Karl Christoph Sproll1, Sabina Leydag2, Henrik Holtmann3, Lara K Schorn2, Joel Aissa4, Patric Kröpil5, Wolfgang Kaisers6, Csaba Tóth7, Jörg Handschel8, Julian Lommen2. 1. Department of Oral and Maxillofacial Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University, Düsseldorf, Germany. christoph.sproll@med.uni-duesseldorf.de. 2. Department of Oral and Maxillofacial Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University, Düsseldorf, Germany. 3. Department of Oral and Maxillofacial Surgery, Protestant Hospital Bethesda, Mönchengladbach, Germany. 4. Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of the Heinrich-Heine-University, Düsseldorf, Germany. 5. Department of Radiology, BG Clinic Duisburg, Duisburg, Germany. 6. Department of Anesthesiology, Medical Faculty of the University of Witten-Herdecke, Helios University Hospital Wuppertal, Wuppertal, Germany. 7. Department of Pathology, Medical Faculty, Heidelberg University Hospital, Heidelberg, Germany. 8. Clinic for Oral and Maxillofacial Surgery, Klinik Am Kaiserteich, Düsseldorf, Germany.
Abstract
INTRODUCTION: Proper management of the clinically involved neck in OSCC patients continues to be a matter of debate. Our aim was to analyze the accuracy of computerized tomography (CT) and ultrasound (US) in anticipating the exact location of lymph node (LN) metastases of OSCC patients across the AAO-HNS (American Academy of Otolaryngology-Head and Neck Surgery) levels ipsi- and contralaterally. Furthermore, we wanted to assess the suitability of therapeutic selective neck dissection (SND) in patients with one or two ipsilateral positive nodes upon clinical staging (cN1/cN2a and cN2b(2/x) patients). METHODS: We prospectively analyzed the LN status of patients with primary OSCC using CT and US from 2007 to 2013. LNs were individually assigned to a map containing the AAO-HNS levels; patients bearing a single or just two ipsilateral positive nodes (designated cN1/cN2a or cN2b(2/x) patients either by CT (CT group) or US alone (US group) or in a group combining findings of CT and US (CTUS group)) received an ipsi-ND (I-V) and a contra-ND (I-IV). 78% of the LNs were sent individually for routine histopathological examination; the remaining were dissected and analyzed per neck level. RESULTS: Upon the analysis of 1.670 LNs of 57 patients, the exact location of pathology proven LN metastases in cN1 patients was more precisely predicted by US compared to CT with confirmed findings only in levels IA, IB und IIA. Clearly decreasing the number of missed lesions, the findings in the CTUS group nearly kept the spatial reliability of the US group. The same analysis for patients with exactly two supposed ipsilateral lesions (cN2b(2/x)) yielded confirmed metastases from levels I to V for both methods individually and in combination and, therefore, render SND insufficient for these cases. CONCLUSION: Our findings stress the importance of conducting both, CT and US, in patients with primary OSCC. Only the combination of their findings warrants the application of therapeutic SND in patients with a single ipsilateral LN metastasis (cN1/cN2a patients) but not in patients with more than one lesion upon clinical staging (≥ cN2b).
INTRODUCTION: Proper management of the clinically involved neck in OSCC patients continues to be a matter of debate. Our aim was to analyze the accuracy of computerized tomography (CT) and ultrasound (US) in anticipating the exact location of lymph node (LN) metastases of OSCC patients across the AAO-HNS (American Academy of Otolaryngology-Head and Neck Surgery) levels ipsi- and contralaterally. Furthermore, we wanted to assess the suitability of therapeutic selective neck dissection (SND) in patients with one or two ipsilateral positive nodes upon clinical staging (cN1/cN2a and cN2b(2/x) patients). METHODS: We prospectively analyzed the LN status of patients with primary OSCC using CT and US from 2007 to 2013. LNs were individually assigned to a map containing the AAO-HNS levels; patients bearing a single or just two ipsilateral positive nodes (designated cN1/cN2a or cN2b(2/x) patients either by CT (CT group) or US alone (US group) or in a group combining findings of CT and US (CTUS group)) received an ipsi-ND (I-V) and a contra-ND (I-IV). 78% of the LNs were sent individually for routine histopathological examination; the remaining were dissected and analyzed per neck level. RESULTS: Upon the analysis of 1.670 LNs of 57 patients, the exact location of pathology proven LN metastases in cN1patients was more precisely predicted by US compared to CT with confirmed findings only in levels IA, IB und IIA. Clearly decreasing the number of missed lesions, the findings in the CTUS group nearly kept the spatial reliability of the US group. The same analysis for patients with exactly two supposed ipsilateral lesions (cN2b(2/x)) yielded confirmed metastases from levels I to V for both methods individually and in combination and, therefore, render SND insufficient for these cases. CONCLUSION: Our findings stress the importance of conducting both, CT and US, in patients with primary OSCC. Only the combination of their findings warrants the application of therapeutic SND in patients with a single ipsilateral LN metastasis (cN1/cN2a patients) but not in patients with more than one lesion upon clinical staging (≥ cN2b).
Authors: Alfio Ferlito; K Thomas Robbins; Jatin P Shah; Jesus E Medina; Carl E Silver; Shawkat Al-Tamimi; Johannes J Fagan; Vinidh Paleri; Robert P Takes; Carol R Bradford; Kenneth O Devaney; Sandro J Stoeckli; Randal S Weber; Patrick J Bradley; Carlos Suárez; C René Leemans; H Hakan Coskun; Karen T Pitman; Ashok R Shaha; Remco de Bree; Dana M Hartl; Missak Haigentz; Juan P Rodrigo; Marc Hamoir; Avi Khafif; Johannes A Langendijk; Randall P Owen; Alvaro Sanabria; Primož Strojan; Vincent Vander Poorten; Jochen A Werner; Stanisław Bień; Julia A Woolgar; Peter Zbären; Jan Betka; Benedikt J Folz; Eric M Genden; Yoav P Talmi; Marshall Strome; Jesús Herranz González Botas; Jan Olofsson; Luiz P Kowalski; Jon D Holmes; Yasuo Hisa; Alessandra Rinaldo Journal: Head Neck Date: 2010-11-17 Impact factor: 3.147
Authors: Remco de Bree; Robert P Takes; Jonas A Castelijns; Jesus E Medina; Sandro J Stoeckli; Anthony A Mancuso; Jennifer L Hunt; Juan P Rodrigo; Asterios Triantafyllou; Afshin Teymoortash; Francisco J Civantos; Alessandra Rinaldo; Karen T Pitman; Marc Hamoir; K Thomas Robbins; Carl E Silver; Otto S Hoekstra; Alfio Ferlito Journal: Head Neck Date: 2014-09-26 Impact factor: 3.147
Authors: Alyson Bessell; Anne-Marie Glenny; Susan Furness; Jan E Clarkson; Richard Oliver; David I Conway; Michaelina Macluskey; Sue Pavitt; Philip Sloan; Helen V Worthington Journal: Cochrane Database Syst Rev Date: 2011-09-07
Authors: Peter T Dziegielewski; Daniel A O'Connell; Jacek Szudek; Brittany Barber; Arjun Joshi; Jeffrey R Harris; Hadi Seikaly Journal: Head Neck Date: 2012-09-25 Impact factor: 3.147
Authors: Philipp Heusch; Christoph Sproll; Christian Buchbender; Elena Rieser; Jan Terjung; Christina Antke; Inga Boeck; Stephan Macht; Axel Scherer; Gerald Antoch; Till A Heusner; Jörg Handschel Journal: Clin Oral Investig Date: 2013-07-27 Impact factor: 3.573