Pre-Treatment Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as Predictors of Occult Cervical Metastasis in Clinically Negative Neck Supraglottic and Glottic Cancer

Background. Among patients with diagnosis of Laryngeal Squamous Cell Carcinoma (LSCC), up to 37.5% of cases may have occult metastasis (OM), and this feature is linked to poor prognosis and high rate of local recurrence. The role of elective neck dissection (END) in clinically negative neck (cN0) LSCC remains controversial. It is of great value to search for low-cost and easily detectable indicators to predict the risk of OM in laryngeal cancer. Recent reports have shown that high values of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) represent a negative prognostic factor in head and neck cancers. The aim of our study has been to investigate the value of pre-treatment NLR and PLR with regard to predicting occult cervical metastasis in cN0 supraglottic and glottic LSCC. Materials and methods. Data of patients affected by LSCC, who had been surgically treated by means of laryngectomy (total, horizontal partial and supracricoid) and END between January 2006 and January 2021, were retrospectively reviewed, using information retrieved from a database dedicated to such procedures in a single tertiary care referral institute. Results. A total of 387 patients were treated for LSCC at our Institute from 2006 to 2021, but only 108 of them met the inclusion criteria. The median age at the time of diagnosis was 64 years (range, 39–89 years). All the tumors were treated with a laryngectomy and an END. A total of 27.7% of patients were found positive for neck node metastasis (the pN+ group), while 78/108 (72.3%) patients were found to be negative for the presence of neck metastasis (the pN0 group). High values of NLR, but not PLR, significantly correlated with the probability of OM, and according to the iterative algorithm of Newton–Raphson, an NLR value of 2.26 corresponds to a probability of OM of 20%. Conclusion. Our analysis revealed a statistical correlation between high NLR pre-treatment values and positive neck OM in patients with LSCC.

Factors Predicting Nodal Metastasis in Penile Cancer: Analysis from a Tertiary Center

<b><i>Introduction:</i></b> Lymph node metastasis is an important prognostic marker in penile cancer. Identification of occult metastasis is by lymphadenectomy based on the histological features of primary tumor; however, this leads to unnecessary surgical morbidity in node negative patients. <b><i>Methods:</i></b> A retrospective analysis of all surgically treated penile cancer patients managed at our institute from January 2011 to March 2014 was performed. Patient characteristics, histological factors, and lymph node involvement were identified. Logistic regression analysis was used to compute odds ratio (OR) in univariate and multivariate analysis. <b><i>Results:</i></b> Ninety seven patients underwent surgical management at our institute during the abovementioned period. Grade III tumor, presence of lymphovascular invasion, tumor thickness &#x3e;10 mm, perineural invasion (PNI) and Ki67 &#x3e;50% were significantly associated with nodal metastasis. On multivariate analysis, only presence of PNI was found to be significant (OR: 6.82) (95% confidence interval: 1.72–27.03) (<i>p</i> = 0.006). <b><i>Conclusion:</i></b> PNI is a strong independent predictor of occult lymph node metastasis in penile cancers. Its inclusion in stratification of clinically node negative patients will identify high-risk patients who will benefit from prophylactic lymphadenectomy.

Prevalence of occult nodal metastases in squamous cell carcinoma of the temporal bone: A systematic review and meta-analysis

Objectives : Primary : To determine the rate of occult cervical metastasis in primary temporal bone squamous cell carcinomas (TBSSC). Secondary : to perform a subgroup meta-analysis of the risk of occult metastasis based on the clinical stage of the tumour and its risk based on corresponding levels of the neck Design : A systematic review and meta-analysis of papers searched through Medline, Cochrane, Embase, Scopus and Web of Science up to January 2021 to determine the pooled rate of occult lymph node/parotid metastases. Quality assessment of the included studies was assessed through the Newcastle-Ottawa scale. Setting : Centres around the world that perform surgery for TBSCC Participants : Patients with TBSCC Results : Overall, 9 out of 1034 screened studies met the inclusion criteria, for a total of 907 patients of which 388 had TBSCC. Out of the 191 patients who underwent a neck dissection, 21 had positive lymph nodes giving a pooled rate of occult metastases of 11% (95% CI: 7%-17%). When analysed using the Modified Pittsburg staging system, 21 pT2 cases had a pooled occult metastases rate of 3% (95% CI: 0%-21%), 27 pT3 cases had a pooled occult metastases rate of 12% (95% CI: 1%-60%), and 65 pT4 cases had a pooled occult metastases rate of 14% (95% CI: 7%-25%). Data available showed that most of the positive nodes were in Level II. Conclusion: The rate of occult cervical metastases in TBSCC increases based on the tumour (T) staging of the disease with majority of nodal disease found in level 2 of the neck.

Role of Selective Neck Dissection in Primary T1, T2, N0 Neck Oral Tongue Carcinoma

Background: Oral tongue is one of the common site for carcinoma. 22% to 39% of oral cancer develops at this site. The high incidence of cervical lymph node metastasis, occult cervical metastasis, Provide a logical basis for treatment of the neck. The aim of this is study was to find out the importance of selective neck dissection in primary T1, T2, N0 Neck Oral Tongue Carcinoma. Methods: This cross-sectional study was conducted in the Department of Otolaryngology- Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College Hospital and National Institute of ENT, Dhaka. Thirty cases of primary T1, T2, N0 Neck Oral Tongue Carcinoma with inclusion criteria was enrolled as a study sample. Patients were evaluated by a complete clinical head and neck examination as well as Imaging (MRI) of the primary tumor and neck. All the data were compiled and sorted properly and the numerical data were analyzed statistically. The results were expressed as percentage and mean ± SD. Chi-square (x2) test or Fisher’s Exact test was done for comparison of data presented in categorical value and p value <0.05 was considered as the level of significance. Among the patients 23(76.7%) were T1 lesion and remaining 7(23.33%) were T2 lesion. Extended Supraomohyoid Selective Neck Dissection (SOSD) (I-IV) was done in all patients. Following histopathological examination, 8(26.67%) patients of N0 neck became positive for nodal metastasis. Results: The study showed that most commonly (50%) involved group of occult metastasis was upper deep cervical lymph node in submandibular area (level-I). Occult nodal metastasis was significantly common 87.5% among male patients than females (p=0.039) and also common 87.5% among <50 years age group (p=0.023). Neck node positive was significantly more 62.5% in T2 lesion (p=0.002) of oral tongue carcinoma. Conclusion: In this study, we found that a number of patients had been histopathologicallly detected micro-metastases in regional neck nodes in clinically N0 patients.So, Extended Supraomohyoid Selective neck dissection (I-IV) was appropriate in T1,T2, N0 Neck Oral Tongue Carcinoma. Bangladesh J Otorhinolaryngol 2021; 27(2): 130-138

The frequency of occult cervical metastasis in oral squamous cell carcinoma patients - A cross sectional study

Objective: To determine the frequency of occult cervical metastasis in oral squamous cell carcinoma patients. Methods: This cross sectional study was conducted in the department of maxillofacial surgery, Mayo Hospital, Lahore from July 31st, 2015 to January 31st, 2016 on 100 patients of oral Squamous Cell Carcinoma (SCC) having clinically and radiologically negative nodes. Prophylactic functional neck dissection was done in each patient and was sent to the pathology lab for evaluation of any occult metastasis. Results: Overall frequency of occult cervical metastasis was found to be 27%. In 41(41 %) specimens of SCC of tongue, 13(31.7%) had occult metastasis. In Alveolar mucosa occult metastasis was found in 4(20 %) out of 20(20 %) patients. In SCC of buccal mucosa occult metastasis was found in 10(29.4%) out of 34(34 %) patients. In SCC of lip no occult metastasis was detected. Conclusion: Within the boundaries of the present study, it is concluded that occult cervical metastasis was most frequent in cases of SCC tongue, whereas no occult cervical metastasis detected in SCC of lip. Key Words: Squamous cell carcinoma, cervical lymph nodes, prophylactic neck dissection, occult cervical metastasis. Continuous...

Assessing the Risk of Nodal Metastases in Canine Integumentary Mast Cell Tumors: Is Sentinel Lymph Node Biopsy Always Necessary?

The recent literature supports the sentinel lymph node (SLN) biopsy in dogs with MCT due to discrepancy with the regional lymph node and the high percentage of occult metastasis. However, the SLN biopsy includes additional anesthesiologic, diagnostic, and surgical procedures, and additional costs. The study aimed to assess the association between clinicopathological variables and SLN status, determining the identification of dogs at lower risk of SLN metastases. Dogs with integumentary MCT were admitted to the lymphoscintigraphic mapping and subsequent biopsy of SLN. The association between clinicopathological variables of MCT and SLN status was statistically tested, both considering occult and overt metastasis together (HN2-HN3) and overt metastasis (HN3) alone. Fifty low-grade cutaneous MCT and 16 subcutaneous MCT were included. A small to moderate association between integumentary MCT ≥ 3 cm and HN2-HN3 SLN was found. A strong association of integumentary MCT dimension and subcutaneous MCT with HN3 SLN occurred. Dimension of low-grade cutaneous and subcutaneous MCT seems to correlate with SLN status, but additional study should confirm this data before excluding small MCT to the SLN biopsy. On the contrary, the study results induce a solid suggestion for mapping and biopsy of the SLN in MCT > 3 cm and subcutaneous MCT.

Is routine neck dissection warranted at salvage laryngectomy?

Background There is controversy regarding management of the neck at salvage laryngectomy. The aim of this study was to perform an analysis to determine the incidence of occult node positivity in this group and analyse factors affecting it. Method A retrospective analysis of 171 patients who underwent salvage total laryngectomy between 2000 and 2015 for recurrent or residual disease following definitive non-surgical treatment and were clinico-radiologically node negative at the time salvage laryngectomy was carried out. Results A total of 171 patients with laryngeal or hypopharyngeal cancers underwent concurrent neck dissection at laryngectomy. There were 162 patients (94.7 per cent) who underwent bilateral neck dissection, and 9 patients (5.3 per cent) who underwent ipsilateral neck dissection. The occult lateral nodal metastasis rate was 10.5 per cent. Of various factors, initial node positive disease was the only factor predicting occult metastasis on univariable and multivariable analysis (p = 0.001). Conclusion Risk of occult metastasis is high in patients who have node positive disease before starting radiotherapy. This group should be offered elective neck dissection.