Prophylactic Neck Dissection in Early Oral Tongue Squamous Cell Carcinoma 2.1 to 4.0 mm Depth

ObjectiveMET positivity is independently associated with survival in oral squamous cell carcinoma (OSCC). Since MET is a known orchestrator of invasive tumor growth, we investigated its association with LNM in early oral tongue squamous cell carcinoma (OTSCC). As it is recommended by the NCCN to use tumor depth of invasion (DOI) in making decisions on elective neck dissection (END), the results obtained for MET positivity were aligned with those for DOI > 4 mm. The cutoff value used in our institution.MethodsTumor samples from patients who underwent primary tumor resection and neck dissection between 1995 and 2013, were collected from the archives of the Leiden and Erasmus University Medical Center. Immunohistochemistry with D1C2 was performed to identify MET negative (< 10% uniform positivity) and MET positive (≥ 10% uniform positivity) cancers. ROC curve analysis and the Chi-squared test were used to investigate the association of MET positivity with LNM (pN+ and occult). Binary logistic regression was used to investigate the association of MET positivity with LNM.ResultsForty-five (44.1%) of the 102 cancers were MET positive. Ninety were cN0 of which 20 were pN+ (occult metastasis). The remaining 12 cancers were cN+, of which 10 were proven pN+ and 2 were pN0. MET positivity was associated with LNM with a positive predictive value (PPV) of 44.4% and a negative predictive value (NPV) of 82.5% for pN+. For the occult group, the PPV was 36.8% and the NPV was 88.5%. Regression analysis showed that MET positivity is associated with pN+ and occult LNM (p-value < 0.05).ConclusionMET positivity is significantly associated with LNM in early OTSCC, outperforming DOI. The added value of MET positivity could be in the preoperative setting when END is being considered during the initial surgery. For cases with DOI ≤ 4 mm, MET positivity could aid in the clinical decision whether regular follow-up, watchful waiting, or END is more appropriate. Realizing that these preliminary results need to be independently validated in a larger patient cohort, we believe that MET positivity could be of added value in the decision making on END in early OTSCC.

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Elective Neck Dissection Versus Observation in cT1–T2 Oral Tongue Squamous Cell Carcinoma: A Meta-Analysis of 11,973 Patients

Indian Journal of Otolaryngology and Head & Neck Surgery ◽

10.1007/s12070-020-02118-y ◽

2020 ◽

Author(s):

Mohammad Akheel ◽

Rinku K. George ◽

Sukirti Tiwari ◽

Amit Jain ◽

Qutubuddin Chahwala ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Neck Dissection ◽

Squamous Cell ◽

Meta Analysis ◽

Tongue Squamous Cell Carcinoma ◽

Elective Neck Dissection ◽

Oral Tongue

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Patterns of cervical lymph node metastases in oral tongue squamous cell carcinoma: implications for elective and therapeutic neck dissection

The Journal of Laryngology & Otology ◽

10.1017/s0022215114000267 ◽

2014 ◽

Vol 128 (3) ◽

pp. 268-273 ◽

Cited By ~ 15

Author(s):

E Dogan ◽

H O Cetinayak ◽

S Sarioglu ◽

T K Erdag ◽

A O Ikiz

Keyword(s):

Squamous Cell Carcinoma ◽

Lymph Node ◽

Cell Carcinoma ◽

Neck Dissection ◽

Squamous Cell ◽

Tongue Squamous Cell Carcinoma ◽

Oral Tongue ◽

Node Negative ◽

Node Metastases ◽

Clinically Node Positive

AbstractObjectives:To determine the patterns of lymph node metastases in oral tongue carcinomas, and examine the implications for elective and therapeutic neck dissection.Method:The study entailed a retrospective analysis of 67 patients with previously untreated oral tongue squamous cell carcinoma who had undergone simultaneous glossectomy and neck dissection.Results:Of the 40 clinically node-negative patients, 7 patients had metastatic lymph nodes on pathological examination. No occult metastasis was found at level IV. Of the 27 clinically node-positive patients, the incidence rate of level IV metastasis was 11.1 per cent (3 out of 27 patients). No ‘skip metastases’ were found at level IV. Level IV metastases were significantly related to clinically staged nodes categorised as over 2a (p = 0.03) and metastasis to level III (p = 0.01).Conclusion:Routine inclusion of level IV in elective neck dissection is not necessary for clinically node-negative patients with oral tongue squamous cell carcinoma. Furthermore, extended supraomohyoid neck dissection with adjuvant radiotherapy can be sufficient in the treatment of selected patients with clinically node-positive necks.

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