scholarly journals Precise Intraoperative Lymph Node Identification by Isosulfan Blue of Occult Neck Lymph Node Metastases for Decision to Convert from Supraomohyoid Neck Dissection to Comprehensive Neck Dissection in Early-Stage Oral Cancer

2021 ◽  
pp. 54-60
Author(s):  
Somjin Chindavijak
Keyword(s):  
Lymph Node ◽  
Oral Cancer ◽  
Lymph Nodes ◽  
Neck Dissection ◽  
Early Stage ◽  
Isosulfan Blue ◽  
Neck Lymph Node ◽  
Blue Node ◽  
Metastatic Lymph ◽  
Supraomohyoid Neck Dissection

Objective: To study the sensitivity and specificity of peritumoral isosulfan blue dye injection for localization of suspected metastatic lymph nodes. Materials and methods: The study included all patients diagnosed with early-stage oral cancer between January 2018 and March 2020. After elevation of the skin flap, the primary site was injected peritumorally with isosulfan blue 0.3-0.5 cc at 1 cm intervals and massaged.  The time at which any draining nodes turned blue was recorded and the node was then excised for frozen section.  After which supraomohyoid neck dissection was performed.  The frozen sections were stained with H&E and analyzed for presence of metastases. Negative sections were further analyzed using immunohistochemistry stains.  Sensitivity, specificity and time of identification suspected metastatic lymph node were analyzed . Results: Nineteen patients with early-stage oral cancer were included.  The majority (78.4%) presented with tongue lesions. The mean injection amount administered was 3.62±0.83 cc, and the number of injections around the tumor were 10.26±2.31. Mean duration from time of injection to the identification of a blue node was 19.26±15.99 min.  Nodes at Level I of the neck were the most common identified as blue nodes (57.8%).  Statistical analysis comparing pathological findings with blue node identification revealed this technique has a sensitivity of 71.4% with specificity of 91.7% and an overall accuracy of 84.2% in identify metastasis lymph node.  Conclusion: Isosulfan blue injection of primary oral tumors demonstrated a high level of efficiency in identifying metastatic lesions in draining lymph nodes. This technique may be helpful in deciding intraoperatively whether to convert from supraomohyoid neck dissection to  comprehensive neck dissection  .

Evaluation of PET imaging in treatment decision making for early stage head and neck squamous cell cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17017-e17017
Author(s):  
R. Dulala ◽  
J. L. Campian ◽  
S. Dubner ◽  
D. Frank ◽  
E. Gabalski ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Predictive Value ◽  
Early Stage ◽  
Pet Scan ◽  
Eligibility Criteria ◽  
Early Stage Disease ◽  
Neck Lymph Node ◽  
Stage Disease ◽  
Pet Scans

e17017 Background: Positron emission tomography (PET) scanning is widely used in staging of patients (pts.) with head and neck squamous cell cancers (HNSCC). However, the role of PET scan in pts. with early stage disease and clinically negative nodes remains controversial. The purpose of our study was to correlate preoperative PET scan findings in early stage disease with operative pathological findings of neck dissection. Methods: A retrospective review of medical records of all pts. treated at Long Island Jewish Medical Center with T1N0 HNSCC from 2002 to 2008 was undertaken. Institutional Review Board approval was obtained for this study. Eligibility criteria included: clinically staged T1N0, documented pre-operative PET scans and primary surgical management including a neck lymph node dissection as part of initial treatment. Data collected included age, gender, physical examination findings, PET scan results, operative pathology and modalities of treatment. Results: Sixty six pts with early stage T1N0 HNSCC were identified. Twelve of sixty six pts met eligibility criteria for this study. Median age was 61 years (range: 27 to 84 yrs), M:F ratio was 1:1. Primary sites of tumor were: tongue (n = 8) 67%; oral cavity (n = 3) 25%; larynx (n = 1) 8%. Preoperative PET scan was positive at primary sites in all pts (n = 12). Additionally, PET positivity was noted in regional lymph node sites in six of twelve pts. Operative pathology confirmed tumor presence in all primary sites. However, nodal involvement was not found in any pt. Median numbers of lymph nodes dissected were 25 (range:13–34). Based on these clinical data, the calculated statistical parameters for preoperative PET scan in detecting occult neck lymph node metastases were: negative predictive value: 100%; positive predictive value: 50%: specificity: 50%; sensitivity: 0%. Conclusions: The clinical application of PET scans in early stage (T1N0) HNSCC may be limited by its high false positive rate. A high negative predictive value suggests that a negative result can exclude metastatic lymph nodes involvement in this group of pts. with early stage disease. Correlation with SUV values of the PET scans and comparisons between the relative PET avidity of the primary tumors and the nodal uptake are ongoing. No significant financial relationships to disclose.

scholarly journals Elective Neck Dissection or Sentinel Lymph Node Biopsy in Early Stage Oral Cavity Cancer Patients: The Dutch Experience

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1783 ◽  
Author(s):  
Inne J. den Toom ◽  
Koos Boeve ◽  
Daphne Lobeek ◽  
Elisabeth Bloemena ◽  
Maarten L. Donswijk ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Oral Cancer ◽  
Neck Dissection ◽  
Early Stage ◽  
Lymph Node Biopsy ◽  
Elective Neck Dissection ◽  
Floor Of Mouth ◽  
Node Biopsy

Background: Sentinel lymph node biopsy (SLNB) has been introduced as a diagnostic staging modality for detection of occult metastases in patients with early stage oral cancer. Comparisons regarding accuracy to the routinely used elective neck dissection (END) are lacking in literature. Methods: A retrospective, multicenter cohort study included 390 patients staged by END and 488 by SLNB. Results: The overall sensitivity (84% vs. 81%, p = 0.612) and negative predictive value (NPV) (93%, p = 1.000) were comparable between END and SLNB patients. The END cohort contained more pT2 tumours (51%) compared to the SLNB cohort (23%) (p < 0.001). No differences were found for sensitivity and NPV between SLNB and END divided by pT stage. In floor-of-mouth (FOM) tumours, SLNB had a lower sensitivity (63% vs. 92%, p = 0.006) and NPV (90% vs. 97%, p = 0.057) compared to END. Higher disease-specific survival (DSS) rates were found for pT1 SLNB patients compared to pT1 END patients (96% vs. 90%, p = 0.048). Conclusion: In the absence of randomized clinical trials, this study provides the highest available evidence that, in oral cancer, SLNB is as accurate as END in detecting occult lymph node metastases, except for floor-of-mouth tumours.

scholarly journals Selective neck dissection in the treatment of pN1/2 neck lymph-node metastases

2003 ◽  
Vol 56 (5-6) ◽  
pp. 221-6 ◽  
Author(s):  
Rajko Jovic ◽  
Karol Canji ◽  
Slobodan Mitrovic ◽  
Vladimir Kljajic
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Neck Dissection ◽  
Lymph Node Metastases ◽  
Adjuvant Radiotherapy ◽  
Selective Neck Dissection ◽  
Neck Lymph Node ◽  
Neck Metastases ◽  
Node Metastases ◽  
Neck Lymph Node Metastases

Introduction As yet there is no single reliable and accurate method for detection of neck lymph node metastases. Therapeutic approaches differ from one author to other. The aim of this paper was to establish the extent to which, with good control of primary process, we can control spreading of malignant disease by means of selective neck dissection. Material and method This retrospective study included 595 surgically treated patients in the period 1990 - 1998. There were 525 patients with malignant laryngeal tumors, and 70 patients with malignant hypopharyngeal tumors. Preoperative diagnostics of enlarged lymph nodes was based on palpation of the neck without CT, US, NMR diagnostics. With all risky N0 patients, selective neck dissection was performed for presence of occult metastases. Intraoperative frozen section analysis was not performed. Adjuvant radiotherapy was performed in all patients in whom presence of neck lymph node metastases was histologically proved. Results Selective lateral neck dissection was performed in 389 (65.4%) patients. In 78 (20%) patients, lymph node metastases were patohistologically detected. In 5 (6.4%) transitional cellular cancer was histologically diagnosed, and the remaining 73 (93.6%) presented with squamous cell cancer. Postoperative radiation therapy was applied in 54 patients (69.2%) while 24 (30.8%) were not irradiated. 5-year survival was achieved in 18 (23.1%), and 3-year survival was achieved in 15 (19.2%) patients. Out of 45 patients who lived less than tree year, 18 (40%) presented with metastatic relapse and fatal outcome. Relapse of neck metastases appeared in 12 (11.9%) on the side and in the zones of lymph nodes which were included in neck dissection. Recurrence of neck metastases appeared in 8.3% of patients who were not irradiated postoperatively and in 32.1% of cases irradiated postoperatively. Discussion This study includes comparison of our results with results of literature data. Conclusion Neck lymph node metastases point to advanced malignant process of the third or forth stage of the disease when results are the worst and 5-year survival decreases with or without adjuvant radiotherapy.

Differentiation of Hyperplastic from Metastatic Lymph Nodes Using a Lymph Node Specific MR Contrast Agent Gadofluorine M

2006 ◽  
Vol 55 (2) ◽  
pp. 183 ◽  
Author(s):  
Joo Hee Cha ◽  
Woo Kyung Moon ◽  
Jung Eun Cheon ◽  
Young Hwan Koh ◽  
Eun Hye Lee ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Contrast Agent ◽  
Metastatic Lymph Nodes ◽  
Metastatic Lymph ◽  
Gadofluorine M

Laparoscopic detection of sentinel lymph nodes followed by lymph node dissection in patients with early stage cervical cancer

2003 ◽  
Vol 90 (2) ◽  
pp. 290-296 ◽  
Author(s):  
Marrije R Buist ◽  
Rik J Pijpers ◽  
Arthur van Lingen ◽  
Paul J van Diest ◽  
Jan Dijkstra ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Early Stage ◽  
Sentinel Lymph Nodes ◽  
Node Dissection ◽  
Early Stage Cervical Cancer

scholarly journals Nanoparticles can improve the positive rate of metastatic lymph node in thyroid cancer surgery

2020 ◽  
Author(s):  
Xindi Su ◽  
Fang Chai ◽  
Benrui Lin ◽  
Lu Qu ◽  
Keyi Liu ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Metastatic Lymph Node ◽  
Cancer Surgery ◽  
Control Group ◽  
Blood Calcium ◽  
Metastatic Lymph ◽  
Positive Rate ◽  
Experimental Group

Abstract Objective. To investigate the application of carbon nanoparticles in lymph node dissection and parathyroid gland protection during thyroid cancer surgery. Subjects and Methods. Retrospective analysis was performed on 282 cases of thyroid cancer surgery in our hospital from 2018 to 2019. All patients underwent total thyroidectomy and cervical central lymph node dissection. Nanocarbon was not used in the control group, but was used in the experimental group. The general situation of the patients, the number of postoperative lymph nodes and the number of metastasis were collected, and the differences between serum parathyroid hormone and blood calcium were compared before and on the 3rd and 30th day after surgery. Results. There was no difference in age, sex and TNM stage between the two groups (P > 0.05). The number of metastatic lymph nodes in the experimental group (9.80 ± 4.80) was different from that in the control group (6.95 ± 3.86) (P < 0.05), and the number of metastatic lymph nodes in the experimental group was different from that in the control group (χ2 = 14.968, P < 0.05). There was no difference in blood calcium and PTH between the two groups before and at 3 and 30 days after surgery (P > 0. 05). Conclusion. The application of carbon nanoparticles in thyroid cancer surgery can significantly increase the number of lymph nodes seized and the positive rate of metastatic lymph node removal, but the protection of parathyroid gland is not obvious.

Supraspinal accessory lymph node metastases in supraomohyoid neck dissection

1996 ◽  
Vol 172 (6) ◽  
pp. 646-649 ◽  
Author(s):  
Dennis H. Kraus ◽  
David B. Rosenberg ◽  
Bruce J. Davidson ◽  
Ashok R. Shaha ◽  
Ronald H. Spiro ◽  
...  
Keyword(s):  
Lymph Node ◽  
Neck Dissection ◽  
Lymph Node Metastases ◽  
Supraomohyoid Neck Dissection ◽  
Node Metastases

scholarly journals Outcome of Cervical Lymph Nodes Dissection for Thyroid Cancer with Nodal Metastases: A Southeast Asian 3-Year Experience

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Raymond Z. M. Lim ◽  
Juin Y. Ooi ◽  
Jih H. Tan ◽  
Henry C. L. Tan ◽  
Seniyah M. Sikin
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Neck Dissection ◽  
Lymph Node Dissection ◽  
Endocrine Surgery ◽  
Node Dissection ◽  
Referral Centre ◽  
Local Data ◽  
Cervical Lymph Nodes

Introduction. Therapeutic nodal dissection is still the mainstay of treatment for patients with lymph node metastases in many centres. The local data, however, on the outcome of therapeutic LND remains limited. Hence, this study aims to inform practice by presenting the outcomes of LND for thyroid cancer patients and our experience in a tertiary referral centre.Methods. This is a single-centre retrospective observational study in a Malaysian tertiary endocrine surgery referral centre. Patients who underwent total thyroidectomy with lymph node dissection between years 2013 and 2015 were included and electronic medical records over a 3-year follow-up period were reviewed. The outcomes of different lymph node dissection (LND), including central neck dissection, lateral neck dissection, or both, were compared.Results. Of the 43 subjects included, 28 (65.1%) had Stage IV cancer. Among the 43 subjects included, 8 underwent central LND, and 15 had lateral LND while the remaining 20 had dissection of both lateral and central lymph nodes. Locoregional recurrence was found in 16 (37.2%) of our subjects included, with no statistical difference between the central (2/8), lateral (7/15), and both (7/20). Postoperative hypocalcaemia occurred in 7 (16.3%) patients, and vocal cord palsy occurred in 5 (11.6%), whereas 9 patients (20.9%) required reoperation. Death occurred in 4 of our patients.Conclusion. High recurrence and reoperative rates were observed in our centre. While the routine prophylactic LND remains controversial, high risk patients may be considered for prophylactic LND. The long-term risk and benefit of prophylactic LND with individualised patient selection in the local setting deserve further studies.

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