Open cervical lymph node biopsy for head and neck cancers: any benefit? (original) (raw)
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Cancer, 1995
A significant proportion of clinically positive palpable cervical lymph nodes in patients with head and neck cancer are histologically benign. The biologic and prognostic significance of this reactive lymph node enlargement has not been fully clarified. In this study, the incidence of clinically positive microscopically negative cervical lymph nodes in a series of 902 patients who had neck procedures as a part of their primary treatment for N0-2 laryngeal cancer was analyzed and survival rates of 342 patients with true negative lymph nodes (N0- necks) were compared with those of 106 patients with clinically false positive lymph nodes (N1-2b- necks). In 86 patients with false positive lymph nodes, a histopathologic analysis was performed to determine the histomorphologic pattern of the enlarged lymph nodes and to evaluate which parameters, if any, correlated with 5-year patient survival. Overall actuarial survival did not differ significantly in the two groups. However, the actuarial survival curves in the false positive group were clearly better compared with those of the true negative group with more advanced laryngeal cancers, particularly T4 lesions (P < 0.05). Interestingly, the analysis of pattern of recurrence showed a higher incidence of distant metastases in false positive patients with advanced stage laryngeal cancer than in true negative subjects. In addition, the histologic examination of 375 enlarged hyperplastic cervical lymph nodes from 86 neck specimens showed the prevalence of sinus histiocytosis in the false positive group and its favorable prognostic significance. No statistically significant differences with regard to the number and size of enlarged lymph nodes were found. On the contrary, lymph node location seems to have a prognostic impact on survival and the reactive benign enlargement of a digastric lymph node is a possible poor prognostic factor. Survival of patients with clinically false positive, histologically benign hyperplastic cervical lymph nodes who have more advanced laryngeal carcinoma is higher than clinically negative patients, suggesting that the presence of palpable benign nodes may be a sign of the host's immune activation, with favorable prognostic significance.
Sentinel Lymph Node Biopsy: A new approach in the management of head and neck cancers
Sultan Qaboos University Medical Journal, 2017
Cervical lymph node metastasis affects the prognosis and overall survival rate of and therapeutic planning for patients with head and neck squamous cell carcinomas (HNSCCs). However, advanced diagnostic modalities still lack accuracy in detecting occult neck metastasis. A sentinel lymph node biopsy is a minimally invasive auxiliary method for assessing the presence of occult metastatic disease in a patient with a clinically negative neck. This technique increases the specificity of neck dissection and thus reduces morbidity among oral cancer patients. The removal of sentinel nodes and dissection of the levels between the primary tumour and the sentinel node or the irradiation of target nodal basins is favoured as a selective treatment approach; this technique has the potential to become the new standard of care for patients with HNSCCs. This article presents an update on clinical applications and novel developments in this field.
Journal of Medical Science And clinical Research, 2017
The single most important factor determining the survival of patients with head and neck malignancy is the presence or absence of metastatic disease in the neck. clinicopathological profile of metastatic lymph nodes were conducted in the department of surgery, Medical College, Kozhikkode for a three years. Thirty nine cases of head and neck malignancy having either clinically evident cervical metastasis or those with a high chance of occult metastasis were selected. Twenty six of 39(66.7%) were male with male to female ratio 2.1 The mean age was 58.7(10.7) years. Most of the patients in this study belonged to 61-70 year group. The most common site of the primary lesion was at the anterior tongue(41%).Twenty one (53.8%) patients was at stage II, followed by 11(28.2%) patients in the stage III. The most common symptom was ulcer of the oral cavity(60%) followed by neck swelling in 15%. Cervical nodes were pathologically positive for metastasis in twenty one of the thirty nine cases (53.8%) of these seven were unilateral and four were bilateral. The commonest presenting feature was ulcer in the mouth followed by neck swelling,pain in the mouth, difficulty in swallowing, change in voice and ankyloglossia. The present study revealed most of the lesion were of ulcerative type.
Ultrasound in Medicine & Biology, 1996
This article is designed to find an appropriate policy to select nonpalpable cervical lymph nodes in head and neck squamous cell carcinoma patients for ultrasound-guided aspiration biopsy CUSS). According to the literature, generally used selection criteria are width of nodes >lO mm, length-to-width ratio >2 and absent echo-rich hilum. In 562 nonpalpable nodes of 355 patients (mean age 60 y, range 20-92 y) with head and neck squamous cell carcinoma, a USB procedure was carried out. Nodes were classified according to dimensions and to echo pattern. Representative cytology was obtained in 489 nodes: 112 were classified as malignant.
Sentinel Lymph Node Biopsy in Cancer of the Head and Neck
Radioguided Surgery, 2008
Our goals was to evaluate how sentinel lymph node biopsy (SLNB) benefit neck management in patients with parotid cancer. Patients diagnosed with cN0 parotid cancer by preoperative fine needle puncture were prospectively enrolled. The neck status was evaluated by SLNB. If node metastasis was proved by SLNB, a neck dissection of level I-V a was performed, or a wait-and-see policy was conducted for the patient. All related information was extracted and analyzed. Positive SLNB result occurred in 33 (16.7%) patients, and level II metastasis was noted in 100% of the patients. Isolated level III metastasis was noted in 3 (9.1%) patients. During our follow-up with mean time of 49.5 months, 20 patients developed regional recurrence, in which 6 patients had neck dissection as part of their initial management. All the recurrent neck disease was successfully salvaged. Therefore, SLNB was a reliable procedure for neck management in parotid cancer.
Lymph nodes assessment of neck in oral squamous cell carcinoma and its implication in management
International Journal of Applied Dental Sciences, 2020
Background and Aim: This study was conducted to find the correlation between clinically palpable neck nodes and their histopathological examination results which gives some information to the clinician regarding the choice of treatment and for appropriate management of the neck. After the surgical procedure, the whole specimen was submitted for the histopathological examination and a correlation between clinical positive or negative nodes and their histologically confirmed malignancies were drawn. Materials & Methods: A total of 200 patients with the diagnosis of oral malignancy subjected to oral and maxillofacial surgery department and institute of oncology over the period of 2 years were included in the study. Once the confirmation by histopathology was done, routine blood investigation, HIV/HBSAg test, ECG was done and physician's consent was taken prior to surgery under general anaesthesia. Pre-operatively thorough clinical palpation of the five levels of cervical lymph nodes was performed bilaterally. Results: On clinical examination of lymph nodes by palpation in 200 cases, 50 sides of necks were negative for palpation and 162 sides of necks were positive for palpation. On the histopathological examination of neck dissections, 8 of necks were positive. That is 46 cases were true positive that the histopathology showed no metastasis and 8 cases were false positive which showed metastasis in histopathology. Conclusion: Histopathology examination with its ability to detect 100% metastases in cervical lymph nodes remains the gold standard. Even though, Clinical examination was and is still the routine first line in detecting cervical lymph node metastases in head and neck squamous cell carcinoma, Its use shall be restricted for only an initial evaluation of the patient.
Neoplastic Lymphadenopathy in Head Neck Region -Cytological Study
https://www.ijhsr.org/IJHSR\_Vol.7\_Issue.3\_March2017/IJHSR\_Abstract.014.html, 2017
Background-FNAC is a gold standard for preoperative assessment of head and neck lymph nodes. It is safe, accurate, easy, effective, fast, minimally invasive, easy to perform and cost effective method. This study was done to evaluate the efficacy of FNAC and establish its reliability as a sole diagnostic method especially in the diagnosis of neoplastic lymph node lesions. Aims and objectives-To study all neoplastic lesions involving lymph node in the head and neck region and their statistical analysis. To evaluate the diagnostic accuracy, sensitivity and specificity of fine needle aspiration technique by correlating cytological and histopathological diagnosis. Methods-We prospectively studied patients referred to the cytology department with clinical diagnosis of lymph nodes swelling in head and neck from July 2011 to June 2013. Detail clinical, cytological and histopathological findings were studied. Results-The technical accuracy rate was 96.12% with 1390 adequate lymph node aspirates. The malignant lymph node lesions accounted for 122 (8.77%). Metastatic malignancies were most common neoplastic lesion and were common in elderly. Diagnosis of 67 cases was confirmed on histopathological examination with sensitivity of 100 % and specificity of 97.87 %. Conclusion-In this study the lymphoid lesions of head and neck region lymph node are studies with special reference to primary lymphoid and metastatic malignancies involving head and neck region lymph nodes and FNAC appears to be the highly effective method of diagnosis.
Aspiration Cytology of Metastatic Cervical Lymph Node: A Tertiary Health Centre Based Study
https://www.ijrrjournal.com/IJRR\_Vol.6\_Issue.10\_Oct2019/Abstract\_IJRR0048.html, 2019
Objective: the present study was conducted to assess the prevalence and cytological pattern of various metastatic cervical lymph nodes in the southern part of Rajasthan, India. Material and Methods: The prospective study was conducted in a tertiary healthcare centre of southern Rajasthan, India during the period of 1 year from August 2018 to August 2019. 100 patients with cytologically diagnosed metastatic cervical lymph node were included in the study. Review of all cytological reports were done according to standard guidelines and the diagnosis was classified and correlated with patient age and sex to explore the pattern and association. Results: Age of the patients' ranges from 29 to 70 years with the mean age of 54.16 years. Maximum patients (80%) were from the age group > 50 years. Among the 100 study participants, 83% were male and 17% were females (Male: Female ratio-4.89:1). Primary site was known in 89% cases while primary was occult in 11% cases. Out of 89 cases of known primary, 32 cases had primary in oral cavity followed by 24 cases having primary in larynx. On cytological examination, squamous cell carcinoma was found to be the most common type of tumour type (71%) followed by Adenocarcinoma (20 %). Conclusion: Fine needle aspiration cytology is an effective, economical and reliable method in diagnosing metastasis with good degree of certainty. Squamous cell carcinoma is most common type of metastatic tumour which commonly affects older individuals after the fifth decade with male preponderance.