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Patterns of cervical lymph node metastases in oral tongue squamous cell carcinoma: implications for elective and therapeutic neck dissection

Published online by Cambridge University Press:  19 February 2014

E Dogan ,
H O Cetinayak ,
S Sarioglu ,
T K Erdag  and
A O Ikiz
E Dogan*
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Dokuz Eylul University School of Medicine, Izmir, Turkey
H O Cetinayak
Affiliation:
Department of Radiation Oncology, Dokuz Eylul University School of Medicine, Izmir, Turkey
S Sarioglu
Affiliation:
Department of Pathology, Dokuz Eylul University School of Medicine, Izmir, Turkey
T K Erdag
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Dokuz Eylul University School of Medicine, Izmir, Turkey
A O Ikiz
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Dokuz Eylul University School of Medicine, Izmir, Turkey
*
Address for correspondence: Dr E Dogan, Ilica Mah, Akcakir Sokak, Keyif Apt, No. 3/6, 35320, Narlidere, Izmir, Turkey Fax: +90 232 4123269 E-mail: ersoy.dogan@deu.edu.tr
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Abstract

Objectives:

To determine the patterns of lymph node metastases in oral tongue carcinomas, and examine the implications for elective and therapeutic neck dissection.

Method:

The study entailed a retrospective analysis of 67 patients with previously untreated oral tongue squamous cell carcinoma who had undergone simultaneous glossectomy and neck dissection.

Results:

Of the 40 clinically node-negative patients, 7 patients had metastatic lymph nodes on pathological examination. No occult metastasis was found at level IV. Of the 27 clinically node-positive patients, the incidence rate of level IV metastasis was 11.1 per cent (3 out of 27 patients). No ‘skip metastases’ were found at level IV. Level IV metastases were significantly related to clinically staged nodes categorised as over 2a (p = 0.03) and metastasis to level III (p = 0.01).

Conclusion:

Routine inclusion of level IV in elective neck dissection is not necessary for clinically node-negative patients with oral tongue squamous cell carcinoma. Furthermore, extended supraomohyoid neck dissection with adjuvant radiotherapy can be sufficient in the treatment of selected patients with clinically node-positive necks.

Keywords

TongueSquamous Cell CarcinomaNeck DissectionNeoplasm MetastasisPathology
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 3 , March 2014 , pp. 268 - 273
Copyright
Copyright © JLO (1984) Limited 2014 

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References

1Don, DM, Anzai, Y, Lufkin, RB, Fu, YS, Calcaterra, TC. Evaluation of cervical lymph node metastases in squamous cell carcinoma of the head and neck. Laryngoscope 1995;105:669–74CrossRefGoogle ScholarPubMed
2Ferlito, A, Silver, CE, Rinaldo, A. Elective management of the neck in oral cavity squamous carcinoma: current concepts supported by prospective studies. Br J Oral Maxillofac Surg 2009;47:5–9CrossRefGoogle ScholarPubMed
3Yii, NW, Patel, SG, Rhys-Evans, PH, Breach, NM. Management of the N0 neck in early cancer of the oral tongue. Clin Otolaryngol 1999;24:75–9Google Scholar
4Yuen, AP, Wei, WI, Wong, YM, Tang, KC. Elective neck dissection versus observation in the treatment of early oral tongue carcinoma. Head Neck 1997;19:583–83.0.CO;2-3>CrossRefGoogle ScholarPubMed
5Beenken, SW, Krontiras, H, Maddox, WA, Peters, GE, Soong, S, Urist, MM. T1 and T2 squamous cell carcinoma of the oral tongue: prognostic factors and the role of elective lymph node dissection. Head Neck 1999;21:124–303.0.CO;2-A>CrossRefGoogle ScholarPubMed
6Medina, JE, Byers, RM. Supraomohyoid neck dissection: rationale, indications and surgical technique. Head Neck 1989;11:111–22CrossRefGoogle ScholarPubMed
7Byers, RM, Weber, RS, Andrews, T, McGill, D, Kare, R, Wolf, P. Frequency and therapeutic implications of “skip metastases” in the neck from squamous carcinoma of the oral tongue. Head Neck 1997;19:14–193.0.CO;2-Y>CrossRefGoogle ScholarPubMed
8Ferlito, A, Mannara, GM, Rinaldo, A, Politi, M, Robiony, M, Costa, F. Is extended selective supraomohyoid neck dissection indicated for treatment of oral cancer with clinically negative neck? Acta Otolaryngol 2000;120:792–5Google Scholar
9Crean, SJ, Hoffman, A, Potts, J, Fardy, MJ. Reduction of occult metastatic disease by extension of the supraomohyoid neck dissection to include level IV. Head Neck 2003;25:758–62CrossRefGoogle ScholarPubMed
10Edge, SB, Byrd, DR, Compton, CC, Fritz, AG, Green, FL, Trotti, A, eds. AJCC Cancer Staging Manual, 7th edn.New York: Springer, 2010Google ScholarPubMed
11Huang, SF, Kang, CJ, Lin, CY, Fan, KH, Yen, TC, Wang, HM et al. Neck treatment of patients with early stage oral tongue cancer: comparison between observation, supraomohyoid dissection, and extended dissection. Cancer 2008;112:1066–75Google Scholar
12Khafif, A, Lopez-Garza, JR, Medina, JE. Is dissection of level IV necessary in patients with T1–T3 N0 tongue cancer? Laryngoscope 2001;111:1088–90Google Scholar
13De Cicco, C, Trifirò, G, Calabrese, L, Bruschini, R, Ferrari, ME, Travaini, LL et al. Lymphatic mapping to tailor selective lymphadenectomy in cN0 tongue carcinoma: beyond the sentinel node concept. Eur J Nucl Med Mol Imaging 2006;33:900–5Google Scholar
14Mishra, P, Sharma, AK. A 3-year study of supraomohyoid neck dissection and modified radical neck dissection type I in oral cancer: with special reference to involvement of level IV node metastasis. Eur Arch Otorhinolaryngol 2010;267:933–8Google Scholar
15Dias, FL, Lima, RA, Kligerman, J, Farias, TP, Soares, JR, Manfro, G et al. Relevance of skip metastases for squamous cell carcinoma of the oral tongue and the floor of the mouth. Otolaryngol Head Neck Surg 2006;134:460–5Google Scholar
16Balasubramanian, D, Thankappan, K, Battoo, AJ, Rajapurkar, M, Kuriakose, MA, Iyer, S. Isolated skip nodal metastasis is rare in t1 and t2 oral tongue squamous cell carcinoma. Otolaryngol Head Neck Surg 2012;147:275–7CrossRefGoogle ScholarPubMed
17Kaya, S, Yilmaz, T, Gursel, B, Saraç, S, Sennaroğlu, L. The value of elective neck dissection in treatment of cancer of the tongue. Am J Otolaryngol 2001;22:59–64Google Scholar
18Akhtar, S, Ikram, M, Ghaffar, S. Neck involvement in early carcinoma of tongue. Is elective neck dissection warranted? J Pak Med Assoc 2007;57:305–7Google ScholarPubMed
19Davidson, J, Khan, Y, Gilbert, R, Birt, BD, Balogh, J, MacKenzie, R. Is selective neck dissection sufficient treatment for the N0/Np+ neck? J Otolaryngol 1997;26:229–31Google ScholarPubMed
20Kowalski, LP, Carvalho, AL. Feasibility of supraomohyoid neck dissection in N1 and N2a oral cancer patients. Head Neck 2002;24:921–4CrossRefGoogle ScholarPubMed
21Cappiello, J, Piazza, C, Giudice, M, De Maria, G, Nicolai, P. Shoulder disability after different selective neck dissections (level II–IV versus levels II–V): a comparative study. Laryngoscope 2005;115:259–63Google Scholar
22Lim, YC, Koo, BS, Lee, JS, Choi, EC. Level V lymph node dissection in oral and oropharyngeal carcinoma patients with clinically node-positive neck: is it absolutely necessary? Laryngoscope 2006;116:1232–5CrossRefGoogle Scholar
23Naiboğlu, B, Karapinar, U, Agrawal, A, Schuller, DE, Ozer, E. When to manage level V in head and neck carcinoma? Laryngoscope 2011;121:545–7CrossRefGoogle Scholar