Cam we detect or predict the presence of occult nodal metastases in patients with squamous carcinoma of the oral tongue?
Cam we detect or predict the presence of occult nodal metastases in patients with squamous carcinoma of the oral tongue?
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DOI：
10.1002/(sici)1097-0347(199803)20:2
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发表时间：
1998-03-01
影响因子：
2.9
通讯作者：
Wolf, PJ
中科院分区：
文献类型：
--
作者：
Byers, RM;El-Naggar, AK;Wolf, PJ
背景对于口腔舌鳞状细胞癌患者，何时进行颈淋巴结清扫术是有争议的，特别是当原发癌可以在不进入颈部的情况下切除时。如果能确定颈部隐匿性淋巴结疾病的高危患者，就可以进行淋巴结清扫和舌切除术。为了更好地确定患者的这种程序，我们相关的各种肿瘤和患者的因素沿着与术前诊断研究的存在或不存在的病理阳性淋巴结的一组患者谁经历了noddysplantation.Methods，91例以前未经治疗的患者活检证实的口腔舌鳞癌进行了前瞻性研究，所有患者都有舌切除术和颈淋巴结清扫术作为他们的初始治疗。将病理结果（即淋巴结伴鳞癌）与术前、术中多种因素进行相关性分析，并进行统计学处理。使用计算机断层扫描和超声并不比临床检查更好地确定是否存在淋巴结转移。最好的预测因素是肌肉浸润深度、双DNA异倍体和肿瘤的组织分化。所有T2-T4期口腔舌鳞状细胞癌患者都应进行选择性颈淋巴结清扫。患有T1 NO癌症的患者，如果有双DNA非整倍体肿瘤，肌肉浸润深度> 4 mm，或有低分化癌症，则应明确接受选择性颈淋巴结清扫术。超声和计算机断层扫描在预测哪些患者有阳性淋巴结方面价值不大。(C)John Wiley & Sons，Inc.
Background. When to do a neck dissection as part of the surgical treatment for a patient with squamous carcinoma of the oral tongue is controversial, particularly when the primary can De resected without entering the neck. if the patient who is al high risk for having occult nodal disease in the neck can De identified, node dissection with the glossectomy could be justified. To better identify patients for this procedure, we correlated various tumor and patient factors along with preoperative diagnostic studies with the presence or absence of pathologically positive nodes in a group of patients who underwent node dissection.Methods, Ninety-one previously untreated patients with biopsy-proved squamous carcinoma of the oral tongue were prospectively studied, All patients had a glossectomy and neck dissection as their initial treatment. The pathology findings (ie, lymph nodes with squamous cancer) were correlated with many preoperative and intraoperative factors, and a statistical analysis was made.Results. The use of computed tomography and ultrasound was not better than the clinical examination in determining the presence or absence of nodal metastases. The best predictors were depth of muscle invasion, double DNA aneuploidy, and histologic differentiation of the tumor.Conclusions. All patients with stage T2-T4 squamous cancers of the oral tongue should have an elective dissection of the neck. Patients with T1NO cancer who have a double DNA-aneuploid tumor, depth of muscle invasion > 4 mm, or have a poorly differentiated cancer should definitely undergo elective neck dissection. Ultrasound and computed tomography are of little value in predicting which patients have positive nodes. (C) 1998 John Wiley & Sons, Inc.