Current State of Neck Dissection in the United States
Current State of Neck Dissection in the United States
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DOI：
10.1007/s12105-009-0129-y
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发表时间：
2009-09-01
影响因子：
2.1
通讯作者：
Seethala, Raja R.
中科院分区：
文献类型：
--
作者：
Seethala, Raja R.
颈部淋巴结的状态是头颈部鳞状细胞癌最重要的预后指标。颈部清扫既是一种治疗方法，也是一种分期方法，并已发展为包括淋巴结组标准化水平名称（I-VI）的各种类型：根治性颈部清扫、改良根治性颈部清扫、选择性颈部清扫和扩展性颈部清扫。颈部剥离的大体和组织学检查应提供关键信息（转移的大小，累及的淋巴结数量），以便进行分期。此外，由于其作为不良预后因素的重要性，淋巴结转移的囊外扩散必须报告。目前淋巴结疾病的困境是微转移的检测、分离的肿瘤细胞和分子阳性。这些疾病类别的意义尚不清楚，尽管它们可以解释约10%的颈部局部复发，尽管通过传统的评估方法病理淋巴结阴性。前哨淋巴结活检最近被应用于头颈部鳞状细胞癌，以加强临床放射检查淋巴结阴性患者的管理。虽然仍处于研究阶段，前哨淋巴结活检在选择需要颈部清扫的患者方面显示出希望。基于快速、高度自动化的实时RT-PCR平台将允许将分子发现纳入前哨淋巴结的术中评估。
The status of the cervical lymph nodes is the most important prognosticator in head and neck squamous cell carcinoma. The neck dissection is both a therapeutic and staging procedure and has evolved to include various types with standardized level designations (I-VI) for lymph node groups: the radical neck dissection, modified radical neck dissection, the selective neck dissection, and the extended neck dissection. The gross and histologic examination of a neck dissection should provide the critical information (size of metastasis, number of lymph nodes involved) for staging purposes. Additionally, extracapsular spread of lymph node metastasis must be reported because of its significance as an adverse prognosticator. Current dilemmas in nodal disease are the detection of micrometastases, isolated tumor cells, and molecular positivity. The significance of these categories of disease is still unclear, though they may explain a subset of the estimated 10% of the regional recurrences in the neck despite pathologic node negativity by traditional methods of evaluation. Sentinel lymph node biopsy has been recently applied to head and neck squamous cell carcinoma to enhance the management of the clinicoradiographically node negative patients. While still investigational, sentinel lymph node biopsy shows promise in selecting patients who require a neck dissection. Rapid highly automated real-time RT-PCR based platforms will allow for incorporation of molecular findings into the intraoperative evaluation of a sentinel lymph node.