Occult level IV metastases in clinically node-negative patients with oral tongue squamous cell carcinoma

Motiee-Langroudi, Maziar; Amali, Amin; Saedi, Babak; Emami, Hamed; Ensani, Fereshteh; Lotfi, Alireza; Anari, Mahtab Rabbani

doi:10.1017/s0022215116000931

Cited by 9 publications

(12 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Reports of level IV metastasis in N0 patients range between 1.5% and 6.3% and level IV skip metastasis to be 0%-3.1%. 8,[12][13][14] Motiee-Langroudis reported the highest rate of both level IV involvement (6.3%) and level IV skip metastasis (3.1%) for N0 patients. 12 The results likely reflect the small sample size of 32 where each patient represents a greater overall percentage.…”

Section: Discussionmentioning

confidence: 95%

“…8,[12][13][14] Motiee-Langroudis reported the highest rate of both level IV involvement (6.3%) and level IV skip metastasis (3.1%) for N0 patients. 12 The results likely reflect the small sample size of 32 where each patient represents a greater overall percentage. Despite the comparatively higher rates, the authors followed the Weiss criteria and recommended a level I-III neck dissection for N0 tongue SCC patients.…”

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

The incidence of occult level IV nodal metastasis in tongue squamous cell carcinoma: a 20 year review

Kong

Field

et al. 2022

ANZ Journal of Surgery

View full text Add to dashboard Cite

Background The extent of neck dissection for tongue SCC is unclear owing to the potential presence of occult level IV metastasis. We aim to assess the incidence of occult level IV nodal metastasis for tongue SCC patients treated in our centre over a 20 year period. Methods A retrospective analysis of data collected from 1999 to 2019 was performed. Patients diagnosed with oral tongue SCC treated primarily with surgery and a neck dissection fulfilled the inclusion criteria. Results A total of 124 patients were included in our study. Sixty‐one patients were N0 with no occult level IV metastasis. About 17.3% of clinically node positive patients had level IV metastasis. Length of hospital stay and complication rates were comparable for patients who received levels I–III and I–IV neck dissections. Conclusion Occult level IV metastasis in N0 tongue SCC patients are exceedingly rare, we would therefore suggest consideration for a level I–III neck dissection. In patients who are clinically node positive, a level I–IV neck dissection would be recommended.

show abstract

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 95%

The incidence of occult level IV nodal metastasis in tongue squamous cell carcinoma: a 20 year review

Kong

Field

et al. 2022

ANZ Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…Other studies have also shown a higher rate of spread to level IV in oral tongue cancer and have also advocated removal of this level [182,183]. Conversely, some investigators have found a much lower rate of spread to level IV, anywhere from 0% to 6.25% and recommend only level I to III dissection in cases of early oral tongue SCC [184][185][186][187][188][189][190]. The surgical anatomical distinction of level III versus level IV is the position of the omohyoid muscle.…”

Section: Surgical Therapymentioning

confidence: 99%

The N0 Neck in Oral Squamous Cell Carcinoma A Comprehensive Review and Update on Diagnosis and Management

Patel¹

2020

GJO

View full text Add to dashboard Cite

Oral cavity cancer represents one of the most devastating diseases worldwide, as the morbidity and mortality associated with it can be quite significant. Spread to cervical lymph nodes represents a major contributor to patient prognosis, however, despite many technological advances, accurate and consistent identification of involvement of the neck in early stage oral squamous cell carcinoma remains a major challenge. With increasingly sensitive and specific imaging modalities, cytological analysis, as well as sentinel node biopsy, identification of regional cervical metastasis continuously improves. The spread of this disease to regional lymph nodes of the neck often results in dramatic changes in treatment and prognosis, and thus management of the neck in early oral cancer is of paramount importance. A consensus on the ideal treatment modality for the clinically node-negative neck still eludes us, with elective neck dissection at the time of primary treatment being the current gold standard, with radiation and chemotherapy having adjunctive roles. The "wait and see" philosophy also has its advocates, as well as its critics. Advances in genetic analysis of tumours may represent the future in patient-specific intervention. This article represents a review of past, present, as well as future advances in the diagnosis and management of the N0 neck in oral cancer, highlighting the most recent research, techniques, and practices worldwide.

show abstract

“…For clinically and radiologically node-negative (cN0) patients with oral and oropharyngeal squamous cell carcinoma (OSCC and OPSCC), accurate detection of positive lymph nodes (LNs) in the neck is critical as there is a 25% chance of micrometastases with an associated 50% decrease in survival. 1,2 The sensitivity of available imaging modalities to detect cervical metastases is only 50%-70% 3 ; therefore, elective neck dissection (END) is performed for both staging and treatment. Sentinel lymph node biopsy (SLNB) avoids overtreatment of 75% of cN0 patients by providing equivalent diagnostic yield to END with less morbidity, 4,5 While SLNB is not broadly considered standard of care for head and neck cancers, the conventional method in which this procedure is performed typically relies on preoperative mapping of radionuclear tracers using scintillation detectors (e.g., lymphoscintigraphy following peritumoral injection of 99m Tc-nanocolloid), and intraoperative guidance to draining LNs via use of handheld gamma probes.…”

Section: Introductionmentioning

confidence: 99%

Preclinical feasibility of robot‐assisted sentinel lymph node biopsy using multi‐modality magnetic and fluorescence guidance in the head and neck

et al. 2022

View full text Add to dashboard Cite

Background: Sentinel lymph node biopsy (SLNB) is a staging procedure dependent on accurate mapping of draining lymphatics via tracers. Robotassisted SLNB enables access to multiple neck levels with a single incision and intraoperative fluorescence guidance to the SLN.Methods: Lymphatic mapping in swine was done using a magnetic tracer and fluorescent dye, injected into the tongue. MRI preoperatively mapped lymphatic spread of the magnetic tracer. Dissection was performed using a da Vinci Xi robot guided by fluorescence-imaging of the dye. Results: Robot-assisted SLNB was successfully performed in all animals (n = 5). A novel MRI protocol differentiated SLNs (n = 6) from lower echelon nodes (n = 11) based on flow progression. Fluorescence imaging provided valuable intraoperative guidance and correlated with magnetic-positive nodes.Conclusions: This study demonstrates preclinical feasibility of a robot-assisted approach to SLNB using magnetic and fluorescent tracers in the head and neck, enabling both preoperative mapping and intraoperative guidance.

show abstract

Occult level IV metastases in clinically node-negative patients with oral tongue squamous cell carcinoma

Abstract: Supraomohyoid neck dissection appears to be an appropriate treatment for N0 tongue squamous cell carcinoma and there is no need for level IV lymph node dissection in a N0 patient.

Cited by 9 publications

References 10 publications

The incidence of occult level IV nodal metastasis in tongue squamous cell carcinoma: a 20 year review

The incidence of occult level IV nodal metastasis in tongue squamous cell carcinoma: a 20 year review

The N0 Neck in Oral Squamous Cell Carcinoma A Comprehensive Review and Update on Diagnosis and Management

Preclinical feasibility of robot‐assisted sentinel lymph node biopsy using multi‐modality magnetic and fluorescence guidance in the head and neck

Contact Info

Product

Resources

About