Use of Decision Analysis in Planning a Management Strategy for the Stage NO Neck

Weiss, Michael H.; Harrison, Louis B.; Isaacs, Richard S.

doi:10.1001/archotol.1994.01880310005001

Cited by 589 publications

(387 citation statements)

References 16 publications

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“…However, treatment of the clinically negative neck is warranted when there is a greater than 20% incidence of occult lymph node disease. 53 Although the 34% rate of occult lymph node metastases in the current study meets this criterion for treatment of the clinically negative neck in patients with SCCOT, approximately two-thirds of early-stage cN0 patients who underwent neck dissection had no pathologic evidence of disease. Neck dissection can be performed with minimal morbidity, but this treatment protocol may result in overtreatment for patients without lymph node disease.…”

Section: Discussionmentioning

confidence: 56%

Disparity in pathologic and clinical lymph node staging in oral tongue carcinoma

Greenberg

Naggar

et al. 2003

Cancer

165

116

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At present, storage capacities of single tank and tank farm have been greatly increasing. This change poses a real challenge for the applicability of current design standards. This article focuses on the applicability of safety spacing between tanks, which is one of the most important parameters of tank farm safety design. Taking PHAST and FDS as main research tools, the consequences of representative accidental scenarios were evaluated for different sizes of oil tanks to study the safety performance change caused by the increase of capability. The research results show that, when current standards are used to design the safety spacing between tanks, the safety performance increases as the capability increases. Considering the high property density, it is suggested that a higher safety performance objective has to be chosen when designing the safety spacing for ultra‐large oil tanks. © 2012 American Institute of Chemical Engineers Process Saf Prog, 2012.

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Section: Discussionmentioning

confidence: 56%

Disparity in pathologic and clinical lymph node staging in oral tongue carcinoma

Greenberg

Naggar

et al. 2003

Cancer

165

116

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“…While this data supports that DOI has a slightly higher predictive value, we demonstrated that muscle invasion has above a 20% PPV for lymph node metastasis. This is clinically significant since the current standard of care contends that a 20% likelihood of occult lymph node metastasis warrants a neck dissection [27,28]. As mentioned previously, using muscle invasion as the criteria is a much easier parameter to access, especially in the frozen section room where many of the decisions must be made as to whether or not to perform a neck dissection.…”

Section: Discussionmentioning

confidence: 99%

Muscle Invasion in Oral Tongue Squamous Cell Carcinoma as a Predictor of Nodal Status and Local Recurrence: Just as Effective as Depth of Invasion?

Chandler

Vance

Budnick

et al. 2011

Head and Neck Pathol

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Tumor depth of invasion (DOI) is a histologic feature that consistently correlates with lymph node metastasis; however, there are many difficulties with accurately assessing DOI. The aim of this study was to identify a simpler and more reproducible method of determining DOI, by using skeletal muscle invasion as a surrogate marker of depth. Oral tongue squamous cell carcinoma American Joint Committee on Cancer (AJCC) stage T1 cases were identified in the Emory University Department of Pathology database. 61 cases, with a minimum of 2 years of follow-up, were included in the study. Cases were examined histologically to assess muscle invasion and DOI. The two methods of measurement were analyzed to determine the positive predictive value (PPV) of DOI or muscle invasion for both nodal disease and local recurrence. Cases with muscle invasion had a 23.3% PPV of occult lymph node metastasis. Cases with DOI of greater than 3 mm had a 29.7% PPV of occult lymph node metastasis. Cases with muscle invasion had a 43.7% PPV of local tumor recurrence. Cases with maximum DOI of greater than 3 mm had a 40.4% PPV of tumor recurrence. Although the PPV of muscle invasion in regards to nodal status was slightly less than DOI, it represents a more easily reproducible parameter which could guide surgeons in determining if the case warrants an elective neck dissection in a cN0 (clinically negative) neck. Interestingly, the PPV of local recurrence was higher with muscle invasion than DOI, and may represent an important indicator for extent of resection.

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“…However, controversy exists in the management of patients with early cancers and N0 neck. Weiss et al suggested that END is necessary if the incidence of occult metastasis is greater than 20% [8]. The proponents of wait and watch policy argue that 80% of patients with N0 neck would be over treated, and subjected to additional morbidity and costs.…”

Section: Discussionmentioning

confidence: 99%

To Operate or Not to Operate N0 Neck in Early Cancer of the Tongue? A Prospective Study

Vijayakumar

Burrah

Sabitha

et al. 2011

Indian J Surg Oncol

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Squamous cell carcinoma (SCC) of the tongue is a common cancer across the globe. These cancers have a high predilection for nodal metastasis and a high incidence of occult metastasis. The management of clinically negative neck nodes (N0) remains controversial. We have undertaken a prospective study to evaluate the rate of occult nodal metastasis, the characteristic of metastasis, and assess the usefulness of tumor depth as a predictor of metastasis and as a guide to treat the neck. Prospective study between January 2000 to December 2005. Patients with SCC of the anterior 2/3rd of tongue with N0 neck were included. Wide excision of the primary and subsequent modified radical neck dissection (in patients with tumor depth>4 mm) was performed. Postoperative radiotherapy was given in patients with lymph node metastasis. Patients who had no node metastasis (p N -ve) were observed. The total number of eligible patients was 180. Occult lymph node metastasis (p N +ve) was seen in 122 (62.2%) patients (p<0.001), multiple levels of node involvement in 79 (70.5%) patients and extracapsular spread (ECS) in 38 (33.6%) patients. Patients in the p N +ve group who were disease free was 63.1% as compared to 68.2% in the p N -ve group (p=0.36). Recurrence was seen in 28 (36.8%) patients of p N +ve group and 14 (31.8%) patients of p N -ve group. Early cancer of tongue with tumor depth >4 mm was associated with predominantly high grade tumors, high incidence of occult nodal metastasis, multiple levels of nodal involvement and ECS. The disease free status of patients with occult metastasis who were treated was similar to that of patients with no nodal metastasis. Elective neck dissection appears essential for early oral tongue cancer with tumor depth >4 mm as there is no investigational modality which can reliably identify patients without occult metastasis.

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Use of Decision Analysis in Planning a Management Strategy for the Stage NO Neck

Cited by 589 publications

References 16 publications

Disparity in pathologic and clinical lymph node staging in oral tongue carcinoma

Disparity in pathologic and clinical lymph node staging in oral tongue carcinoma

Muscle Invasion in Oral Tongue Squamous Cell Carcinoma as a Predictor of Nodal Status and Local Recurrence: Just as Effective as Depth of Invasion?

To Operate or Not to Operate N0 Neck in Early Cancer of the Tongue? A Prospective Study

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