Clinicopathological analysis of elective neck dissection for N0 neck of early oral tongue carcinoma
Clinicopathological analysis of elective neck dissection for N0 neck of early oral tongue carcinoma
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DOI：
10.1016/s0002-9610(98)00294-3
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发表时间：
1999-01-01
影响因子：
3
通讯作者：
Ho, CM
中科院分区：
文献类型：
--
作者：
Yuen, APW;Lam, KY;Ho, CM
背景：本研究旨在通过全器官连续切片评价择期颈清扫术作为早期口腔舌癌NO颈分期和治疗的效果。方法：纳入50例I期和II期患者。颈清扫标本以3mm间隔对整个器官进行切片，以评估淋巴结转移。结果：有18例（36％）患者存在亚临床淋巴结转移，在所有检查的2,826个淋巴结中，转移淋巴结总数为31个（1％）。转移灶的中位尺寸为3mm，占受累淋巴结横截面积中位的6%。同侧 II 级淋巴结是最常见的转移部位（26%）。 34% 术前放射学评估阴性的患者和 20% 术中颈部淋巴结冰冻切片取样阴性的患者存在转移淋巴结。亚临床淋巴结转移患者择期颈淋巴结清扫后若不进行术后放疗，区域复发率高（62%），生存率低（27%）。 结论：同侧I、II、III级颈清扫术是早期口腔舌癌NO颈部分期的充分诊断方法，其诊断作用是现有的术前放射学筛查和术中冰冻切片取样无法替代的。然而，择期选择性颈清扫术是一种有效但不充分的治疗方法，对于所有病理阳性的颈部都必须考虑术后辅助放疗和化疗。美国外科杂志。 1999； 177:90-92，(C) 1999，Excerpta Medica, Inc.
BACKGROUND: The study aims at evaluation of the efficacy of elective neck dissection as a staging and therapeutic procedure for NO neck of early carcinoma of the oral tongue by whole organ serial sectioning,METHODS: There were 50 stage I and II patients. The neck dissection specimens were whole organ sectioned in 3-mm intervals for the evaluation of nodal metastasis.RESULTS: There were 18 (36%) patients with subclinical nodal metastasis, The total number of metastatic nodes were 31 (1%) among all 2,826 nodes being examined. The metastatic foci had a median size of 3 mm and occupied a median of 6% of the cross sectional area of the involved nodes. The ipsilateral level II nodes were the commonest (26%) site of metastasis. Metastatic nodes were present in 34% patients who had negative preoperative radiological assessment and in 20% patients who had negative intraoperative frozen section sampling of neck nodes. Patients with subclinical nodal metastasis had a high incidence of regional recurrence (62%) and low survival (27%) when postoperative radiotherapy was not given after elective neck dissection.CONCLUSIONS: Ipsilateral level I,II,III neck dissection is an adequate diagnostic procedure for staging of the NO neck of early oral tongue carcinoma, Its diagnostic role cannot be replaced by the available pre-operative radiological screening and intra-operative frozen section sampling. However, elective selective neck dissection is an effective but not adequate therapeutic procedure, and post-operative adjuvant radiotherapy and chemotherapy have to be considered for all pathologically positive necks. Am J Surg. 1999; 177:90-92, (C) 1999 by Excerpta Medica, Inc.