Need for Intensive Histopathologic Analysis to Determine Lymph Node Metastases When Using Sentinel Node Biopsy in Oral Cancer
Need for Intensive Histopathologic Analysis to Determine Lymph Node Metastases When Using Sentinel Node Biopsy in Oral Cancer
复制标题
DOI：
10.1097/mlg.0b013e31815d8e15
复制
发表时间：
2008-03-01
期刊：
影响因子：
2.6
通讯作者：
Specht, Lena
中科院分区：
文献类型：
--
作者：
Bilde, Anders;von Buchwald, Christian;Specht, Lena
目的：确定前哨淋巴结活检（SNB）辅助颈清扫术对 T1 至 2N0M0 期口腔鳞状细胞癌（SCC）患者的预测价值，并确定亚淋巴结转移的发生率。研究设计：前瞻性队列研究。方法：51 例临床 N0 颈部患者接受了 SNB 辅助颈清扫术。使用动态和平面淋巴闪烁扫描和单光子发射计算机断层扫描确定前哨淋巴结（SN）的定位。使用苏木精 (H&E) 逐步连续切片和福尔马林固定、石蜡包埋的组织进行免疫组织化学，对收获的 SN 进行组织病理学检查。 结果：总共切除了 181 个 SN，每个患者平均切除 3 个（范围 1-7）个 SN。 4%（51 名中的 2 名）使用常规 H&E 染色可以识别出隐匿性淋巴结转移的患者，而当 H&E 评估为阴性时，18%（49 名中的 9 名）由于额外的组织病理学检查而被提前分期。总体而言，亚临床转移的发生率为 22%（51 例中的 11 例）。 结论：在这项研究中，SNB 辅助颈清扫术在识别亚临床转移方面被证明在技术上是可行的，因此在进行额外的组织病理学检查时，可以对口腔 SCC T1 至 2N0M0 患者的颈部进行高度敏感的准确分期。如果依赖 SNB，并且仅在 SN 阳性的情况下才进行选择性颈清扫术，则本研究中的绝大多数患者将不会进行选择性颈清扫术。未来的研究应集中于确定单独的 SNB 是否会降低患者的发病率，以及与口腔 SCC 患者的选择性颈清扫术相比，这种方法在治疗颈部淋巴结转移方面是否同样有效。
Objective: To determine the predictive value of sentinel node biopsy (SNB)-assisted neck dissection in patients with oral squamous cell carcinoma (SCC) stage T1 to 2N0M0 and to determine the incidence of subdinical metastases.Study Design: Prospective cohort study.Methods: Fifty-one patients with clinically N0 neck underwent SNB-assisted neck dissection. The localization of the sentinel node (SN) was determined using dynamic and planar lymphoscintigraphy and single photon emission computed tomography-computed tomography. Histopathologic examination of the harvested SN was performed using step-serial sectioning with hematoxylineosin (H&E) and immunohistochemistry on formalin-fixed, paraffin-embedded tissue.Results: A total of 181 SNs were excised with a median of 3 (range 1-7) SNs per patient. Four percent (2 of 51) of patients with subdinical (occult) lymph node metastasis would have been identified using routine H&E staining, whereas the 18% (9 of 49) were upstaged as a result of additional histopathology when the H&E evaluation was negative. Overall, the incidence of subclinical metastases was 22% (11 of 51).Conclusion: In this study, SNB-assisted neck dissection proved to be technically feasible in identifying subdinical metastasis, thus accurately staging the neck with a high degree of sensitivity in patients with oral SCC T1 to 2N0M0 when additional histopathology was performed. The vast majority of patients in this study would have been spared selective neck dissection had reliance on SNB been used and selective neck dissection performed only in the case of a positive SN. Future studies should focus on determining whether SNB alone reduces patient morbidity and whether this is as equally effective in the treatment of cervical nodal metastases as compared with selective neck dissection in patients with oral SCC.