indicate the total number of dissected lymph nodes following neck dissection, while lymph node ratio (LNR) is the proportion of metastatic lymph nodes to the total number of removed lymph nodes following neck dissection. This ratio serves to determine both the extent of cancer lymphatic spread and the effectiveness of its clearance. Calculating LNY and LNR following neck dissection holds particular significance when dealing with advanced laryngeal cancer. These values are supposed to have a direct impact on both prognosis and oncological outcomes, warranting their inclusion in the staging of such patients. Wide variations were observed in both LNY and LNR, which were mainly dependent not only on the tumor burden but also on surgical and pathological skills. Therefore, standardization is required in the pathological processing as well as surgical techniques of neck dissections to minimize these variations. Further studies are needed to validate these observations and to guide their inclusion in pathological TNM classification.

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“…The lymph node yield from neck dissection has also been associated with the survival outcome for HNSCC patients [ 13 , 14 ]. A lymph node yield ≥ 18 was significantly associated with both decreased recurrence and improved survival [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Pathologically Positive Nodal Number in p16-Negative Oropharyngeal and Hypopharyngeal Squamous Cell Carcinoma with pN3b Status

et al. 2022

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In this study, we aimed to investigate the prognostic value of the number of pathologically positive nodes (pN+) in p16-negative oropharyngeal (OPSCC) and hypopharyngeal (HPSCC) squamous cell carcinoma cases with pN3b status after surgery. We reviewed the clinical and pathological features of 120 newly diagnosed p16-negative OPSCC and HPSCC patients with pN3b status after radical surgery. The primary endpoints were the 5-year overall survival (OS), cancer-specific survival (CSS), and their prognostic factors. We used the Cox proportional hazards model for survival analysis. We generated predictive nomograms that incorporated the clinicopathological factors of OS and CSS. The 5-year OS and CSS rates were 44.1% and 59.1%, respectively. The optimal number of pN+ to predict the 5-year OS and CSS was pN+ = 3. In the Cox model, we observed that pN+ ≥ 3 was a significantly negative predictor of OS (HR: 1.9, 95% CI: 1.1–3.2, p = 0.021) and CSS (HR: 2.3; 95% CI: 1.2–4.6; p = 0.015). After adding the pN+ variable, the c-index of the predictive nomogram incorporating assorted clinicopathological factors increased from 0.66 to 0.689 for OS and from 0.713 to 0.75 for CSS. The results highlight the prognostic value of the pN+ number in p16-negative OPSCC and HPSCC patients with pN3b status.

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Lymph node yield in treatment naïve cases of head and neck squamous cell carcinoma: en bloc lymphadenectomy versus level-by-level dissection

Cited by 5 publications

References 52 publications

MRI visibility and displacement of elective lymph nodes during radiotherapy in head and neck cancer patients

MRI visibility and displacement of elective lymph nodes during radiotherapy in head and neck cancer patients

Lymph Node Yield and Ratio during Surgery for Advanced Laryngeal Carcinoma

Prognostic Value of Pathologically Positive Nodal Number in p16-Negative Oropharyngeal and Hypopharyngeal Squamous Cell Carcinoma with pN3b Status

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