Use of Lugol's iodine in the resection of oral and oropharyngeal squamous cell carcinoma

McMahon, Jeremy; Devine, J.C.; McCaul, James; McLellan, Douglas; Farrow, Adrian

doi:10.1016/j.bjoms.2009.05.007

Cited by 53 publications

(59 citation statements)

References 17 publications

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“…Our cohort study data show a reduction in margin dysplasia using Lugol’s iodine at cancer resection from 32% for control to 4% for intervention groups [12]. Our feasibility study showed very high patient acceptance rates (unpublished data) and we are very optimistic that this trial will recruit participants.…”

Section: Discussionmentioning

confidence: 91%

LIHNCS - Lugol’s iodine in head and neck cancer surgery: a multicentre, randomised controlled trial assessing the effectiveness of Lugol’s iodine to assist excision of moderate dysplasia, severe dysplasia and carcinoma in situ at mucosal resection margins of oral and oropharyngeal squamous cell carcinoma: study protocol for a randomised controlled trial

McCaul

Cymerman

Hislop

et al. 2013

Trials

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BackgroundOral cavity and oropharynx cancer are increasing in incidence worldwide but survival outcomes have not significantly improved over the last three decades. The presence of dysplasia or carcinoma in situ at surgical margins following resection of squamous carcinoma of the mucosal surfaces of the head and neck has been shown to be associated with a higher incidence of local recurrence and reduced survival. While invasive carcinoma in mucosal surfaces can usually be distinguished from adjacent normal mucous membrane, pre-malignant disease is much less readily distinguished at operation. We describe a protocol for a randomised, controlled trial in which we will assess the effectiveness of Lugol’s iodine staining in allowing visualisation and excision of cancer margin dysplasia at time of primary surgery.Methods/DesignWe will recruit 300 patients diagnosed with oral cavity or oropharynx squamous cell carcinoma. All participants will be planned for primary surgery with curative intent. After completion of baseline assessment participants will be randomised into either a standard surgical treatment arm or surgical treatment including Lugol’s iodine staining.DiscussionThis paper describes the rationale and design of a unique trial in head and neck surgical oncology. If margin dysplasia visualisation with Lugol’s iodine allows complete excision of high-risk, pre-cancer mucosa at time of primary surgery, this may lead to a reduction in local recurrence and improved survival.Trial registrationCurrent Controlled Trials ISRCTN03712770.

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Section: Discussionmentioning

confidence: 91%

LIHNCS - Lugol’s iodine in head and neck cancer surgery: a multicentre, randomised controlled trial assessing the effectiveness of Lugol’s iodine to assist excision of moderate dysplasia, severe dysplasia and carcinoma in situ at mucosal resection margins of oral and oropharyngeal squamous cell carcinoma: study protocol for a randomised controlled trial

McCaul

Cymerman

Hislop

et al. 2013

Trials

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“…For example, we applied Lugol's iodine staining [14–16] and titanium seed marker implantation [18] to estimate the extension of the tumor (Fig. 1).…”

Section: Discussionmentioning

confidence: 99%

“…Implantation was performed under general anesthesia in all patients except one, who received local anesthesia because of insufficient pulmonary function. Inspection and palpation was performed by more than two physicians and Lugol's iodine staining was performed to estimate the superficial extension of the tumor [14–16]. Intraoral ultrasonography (SSD-1000 ® ; Hitachi Aloka Medical Ltd., Tokyo, Japan) was performed to define tumor thickness [17].…”

Section: Methodsmentioning

confidence: 99%

High-dose-rate interstitial brachytherapy for mobile tongue cancer: preliminary results of a dose reduction trial

Akiyama¹,

Yoshida²,

Yamazaki³

et al. 2014

jcb

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PurposeTo compare the outcome of our facility with another about the shortened schedule (60 Gy in 10 fractions to 54 Gy in 9 fractions) of high-dose-rate interstitial brachytherapy (HDR ISBT) for mobile tongue cancer.Material and methodsEighteen patients were treated with HDR ISBT as a monotherapy in dose reduction schedule with some unique technique to determine the border of tumor accuracy (lugol's staining and metal marker), and to minimize adverse effect (lead-lined silicon block) at our facility.ResultsThe 2-year local and regional control rates and cause-specific survival rate were 82%, 80%, and 83% and moderate to severe late complications occurred in five patients (28%), which were almost the same treatment results achieved by another facility.ConclusionsWe recommend 54 Gy in 9 fractions over 7 days as a feasible treatment to reduce patient discomfort in mobile tongue cancer patients.

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“…A set of criteria for assessing margin clearance was identified (table 2) [14,15,16,17,18] based on accepted cytological features of malignancy, after sequentially checking each imprint from the mucosal margins for adequacy, cellular arrangement, tumor diathesis and high/variable nuclear to cytoplasmic ratio in an order. The margins were reported as ‘suspicious’ (increased nuclear cytoplasmic ratio + presence of one or more features from category 1), ‘positive’ (increased nuclear cytoplasmic ratio + presence of at least two features from category 1 + any 1 feature from category 2) and ‘negative’ (absence of epithelial cells in imprints or absence of all of the above-mentioned features in cells present in imprints).…”

Section: Methodsmentioning

confidence: 99%

Intraoperative Imprint Evaluation of Surgical Margins in Oral Squamous Cell Carcinoma

Yadav¹,

Donoghue²,

Tauro³

et al. 2012

Acta Cytologica

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Background: Oral squamous cell carcinoma (OSCC) is a multifactorial malignant epithelial neoplasm. Tumor clearance at the surgical margins in OSCC is a critical factor which strongly influences both the local recurrence and overall survival rate. A quick and accurate intraoperative diagnostic procedure can make a significant difference to the survival rate. Touch imprint cytology (TIC) has commonly been used in the past for the diagnosis of tumors and the detection of sentinel lymph node metastasis. It is routinely applied for intraoperative margin analysis of breast lumpectomy specimens, where it has been proven to have a good success rate. The effectiveness and reliability of TIC in the intraoperative margin evaluation of OSCC, however, has not been established so far. Objective: To investigate the diagnostic accuracy of the intraoperative TIC technique for assessing surgical margins in OSCC in comparison to paraffin-embedded hematoxylin and eosin-stained sections. Materials and Methods: Thirty previously untreated, biopsy-proven OSCC patients undergoing surgical treatment between December 2008 and September 2010 were included. Patients diagnosed with histological variants of squamous cell carcinoma (SCC) or recurrent tumor were excluded. Three hundred forty-eight touch imprint slides were prepared from 174 margins of 30 resected tumor specimens. Imprints from tumor proper were taken as positive controls. The slides were reported as positive, negative or suspicious for tumor. After all cytological interpretation was completed, the results were compared with the corresponding histological diagnosis. Results: This pioneer study showed that TIC has an overall accuracy of 83%, sensitivity of 91.1%, specificity of 74.4%, positive predictive value of 79.2% and a negative predictive value of 88.6%. The false-positive margins evaluated by TIC were 43 (12.3%) and the false-negative ones were 16 (4.6%). Conclusion: TIC is a quick, simple, inexpensive, highly accurate and reliable intraoperative technique to assess surgical margins in SCC of the oral cavity.

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Use of Lugol's iodine in the resection of oral and oropharyngeal squamous cell carcinoma

Cited by 53 publications

References 17 publications

High-dose-rate interstitial brachytherapy for mobile tongue cancer: preliminary results of a dose reduction trial

Intraoperative Imprint Evaluation of Surgical Margins in Oral Squamous Cell Carcinoma

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