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Surgical anatomy of the lingual lymph nodes: systematic literature analysis and proposition for topographic classification. Surg Radiol Anat 2023; 45:227-239. [PMID: 36735058 DOI: 10.1007/s00276-023-03078-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Metastatic involvement of the lingual lymph nodes (LLNs) in oral cavity squamous cell cancer (SCC) has recently been proven to significantly reduce locoregional control and survival. Despite recent refinements in the detection of these lesions, the understanding of the LLN topographic anatomy among clinicians is limited. A proposition of a topographic division on LLN based on a comprehensive literature search and synthesis may be helpful in this condition. METHODS A literature search and election based on contemporary PRISMA guidelines was performed for sources on LLN anatomy with special attention on their subdivision. RESULTS Four topographic LLN subgroups were defined: median-between genioglossal and geniohyoid muscles; intermediate parahyoid-medial to the hyoglossal muscle, at the greater cornu of the hyoid bone; lateral sublingual (paraglandular) LLNs-at the sublingual salivary gland; lateral submandibular (paraglandular) LLNs -lateral to the hyoglossal muscle, at the deep surface of the submandibular salivary gland. CONCLUSION The development and implementation of a unified anatomical topographic classification of LLN subgroups may be among the important conditions for improving the detection and treatment of LLN lesions.
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Neville JF, Tilak M, Singh AK, Sharma NK, Kumar JA, Mishra N, Durrani F. En Block Versus Separate Management of Cervical Nodes in Tongue and Floor of the Mouth Cancers- Is There a Difference? An Analysis of 85 Cases in a Tertiary Care Institute. Indian J Otolaryngol Head Neck Surg 2022; 74:6122-6128. [PMID: 36742752 PMCID: PMC9895753 DOI: 10.1007/s12070-021-02743-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/27/2021] [Indexed: 02/07/2023] Open
Abstract
To evaluate difference in local recurrence, regional (neck) recurrence as well as distant metastases between cases operated with en-block excision of primary cancer and neck nodes versus their separate removal, in squamous cell carcinomas of anterior 2/3 of tongue and floor of the mouth. A total 85 patients of cT1-T4a N0-N2b of carcinoma anterior 2/3 of tongue and floor of mouth were evaluated. Amongst these patients 39 cases of in-continuity en-block neck dissection and 46 cases of discontinuous neck dissection were evaluated for post-operative complications as well as oncological outcome for a follow up period of 3 years. Patient population was similar in both groups with tongue cancers being the commonest site and tobacco being the most common addiction. Primary site hematoma was seen more in the in-continuity en-block neck dissection group with a p-value of 0.0276, which was statistically significant. Post-operative oro-cutaneous fistula occurred more in in-continuity enblock neck dissection as compared to discontinuous neck dissection, but the difference was not statistically significant. Local recurrence rate was significantly more in cases of discontinuous neck dissection (19.565) as compared to in-continuity en-block neck dissection (5.12%) with a p-Value 0.0481. A statistically non-significant but higher loco-regional recurrence was observed in cases of discontinuous neck dissection as compared to cases of in-continuity en-block neck dissection (10.56% vs 2.56). In the present study recurrence-free survival RFS 3 year in cases of en-block in-continuity neck dissection (84.06%) cases as compared to discontinuous neck dissection cases (63.04%) with p Value 0.025698. In-continuity en-block in continuity neck dissection has lower loco-regional recurrence and may impact overall distant metastases. Though early postoperative complications are more in in-continuity en-block in continuity neck dissection as compared to discontinuous neck dissection, most are managed conservatively. Further studies with a larger sample size are needed to evaluate its outcome in a comprehensive manner.
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Affiliation(s)
- J. F. Neville
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P India
| | - Mandar Tilak
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P India
| | - Akhilesh Kumar Singh
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P India
| | - Naresh Kumar Sharma
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P India
| | - Janani Anand Kumar
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P India
| | - Nitesh Mishra
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P India
| | - Farhan Durrani
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P India
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Zhu Y, Xiao T, He Y, Hong X, Zhou T, Da M, Ge S, Xie D, Wang Z. Application of near-infrared fluorescence imaging in lingual lymph node screening and drainage pattern observation for tongue cancer. Front Cell Dev Biol 2022; 10:986575. [PMID: 36238684 PMCID: PMC9552325 DOI: 10.3389/fcell.2022.986575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Lingual lymph node (LLN) metastasis is regarded as an indicator of unfavorable prognosis and a crucial sign of the high degree of primary tumor aggressiveness. However, detecting LLN metastasis is an important but frequently overlooked aspect of diagnosis and surgical treatment planning. The study aims to identify LLNs by intraoperative near-infrared (NIR) fluorescence imaging with indocyanine green absorbed into human serum albumin (ICG: HSA) and describe the presence of lymphatic drainage channels from the floor of the mouth in patients with tongue carcinoma.Materials and Methods: 21 patients diagnosed with cT1-T4 squamous cell carcinoma (SCC) of the tongue margin and scheduled to undergo tumor resection and unilateral neck dissection were enrolled. After exposing the neck, the patients were injected with 0.3 ml of ICG: HSA (500 μM) in three quadrants around the tumor, excluding the mucous membrane of the basal region cavity. Employing a near-infrared fluorescence imaging system, the fluorescence of levels I, II, III, and IV was measured during neck dissection.Results: LLNs were detected in four patients and were identified as metastatic LLNs in all 21 patients. The near-infrared fluorescence imaging system showed the existence of lymphatic drainage channels in the floor of the mouth. In patients receiving peritumoral injection of ICG: HSA, the mean fluorescence intensity (MFI)of metastatic lymph nodes (LNs) (178.4 ± 64.39, mean ± SD) was higher than that in non-metastatic LNs (132.0 ± 76.5, mean ± SD) (p < 0.05).Conclusion: NIR fluorescence imaging with ICG: HSA could be used for intraoperative identification of LLNs and assist in the determination of metastatic lymph nodes for tongue carcinoma patients. Additionally, this finding demonstrates the feasibility of near-infrared fluorescence imaging in defining lymphatic drainage channels in the head and neck.
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Affiliation(s)
| | | | | | | | | | | | | | - Diya Xie
- *Correspondence: Diya Xie, ; Zhiyong Wang,
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Sugiyama S, Iwai T, Baba J, Oguri S, Izumi T, Kuwahata A, Sekino M, Kusakabe M, Mitsudo K. Sentinel lymph node biopsy with a handheld cordless magnetic probe following preoperative MR lymphography using superparamagnetic iron oxide for clinically N0 early oral cancer: A feasibility study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:521-526. [PMID: 35007780 DOI: 10.1016/j.jormas.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/02/2022] [Accepted: 01/05/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Radioisotope (RI) tracers are generally used for preoperative mapping of sentinel lymph node (SLN) and intraoperative detection with a portable γ probe. However, the use of RI has several limitations. Therefore, a method without RI is required for the widespread application of SLN biopsy. The purpose of this study was to evaluate the feasibility of SLN biopsy with a handheld cordless magnetic probe following magnetic resonance lymphography (MRL) using superparamagnetic iron oxide (SPIO) and for clinically N0 early oral cancer. MATERIALS AND METHODS MRL using SPIO and SLNB with the handheld cordless magnetic probe were performed for 27 patients with clinically N0 early oral cancer. RESULTS In all 27 patients (100%), SLNs were detected by MRL, and the total and mean number of SLNs were 73 and 2.7, respectively. All SLNs identified by MRL were detectable using the magnetic probe in all patients. CONCLUSIONS SLNB with handheld cordless magnetic probe following preoperative SLN mapping by MRL using SPIO is feasible, without RI use, for neck management in cases of clinically N0 early oral cancer.
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Affiliation(s)
- Satomi Sugiyama
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Toshinori Iwai
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Junichi Baba
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Senri Oguri
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Toshiharu Izumi
- Department of Radiology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Akihiro Kuwahata
- Department of Electrical Engineering, Tohoku University Graduate School of Engineering, Sendai, Miyagi 980-8579, Japan
| | - Masaki Sekino
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Tokyo 113-0032, Japan
| | - Moriaki Kusakabe
- Research Center for Food Safety, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo 113-0032, Japan; Department of Medical Device, Matrix Cell Research Institute Inc, Ushiku, Ibaraki 300-1232, Japan
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
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Prognostic Significance of the Metastatic Lingual Lymph Node in Oral Tongue and Floor of Mouth Squamous Cell Carcinoma. J Oral Maxillofac Surg 2021; 80:553-558. [PMID: 34871585 DOI: 10.1016/j.joms.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE The lingual lymph node (LLN) located on the internal surface of mylohyoid muscle is not currently included in oral cavity cancer surgery or conventional neck dissection. We investigated the risk factors for LLN metastasis and evaluated its oncologic significance in patients with oral tongue and floor of mouth squamous cell carcinoma. PATIENTS AND METHODS Adult patients (≥20 years) undergoing upfront surgery and LLN dissection for oral tongue and floor of mouth squamous cell carcinoma between 2009 and 2018 were retrospectively analyzed. Patients who had relapsed after previous treatment or had neoadjuvant chemotherapy or had not undergone surgery were excluded. Association between clinicopathological risk factors (age, gender, tumor differentiation, stage, lymphatic invasion, perineural invasion, vascular invasion, metastatic lymph node ratio, and extranodal extension) and LLN metastasis was evaluated using logistic regression analysis. Disease-free survival in accordance with LLN metastasis was evaluated by the Kaplan-Meier method. RESULTS A total of 51 patients were included, and LLN metastasis was found in 9 patients (17.6%). LLN metastasis was significantly associated with advanced nodal stage, poor tumor differentiation, and vascular invasion. Cox proportional-hazards regression models showed that LLN metastasis was associated with an 8.0-fold higher risk of mortality than the absence of LLN metastasis. Patients with LLN metastasis had significantly worse 5-year disease-free survival rate than those without metastasis (22.2% vs 85.7%; P < .001). CONCLUSIONS This study suggests that LLN metastasis is a poor prognostic factor in patients with oral tongue and floor of mouth squamous cell carcinoma. The sublingual space should be carefully evaluated preoperatively and intraoperatively.
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Kuroshima T, Onozato Y, Oikawa Y, Ohsako T, Kugimoto T, Hirai H, Tomioka H, Michi Y, Miura M, Yoshimura R, Harada H. Prognostic impact of lingual lymph node metastasis in patients with squamous cell carcinoma of the tongue: a retrospective study. Sci Rep 2021; 11:20535. [PMID: 34654881 PMCID: PMC8520004 DOI: 10.1038/s41598-021-99925-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/27/2021] [Indexed: 11/09/2022] Open
Abstract
Squamous cell carcinoma (SCC) of the tongue rarely metastasizes to the lingual lymph nodes (LLNs), which are inconstant nodes and often situated outside the areas of basic tongue tumor surgery. The current study evaluated the clinicopathological features and prognostic impact of LLN metastasis (LLNM), compared to that of cervical lymph node metastasis, in patients with tongue SCC. A total of 608 patients underwent radical surgery for tongue SCC at our department between January 2001 and December 2016. During neck dissection, we scrutinized and resected lateral LLNs, when present. Of the 128 patients with lymph node metastasis, 107 had cervical lymph node metastasis and 21 had both cervical lymph node metastasis and LLNM. Univariate analysis demonstrated that LLNM was significantly associated with the adverse features of cervical lymph node metastasis. The 5-year disease-specific survival (5y-DSS) was significantly lower in patients with LLNMs than in those without LLNMs (49.0% vs. 88.4%, P < 0.01). Moreover, Cox proportional hazards model analyses revealed that cervical lymph node metastasis at level IV or V and LLNM were independent prognostic factors for 5y-DSS. LLNM has a strong negative impact on survival in patients with tongue SCC. An advanced status of cervical lymph node metastasis may predict LLNM.
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Affiliation(s)
- Takeshi Kuroshima
- Division of Health Science, Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Yusuke Onozato
- Division of Oral Health Science, Department of Oral Radiation Oncology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Yu Oikawa
- Division of Health Science, Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Toshimitsu Ohsako
- Division of Health Science, Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Takuma Kugimoto
- Division of Health Science, Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Hideaki Hirai
- Division of Health Science, Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Hirofumi Tomioka
- Division of Health Science, Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Yasuyuki Michi
- Division of Health Science, Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Masahiko Miura
- Division of Oral Health Science, Department of Oral Radiation Oncology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Ryoichi Yoshimura
- Division of Maxillofacial and Neck Reconstruction, Department of Radiation Therapeutics and Oncology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Hiroyuki Harada
- Division of Health Science, Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
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7
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Sugiyama S, Iwai T, Baba J, Oguri S, Izumi T, Sekino M, Kusakabe M, Mitsudo K. MR lymphography with superparamagnetic iron oxide for sentinel lymph node mapping of N0 early oral cancer: A pilot study. Dentomaxillofac Radiol 2021; 50:20200333. [PMID: 33180632 DOI: 10.1259/dmfr.20200333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The purpose of this pilot study was to evaluate the usefulness of magnetic resonance lymphography (MRL) with superparamagnetic iron oxide (SPIO) in sentinel lymph node (SLN) mapping of clinically N0 early oral cancer, and to conduct a comparative study of this MRL with CT lymphography (CTL). METHODS CTL and MRL were performed for SLN mapping before surgery for 20 patients with clinically N0 early oral cancer. The detection rate, number, and location of SLNs in CTL and MRL were evaluated. Furthermore, optimal scanning/imaging timing in MRL was examined. RESULTS SLNs were detected by CTL in 18 (90%) patients, and the total and mean number of SLN were 35 and 1.8, respectively. All SLNs could be detected 2 min and 3.5-5 min after contrast medium injection. In all patients, SLNs were detected by MRL at 10 min after SPIO injection, and the total and mean number of SLN was 53 and 2.7, respectively. MRL at 30 min after the injection showed additional 18 secondary lymph nodes. CONCLUSION MRL with SPIO is safe and useful imaging for the detection of SLNs in clinically N0 early oral cancer, and the optimal imaging timing is 10 min after SPIO injection.
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Affiliation(s)
- Satomi Sugiyama
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan
| | - Toshinori Iwai
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan
| | - Junichi Baba
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan
| | - Senri Oguri
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan
| | - Toshiharu Izumi
- Department of Radiology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan
| | - Masaki Sekino
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Moriaki Kusakabe
- Research Center for Food Safety, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan.,Department of Medical Device, Matrix Cell Research Institute Inc, Ushiku, Ibaraki, Japan
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan
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Lingual Lymph Node Metastases as a Prognostic Factor in Oral Squamous Cell Carcinoma-A Retrospective Multicenter Study. ACTA ACUST UNITED AC 2021; 57:medicina57040374. [PMID: 33921486 PMCID: PMC8070109 DOI: 10.3390/medicina57040374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 11/17/2022]
Abstract
Backgrounds and Objectives: The epidemiology and prognostic role of lingual lymph node (LLN) metastasis in patients with oral squamous cell carcinoma (OSCC) remain unclear. Here, we aimed to analyze the clinicopathological features, risk factors, and prognostic role of LLN metastasis in patients with OSCC. Materials and Methods: In total, 945 patients with OSCC were retrospectively analyzed. Clinicopathological features were compared between patients with and without LLN metastasis. The risk factors of LLN metastasis and its effects on survival outcomes were evaluated using multi-variate analysis. Results: LLN metastasis was noted in 67 patients (7.1%). Habitual alcohol consumption and clinical neck node metastasis were independent risk factors for LLN metastasis. LLN metastasis was an independent prognostic factor for disease-free and overall survival, although LLN dissection did not improve survival outcomes. Conclusion: LLN metastasis is an independent adverse prognostic factor. Further prospective studies are needed to fully assess the extent of LLN dissection required in OSCC patients.
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Suzuki M, Eguchi K. Metastasis to the lateral lingual lymph node located behind the submandibular gland: A case of squamous cell carcinoma of the tongue. Clin Case Rep 2021; 9:1763-1766. [PMID: 33768931 PMCID: PMC7981743 DOI: 10.1002/ccr3.3898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 11/29/2022] Open
Abstract
Inconsistency in the definition of LLNs may be a hurdle in ensuring the accuracy of the evidence. Refinements in the classification of LLNs, based on the fascial anatomy and lymphatic vessels, are warranted.
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Affiliation(s)
- Masami Suzuki
- Department of Head and Neck SurgeryGunma Prefectural Caner CenterOhtaJapan
- Department of Otolaryngology‐Head and Neck SurgeryJichi Medical University Saitama Medical CenterOmiyaJapan
| | - Kohtaro Eguchi
- Department of Head and Neck SurgeryNational Cancer Center HospitalChuo‐kuJapan
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Bang J, Jung WS, Cho JH. Sonographicdetectionof a metastatic lingual lymph node in a patient with tongue cancer. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:343-345. [PMID: 32243597 DOI: 10.1002/jcu.22832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/04/2020] [Accepted: 03/19/2020] [Indexed: 06/11/2023]
Abstract
A 41-year-old male was diagnosed with tongue cancer. Preoperative imaging revealed no metastatic lymph nodes. Intraoperative sonography detected a minute hypoechoic lesion in the sublingual space. A pea-sized mass was found during dissection of that space and histopathology revealed a metastatic lymph node. The lingual lymph node should routinely be evaluated sonographically prior to surgical resection of tongue cancer.
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Affiliation(s)
- Jooin Bang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Won-Sang Jung
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung-Hae Cho
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Gvetadze SR, Ilkaev KD. Lingual lymph nodes: Anatomy, clinical considerations, and oncological significance. World J Clin Oncol 2020; 11:337-347. [PMID: 32874949 PMCID: PMC7450815 DOI: 10.5306/wjco.v11.i6.337] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/04/2020] [Accepted: 05/05/2020] [Indexed: 02/06/2023] Open
Abstract
Lingual lymph nodes are an inconstant group of in-transit nodes, which are located on the route of lymph drainage from the tongue mucosa to the regional nodes in neck levels I and II. There is growing academic data on the metastatic spread of oral cancer, particularly regarding the spreading of oral tongue squamous cell carcinoma to lingual nodes. These nodes are not currently included in diagnostic and treatment protocols for oral tongue cancer. Combined information on surgical anatomy, clinical observations, means of detection, and prognostic value is presented. Anatomically obtained incidence of lingual nodes ranges from 8.6% to 30.2%. Incidence of lingual lymph node metastasis ranges from 1.3% to 17.1%. It is clear that lymph nodes that bear intervening tissues from the floor of the mouth should be removed to improve loco-regional control. Extended resection volume, which is required for the surgical treatment of lingual node metastasis, cannot be implied to every tongue cancer patient. As these lesions significantly influence prognosis, special efforts of their detection must be made. Reasonably, every tongue cancer patient must be investigated for the existence of lingual lymph node metastasis. Lymphographic tracing methods, which are currently implied for sentinel lymph node biopsies, may improve the detection of lingual lymph nodes.
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Affiliation(s)
- Shalva R Gvetadze
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow 119991, Russia
| | - Konstantin D Ilkaev
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow 119991, Russia
- Blokhin National Medical Research Center of Oncology, Moscow 115478, Russia
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12
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Sugiyama S, Iwai T, Izumi T, Baba J, Oguri S, Hirota M, Mitsudo K. Sentinel lymph node mapping of clinically N0 early oral cancer: a diagnostic pitfall on CT lymphography. Oral Radiol 2020; 37:251-255. [PMID: 32419102 DOI: 10.1007/s11282-020-00442-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/03/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The purpose of this study was to reevaluate preoperative computed tomography lymphography (CTL) and enhanced CT images during follow-up to clarify whether SLNs enhanced by CTL were identified accurately before primary surgery with sentinel lymph node biopsy (SLNB) for clinically N0 early oral cancer. METHODS Thirty two early oral cancer patients without cervical lymph node metastasis were enrolled in this study. To clarify whether SLNs enhanced by CTL were identified accurately before primary surgery with SLNB, we reevaluated preoperative CTL and enhanced CT images during follow-up in all patients. RESULTS SLNs were detected by CTL in 31 of 32 patients (96.9%). During follow-up after primary surgery with SLNB, 4 of 27 patients without SLN metastasis had occult neck metastasis. Of the 4 patients, only 1 patient with cancer of floor of the mouth had overlooking of SLN, and the overlooking rate of SLN was 3.1%. The overlooked small SLN (2.9 × 3.3 × 3.1 mm) was located at contralateral level IB. The CT numbers before, 2, 5, 10 min after iopamidol injection, were 33 HU, 37 HU, 62 HU, 52 HU, respectively. The CT numbers of overlooked SLN 5 and 10 min after the injection was higher than CT images scanned before the iopamidol injection. CONCLUSIONS The enhancement of SLNs in CTL images after iopamidol injection should be compared sufficiently with CT images before iopamidol injection to avoid overlooking of SLNs in N0 early oral cancer.
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Affiliation(s)
- Satomi Sugiyama
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Toshinori Iwai
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Toshiharu Izumi
- Department of Radiology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Junichi Baba
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Senri Oguri
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Makoto Hirota
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
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Yang W, Sun M, Jie Q, Zhou H, Zhang P, Zhu J. Lingual Lymph Node Metastasis in cT1-2N0 Tongue Squamous Cell Carcinoma: Is It an Indicator for Elective Neck Dissection. Front Oncol 2020; 10:471. [PMID: 32318349 PMCID: PMC7154091 DOI: 10.3389/fonc.2020.00471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 03/16/2020] [Indexed: 12/22/2022] Open
Abstract
Objective: Accurate predictors for occult metastasis in cT1-2N0 tongue squamous cell carcinoma (SCC) remains scarce, the main goal in current study was to evaluate whether there is significant association between lingual lymph node (LLN) metastasis and occult lymph node metastasis as well as whether there is prognostic value of LLN metastasis in early stage tongue SCC. Methods: Patients with surgically treated primary cT1-2N0 tongue SCC were prospectively enrolled from January 2010 to December 2018. LLNs were dissected independently for pathologic analysis. The main study endpoints were locoregional control survival (LRC) and disease-specific survival (DSS). The Chi-square test and multivariate regression analysis were used to assess the predictors for occult metastasis. The Kaplan-Meier approach and Cox model were used to analyze the potential prognostic factors. Results: A total of 317 patients were enrolled for analysis. Eighty-eight patients had occult metastasis with a prevalence of 27.8%. LLNs presented in 89 patients, in which 43 patients had LLN metastasis. In the 43 patients with positive LLNs, 20 patients had occult metastasis, in 274 patients with negative LLNs or no LLNs, 68 patients had occult metastasis, the difference was significant (p = 0.012). Further multivariate regression analysis confirmed the independence of LLN metastasis in predicting the occult metastasis. In patients without LLNs, the 5-year LRC rate was 79%, in patients with negative LLNs, the 5-year LRC rate was 78%, in patients with positive LLNs, the 5-year LRC rate was 62%, the difference was significant (p = 0.024). In patients without LLNs, the 5-year DSS rate was 84%, in patients with negative LLNs, the 5-year DSS rate was 74%, in patients with positive LLNs, the 5-year DSS rate was 51%, the difference was significant (p < 0.001), further Cox model confirmed the independence of LLN metastasis in affecting the LRC and DSS. Conclusions: LLN metastasis is significantly associated with occult neck lymph node metastasis, and decrease the LRC and DSS in early stage tongue SCC.
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Affiliation(s)
- Wenli Yang
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Minglei Sun
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiaoyan Jie
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haixia Zhou
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peng Zhang
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Juanfang Zhu
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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14
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Eguchi K, Muro S, Miwa K, Yamaguchi K, Akita K. Deep cervical fascia as an anatomical landmark of lingual lymph nodes: An anatomic and histologic study. Auris Nasus Larynx 2019; 47:464-471. [PMID: 31864835 DOI: 10.1016/j.anl.2019.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 11/18/2019] [Accepted: 11/29/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES We aimed to discuss the definition of lingual lymph nodes based on the deep cervical fascia anatomy. METHODS A total of 11 cadavers were histopathologically evaluated. Specimens were dissected into serial stepwise cross-sections. The deep cervical fascia and lymph nodes were evaluated by staining the cross-sections with Elastica van Gieson and hematoxylin and eosin stains, respectively. The gross anatomy of the deep cervical fascia was evaluated in 1 cadaver after bilateral dissection. RESULTS A single severely degenerated medial lingual lymph node (MLLN) was identified in the lingual septum of 1 cadaver. A single lateral lingual lymph node (LLLN) was identified in 1 cadaver, between the genioglossus and the hyoglossus. The superficial layer of deep cervical fascia (SLDF) was found to split into two layers encapsulating the submandibular gland. The deeper portion of this fascia was in close contiguity with the hyoglossus and formed the boundary between the mouth and the neck. The SLDF was found to be discontinuous with the area between the sublingual space and the submandibular gland. CONCLUSIONS The SLDF could serve as an anatomical landmark for lingual lymph nodes, since it is considered to be the demarcating boundary during neck dissection. When lymph nodes that are located deeper than the SLDF were defined as lingual lymph nodes, 1 MLLN and 1 LLLN were identified.
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Affiliation(s)
- Kohtaro Eguchi
- Department of Clinical Anatomy, Tokyo Medical and Dental University Graduate School, Tokyo, Japan; Division of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Satoru Muro
- Department of Clinical Anatomy, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Koh Miwa
- Department of Clinical Anatomy, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Kumiko Yamaguchi
- Department of Clinical Anatomy, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
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15
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Sugiyama S, Iwai T, Izumi T, Ishiguro K, Baba J, Oguri S, Mitsudo K. CT lymphography for sentinel lymph node mapping of clinically N0 early oral cancer. Cancer Imaging 2019; 19:72. [PMID: 31718717 PMCID: PMC6852886 DOI: 10.1186/s40644-019-0258-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/30/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The objectives of this retrospective study were to evaluate the usefulness of computed tomography lymphography (CTL) and to clarify the optimal timing of CTL in sentinel lymph node (SLN) mapping of clinically N0 early oral cancer. METHODS Twenty patients with clinically N0 early oral cancer underwent CTL with a 128 multi-detector row CT scanner to detect SLN the day before resection of primary tumor and SLN biopsy with indocyanine green (ICG) fluorescence guidance. CT scanning was performed in the first 10 patients at 2, 5, and 10 min after submucosal injection of iopamidol and in the remaining 10 patients at 2, 3.5, 5, and 10 min after the injection of contrast medium. We evaluated the SLN detection rate at each scan timing and the number and location of SLNs. We evaluated whether CTL-enhanced SLNs could be identified intraoperatively as ICG fluorescent lymph nodes. RESULTS SLNs were detected by CTL in 19 of the 20 patients (95.0%), and the mean number of SLNs was 2 (range, 1-4). All SLNs were located on the ipsilateral side; 35 of 37 SLNs were located at level I and II, and 2 SLNs were lingual lymph nodes. All SLNs could be detected 2 min and 3.5-5 min after contrast medium injection, and CTL-enhanced SLNs could be identified intraoperatively as fluorescent lymph nodes. CONCLUSIONS CTL could facilitate the detection of SLNs in early oral cancer, and the optimal timing of CT scanning was at 2 and 5 min after injection of contrast medium.
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Affiliation(s)
- Satomi Sugiyama
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Toshinori Iwai
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Toshiharu Izumi
- Department of Radiology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Keita Ishiguro
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Junichi Baba
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Senri Oguri
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
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16
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Eguchi K, Kawai S, Mukai M, Nagashima H, Shirakura S, Sugimoto T, Asakage T. Medial lingual lymph node metastasis in carcinoma of the tongue. Auris Nasus Larynx 2019; 47:158-162. [PMID: 30929928 DOI: 10.1016/j.anl.2019.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 12/22/2022]
Abstract
Lingual lymph node metastases are rarely seen in carcinoma of the tongue, and these nodes are not removed during neck dissection. Lingual lymph nodes are classified into medial and lateral groups, and metastasis to the former is extremely rare. A 55-year-old male with squamous cell carcinoma of the tongue, (stage T4aN0M0), underwent hemiglossectomy with neck dissection and free flap reconstruction. The lingual septum had a mass, 8 mm in size, which was diagnosed as medial lingual lymph node metastasis on histopathology. The patient developed multiple distant metastases and died of disease 18 months after the initial surgery. The presence of medial lymph node metastasis could result in contralateral neck metastases and worsen prognosis. Such cases may warrant more intensive therapy than recommended by current guidelines.
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Affiliation(s)
- Kohtaro Eguchi
- Division of Otolaryngology - Head and Neck Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan; Department of Clinical Anatomy, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
| | - Shigeo Kawai
- Division of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Masayoshi Mukai
- Division of Otolaryngology - Head and Neck Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hiroaki Nagashima
- Division of Otolaryngology - Head and Neck Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Satoshi Shirakura
- Division of Otolaryngology - Head and Neck Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Taro Sugimoto
- Division of Otolaryngology - Head and Neck Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Takahiro Asakage
- Department of Head and Neck Surgery, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
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17
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Fang Q, Li P, Qi J, Luo R, Chen D, Zhang X. Value of lingual lymph node metastasis in patients with squamous cell carcinoma of the tongue. Laryngoscope 2019; 129:2527-2530. [PMID: 30861130 DOI: 10.1002/lary.27927] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/11/2019] [Accepted: 02/22/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate the role of lingual lymph node (LLN) metastasis on locoregional control (LRC) in patients with locally advanced tongue squamous cell carcinoma (SCC). METHODS A total of 231 patients were prospectively enrolled. Analyses focused on the association between the LLN metastasis and clinical pathologic variables as well as the significance of LLN metastasis in predicting prognosis. RESULTS LLNs were noted in 58 patients, 33 of whom were positive for LLN metastasis. LLN metastasis was significantly related to adverse pathologic characteristics. In patients with LLN metastasis, the 5-year LRC rate was 45%. In patients without LLN metastasis, the 5-year LRC rate was 65% and the difference was significant (P = 0.013). Further, Cox model analysis confirmed the independence of LLN metastasis from prognosis prediction. CONCLUSION LLN metastasis in locally advanced tongue SCC is relatively uncommon; however, LLNs should be routinely dissected because they could significantly decrease locoregional control. LEVEL OF EVIDENCE 2b. Laryngoscope, 129:2527-2530, 2019.
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Affiliation(s)
- Qigen Fang
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, People's Republic of China
| | - Peng Li
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, People's Republic of China
| | - Jinxing Qi
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, People's Republic of China
| | - Ruihua Luo
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, People's Republic of China
| | - Defeng Chen
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, People's Republic of China
| | - Xu Zhang
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, People's Republic of China
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18
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Wu WJ, Zheng L, Zhang JG. The use of carbon nanoparticles to track occult lingual lymph nodes in early-stage tongue squamous cell carcinoma. Int J Oral Maxillofac Surg 2019; 48:1153-1155. [PMID: 30876796 DOI: 10.1016/j.ijom.2019.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/25/2018] [Accepted: 02/21/2019] [Indexed: 02/07/2023]
Abstract
The lingual lymph nodes (LLNs) can only be detected with difficulty in early-stage tongue squamous cell carcinomas owing to the small size. Recurrence or metastasis could occur in the floor of the mouth as a result of neglecting the LLNs. The injection of carbon nanoparticles to track occult LLNs in early-stage tongue squamous cell carcinoma is presented and discussed. This technique is simple and easy to use intraoperatively. If LLNs were stained black during the operation, the sublingual gland along with the fatty tissue of the floor of the mouth were removed simultaneously. The LLNs in early-stage tongue squamous cell carcinoma deserve more attention.
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Affiliation(s)
- W-J Wu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - L Zheng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
| | - J-G Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
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19
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Nishio N, Fujimoto Y, Hiramatsu M, Yamamoto Y, Sone M. Sonographic detection of a lingual node metastasis from early squamous cell cancer of the tongue. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:69-72. [PMID: 28440859 DOI: 10.1002/jcu.22486] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 02/27/2017] [Accepted: 03/13/2017] [Indexed: 06/07/2023]
Abstract
Lingual node metastasis from early-stage squamous cell carcinoma of the tongue is uncommon and difficult to detect. We present a case of a lingual lymph node metastasis from an early tongue cancer. Sonography demonstrated a small nonpalpable lingual node on the floor of the mouth. The patient underwent complete surgical resection and had no evidence of recurrence 5 years later. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:69-72, 2018.
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Affiliation(s)
- Naoki Nishio
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Mariko Hiramatsu
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoko Yamamoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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20
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Wang HC, Zheng Y, Pang P, Li RW, Qi ZZ, Sun CF. Discontinuous Versus In-Continuity Neck Dissection in Squamous Cell Carcinoma of the Tongue and Floor of the Mouth: Comparing the Rates of Locoregional Recurrence. J Oral Maxillofac Surg 2017; 76:1123-1132. [PMID: 29247622 DOI: 10.1016/j.joms.2017.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/09/2017] [Accepted: 11/12/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE To date, consensus has not been reached on which treatment modality, that is, in-continuity neck dissection or discontinuous neck dissection, is more appropriate for managing patients with squamous cell carcinoma (SCC) of the tongue and floor of the mouth. This study aimed to perform a meta-analysis to compare discontinuous neck dissection with in-continuity neck dissection as a treatment modality for SCC of the tongue and floor of the mouth. MATERIALS AND METHODS The PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang databases were searched for articles that compared discontinuous neck dissection with in-continuity neck dissection in SCC of the tongue and floor of the mouth until March 1, 2017. The predictor variable was whether discontinuous neck dissection or in-continuity neck dissection was performed in each group. The primary outcome variable was the incidence of locoregional recurrence. Two authors individually extracted the data and assessed the study quality. The meta-analysis was performed using Stata (version 13.0; StataCorp, College Station, TX). RESULTS We included 8 studies with 796 patients in our meta-analysis. The results showed that in-continuity neck dissection had a statistically significantly lower incidence of locoregional recurrence than discontinuous neck dissection (random-effects model: relative risk, 0.459; 95% confidence interval, 0.240 to 0.877; P = .019). Because significant heterogeneity among studies (I2 = 74.5%, P < .001) was found in the heterogeneity evaluation, a separate analysis was performed. However, the results still showed that in-continuity neck dissection had a statistically significantly lower rate of locoregional recurrence than discontinuous neck dissection in patients with T2 and T3 SCC of the tongue and floor of the mouth (fixed-effects model: relative risk, 0.281; 95% confidence interval, 0.183 to 0.433; P < .001). CONCLUSIONS Compared with discontinuous neck dissection, in-continuity neck dissection can significantly reduce the rate of locoregional recurrence in patients with SCC of the tongue and floor of the mouth.
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Affiliation(s)
- He-Chen Wang
- Master Student, Department of Oromaxillofacial-Head and Neck Surgery and Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, China
| | - Yan Zheng
- Master Student, Department of Periodontics, School of Stomatology, China Medical University, Shenyang, China
| | - Pai Pang
- Doctoral Student, Department of Oromaxillofacial-Head and Neck Surgery and Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, China
| | - Rui-Wu Li
- Professor, Department of Oromaxillofacial-Head and Neck Surgery and Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, China
| | - Zhong-Zheng Qi
- Attending Physician, Department of Oromaxillofacial-Head and Neck Surgery and Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, China
| | - Chang-Fu Sun
- Professor, Department Head, and Vice Dean, Department of Oromaxillofacial-Head and Neck Surgery and Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, China.
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21
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Kaya İ, Öztürk K, Turhal G. Sublingual Lymph Node Metastasis in Early-Stage Floor of the Mouth Carcinoma. Turk Arch Otorhinolaryngol 2017. [PMID: 29515931 DOI: 10.5152/tao.2017.2461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Metastasis to the sublingual lymph nodes is very rare in oral cavity cancers. We present an early-stage floor of the mouth (FOM) cancer case with metastasis to the sublingual lymph node. Even though the rate of metastatic sublingual lymph nodes is low, the uncommon presence of sublingual lymph node metastasis in an early-stage FOM cancer case raises the question of routine FOM dissection. Further anatomic and pathologic studies addressing the rate and pattern of sublingual lymph node metastasis are warranted.
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Affiliation(s)
- İsa Kaya
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - Kerem Öztürk
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - Göksel Turhal
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey
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22
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Median Lingual Lymph Nodes: Prevalence on Imaging and Potential Implications for Oral Cavity Cancer Staging. J Comput Assist Tomogr 2017; 41:528-534. [PMID: 28099223 DOI: 10.1097/rct.0000000000000568] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study sought to estimate the prevalence of median lingual lymph node (MLLN) metastases from oral cavity squamous cell carcinoma (OCSCC) and determine the frequency with which MLLNs can be identified with magnetic resonance imaging (MRI) in control subjects. METHODS Pathology reports were used to identify patients with surgically treated OCSCC who underwent preoperative positron emission tomography-computed tomography to define the prevalence of MLLN metastases. As a control group, 500 consecutive face-neck MRIs from noncancer patients were reviewed for structures consistent with MLLNs. RESULTS In the study group, 1 (0.95%) of 105 OCSCC cases demonstrated a single MLLN metastasis from a lateral tongue tumor (T4aN2c). The MLLN exceeded 1 cm in all planes and was abnormal in morphology. The frequency of suspected MLLNs in controls was 1.0%, with a maximum measurement of 0.9 cm. CONCLUSIONS Median lingual lymph nodes are infrequently identified with MRI in controls, concordant with the low prevalence of metastases from OCSCC to this inconstant nodal group.
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23
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Ren ZH, Wu HJ, Zhang S, Wang K, Gong ZJ, He ZJ, Peng J. A new surgical strategy for treatment of tongue squamous cell carcinoma based on anatomic study with preliminary clinical evaluation. J Craniomaxillofac Surg 2015; 43:1577-82. [PMID: 26321124 DOI: 10.1016/j.jcms.2015.07.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 07/17/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND This study characterized the infiltration of primary tumors along the intrinsic and extrinsic muscles of the tongue in oral tongue squamous cell carcinoma (OTSCC), to create a new surgical strategy that is suitable for most stages. A preliminary evaluation of this novel surgical approach was also conducted. METHODS An anatomic study of macroscopic specimens from 10 human cadavers and 100 OTSCC patients was conducted. The anatomic characteristics of the primary tumors and the origin and distribution of fibers of the intrinsic and extrinsic tongue muscles were observed and measured. After initial treatment with curative intent, the 100 patients were regularly followed-up with clinical examination and imaging. RESULT Based on the anatomic characteristics of the primary tumors and tongue muscles, a new surgical approach was developed, and was described as muscle anatomy tongue surgery (MATS). MATS proved suitable for almost all stages of OTSCC. According to the morphology of the invasive tumor front, the 100 cases were divided into four types. The rate of 2-year local disease control was 98%, locoregional control 86%, disease-free survival 85%, and overall survival 89%. Tongue functions were perfectly recovered in more than 60% of the patients. CONCLUSION Application of the principles of MATS to the treatment of OTSCC proved suitable for almost all stages of the disease. MATS is a novel surgical technique that may improve outcomes in tongue cancer surgery.
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Affiliation(s)
- Zhen-Hu Ren
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China; Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China.
| | - Han-Jiang Wu
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China.
| | - Sheng Zhang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Kai Wang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Zhao-Jian Gong
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Zhi-Jing He
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Jie Peng
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China
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24
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Ananian SG, Gvetadze SR, Ilkaev KD, Mochalnikova VV, Zayratiants GO, Mkhitarov VA, Yang X, Ciciashvili AM. Anatomic-histologic study of the floor of the mouth: the lingual lymph nodes. Jpn J Clin Oncol 2015; 45:547-54. [PMID: 25770836 DOI: 10.1093/jjco/hyv029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 02/16/2015] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The lingual lymph nodes are inconstant nodes located within the fascial/intermuscular spaces of the floor of the mouth. Oral tongue squamous cell carcinoma has been reported to recur and metastasize in lingual lymph nodes with poor prognosis. Lingual lymph nodes are not currently included in basic tongue squamous cell carcinoma surgery. METHODS Twenty-one cadavers (7 males, 14 females) were studied, aged from 57 to 94 years (mean age 76.3 years). The gross specimen of the floor of the mouth was divided into blocks: A (median nodes), B, B' (parahyoid), C, C' (paraglandular). Serial histological microslides were cut and stained with hematoxylin-eosin. Frequency of lingual lymph nodes in each block and their microscopic features were assessed. RESULTS The lingual lymph nodes in overall number of 7 were detected in 5 of the 21 cadavers (23.8%). The total incidence of lingual lymph node was 33.3% (7 nodes/21 cadavers). Block A failed to demonstrate any lymph nodes (0%); Blocks B, B'-2 nodes (9.5%) and 2 nodes (9.5%), respectively; Blocks C, C'-1 node (4.8%) and 2 nodes (9.5%), respectively. The mean lingual lymph node length was 4.1 mm (from 1.4 to 8.7 mm), the mean thickness was 2.8 mm (from 0.8 to 7.5 mm). Five cadavers (23.8%) revealed mucosa-associated lymphoid tissue. Atrophic changes appeared in 4 (57.1%) lingual lymph nodes. CONCLUSION The presence of lymph node-bearing tissue in the floor of the mouth is demonstrated. In account of resection radicalism and better local control the fat tissue of the floor of the mouth should be removed in conjunction to glossectomy. Further anatomic and clinical research is required to establish the role of lingual lymph node in oral squamous cell carcinoma recurrence and metastasis.
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Affiliation(s)
- Sargis G Ananian
- Department of Consulting and Diagnostics, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow Department of Oral and Maxillofacial Surgery, Russian Medical Academy of Postgraduate Education Studies, Moscow
| | - Shalva R Gvetadze
- Department of Consulting and Diagnostics, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow Department of Oral and Maxillofacial Surgery, Russian Medical Academy of Postgraduate Education Studies, Moscow Department of Congenital Maxillofacial Defects and Deformations, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow
| | - Konstantin D Ilkaev
- Department of Head and Neck Surgery, N.N. Blokhin Russian Cancer Research Center of Russian Academy of Medical Sciences, Moscow
| | - Valeria V Mochalnikova
- Department of Human Tumor Morphology, N.N. Blokhin Russian Cancer Research Center of Russian Academy of Medical Sciences, Moscow
| | - Georgiy O Zayratiants
- Department of Pathologic Anatomy, Moscow State University of Medicine and Dentistry, Moscow
| | - Vladimir A Mkhitarov
- Laboratory of Immunomorphology of Inflammation, Group of Informatics and Morphometry, Research Institute of Human Morphology of Russian Academy of Medical Sciences, Moscow, Russia
| | - Xin Yang
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Tongji University, Shanghai, PR China
| | - Aleksandr M Ciciashvili
- Department of Oral and Maxillofacial Surgery and Implantology, Moscow State University of Medicine and Dentistry, Moscow, Russia
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Amar A, Rapoport A, Curioni OA, Dedivitis RA, Cernea CR, Brandão LG. Prognostic value of regional metastasis in squamous cell carcinoma of the tongue and floor of mouth. Braz J Otorhinolaryngol 2014; 79:734-7. [PMID: 24474486 PMCID: PMC9442422 DOI: 10.5935/1808-8694.20130134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 08/01/2013] [Indexed: 11/20/2022] Open
Abstract
The presence of metastatic nodes is a survival-limiting factor for patients with mouth tumors. Objective To evaluate the causes of treatment failure in carcinomas of the tongue and floor of the mouth due to staging. Method This study included 365 patients with squamous cell carcinoma of the mouth treated from 1978 to 2007; 48 were staged as T1, 156 as T2, 98 as T3, and 63 as T4, of which 193 were pNo and 172 pN+. Results Among the pN+ cases, 17/46 (36.9%) of the patients not treated with radiation therapy had relapsing tumors, against 46/126 (36.5 %) of the patients who underwent radiation therapy. Success rates in the group of subjects submitted to salvage procedures were 16/51 (31.3%) for pN0 patients and 3/77 (3.9%) for pN+ patients. Conclusion Salvage procedure success and survival rates are lower for pN+ patients; pN+ individuals also have more relapsing local disease.
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Affiliation(s)
- Ali Amar
- Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, Hospital Heliópolis, São PauloSP
| | | | - Otávio Alberto Curioni
- Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, Hospital Heliópolis, São Paulo
| | - Rogério Aparecido Dedivitis
- Departamento de Cirurgia de Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
| | - Claudio Roberto Cernea
- Departamento de Cirurgia de Cabeça e Pescoço, Faculdade de Medicina, Universidade de São Paulo
| | - Lenine Garcia Brandão
- Departamento de Cirurgia de Cabeça e Pescoço, Faculdade de Medicina, Universidade de São Paulo
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Omura K. Current status of oral cancer treatment strategies: surgical treatments for oral squamous cell carcinoma. Int J Clin Oncol 2014; 19:423-30. [DOI: 10.1007/s10147-014-0689-z] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Indexed: 12/21/2022]
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Zhang T, Lubek JE, Salama A, Dyalram D, Liu X, Ord RA. Treatment of cT1N0M0 Tongue Cancer: Outcome and Prognostic Parameters. J Oral Maxillofac Surg 2014; 72:406-14. [DOI: 10.1016/j.joms.2013.05.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 05/15/2013] [Accepted: 05/19/2013] [Indexed: 10/26/2022]
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Ord RA. Surgical management of the N0 neck in early stage T1-2 oral cancer; a personal perspective of early and late impalpable disease. Oral Maxillofac Surg 2012; 16:181-188. [PMID: 22581159 DOI: 10.1007/s10006-012-0325-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 04/03/2012] [Indexed: 05/31/2023]
Abstract
INTRODUCTION The management of the N0 neck in early stage oral cancer remains controversial. The evidence in the literature for elective neck dissection, which is reviewed in this paper, is conflicting. My personal view is that most papers mistakenly assume that the N0 equates to an "early stage" neck whereas a neck with palpable nodes represents disease at a "late" stage. DISCUSSION I believe that this is the same mindset that prevented us from realizing that depth rather than size was the important prognostic determinant for the primary tumor; because the T stage was based on tumor size. The N stage is also based on size and number of nodes and by these criteria N0 would be the earliest stage. However, although an N0 neck with impalpable intra-nodal disease may be regarded as early impalpable disease an N0 neck with microscopic extra-capsular spread (ECS) would be "late/advanced" impalpable disease. Likewise, a clinically positive neck with intra-nodal disease still represents early disease compared to a clinically positive neck with ECS. CONCLUSION The lack of trials and studies stratifying NO and N +ve necks into early and late disease and comparing outcomes between these cohorts may explain the lack of clear-cut evidence regarding the role for elective neck dissection.
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Affiliation(s)
- R A Ord
- Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, USA.
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29
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Saito M, Nishiyama H, Oda Y, Shingaki S, Hayashi T. The lingual lymph node identified as a sentinel node on CT lymphography in a patient with cN0 squamous cell carcinoma of the tongue. Dentomaxillofac Radiol 2011; 41:254-8. [PMID: 22074865 DOI: 10.1259/dmfr/61883763] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We performed CT lymphography on an 81-year-old female patient with a histologically confirmed squamous cell carcinoma of the tongue with no clinical or radiological evidence of cervical lymph node involvement. The lateral lingual lymph node was identified as a sentinel node, which is the first lymph node to receive drainage from a primary tumour. CT lymphography also showed draining lymphatics passing through the sublingual space, the medial side of the submandibular gland and near the hyoid bone and connected with the middle internal jugular node. Although metastasis to the lateral lingual lymph node is known as one of the crucial events in determining survival outcome in cancer of the tongue and floor of the mouth, very few reports are available on the imaging of the lateral lingual lymph node metastasis. This is the first report regarding the lateral lingual lymph node identified as a sentinel node demonstrated on CT lymphography.
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Affiliation(s)
- M Saito
- Division of Oral and Maxillofacial Radiology, Department of Tissue Regeneration and Reconstruction Course for Oral Life Science, Niigata University Graduate School of Medical and Dental Sciences, Chuou-ku, Niigata, Japan.
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Zhang T, Ord RA, Wei WI, Zhao J. Sublingual lymph node metastasis of early tongue cancer: report of two cases and review of the literature. Int J Oral Maxillofac Surg 2011; 40:597-600. [PMID: 21277742 DOI: 10.1016/j.ijom.2010.12.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 11/02/2010] [Accepted: 12/21/2010] [Indexed: 12/22/2022]
Abstract
Sublingual lymph node metastasis of early stage squamous cell carcinoma of the tongue (SCCT) is seldom reported. Lymphatic tissue in the floor of mouth, which intervenes between the tongue and neck, will be left behind by a primary tumour resection with discontinuous neck dissection. The authors present two cases of early stage SCCT with sublingual lymph node metastasis, review the literature, and discuss the management of the floor of mouth for early stage SCCT. The authors suggest that more attention should be paid to possible sublingual lymph node metastasis for T1/T2 SCC of the ventral tongue with deeply endophytic infiltration.
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Affiliation(s)
- T Zhang
- Department of Oral & Maxillofacial Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China.
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31
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Pan WR, le Roux CM, Levy SM, Briggs CA. Lymphatic drainage of the tongue and the soft palate. EUROPEAN JOURNAL OF PLASTIC SURGERY 2010. [DOI: 10.1007/s00238-010-0417-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ando M, Asai M, Ono T, Nakanishi Y, Asakage T, Yamasoba T. Metastases to the lingual nodes in tongue cancer: a pitfall in a conventional neck dissection. Auris Nasus Larynx 2009; 37:386-9. [PMID: 19897329 DOI: 10.1016/j.anl.2009.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 10/04/2009] [Accepted: 10/06/2009] [Indexed: 12/22/2022]
Abstract
Some classical textbooks of anatomy provided a detailed description of the lingual nodes, which are small inconstant lymph nodes in the floor-of-mouth and the upper neck. The clinical importance of these lymph nodes in cancer therapy, however, has been underestimated so far. We previously reported an extremely poor prognosis of oral tongue cancer patients who had lesions at the root of the lingual artery and assumed that metastases in occult lingual nodes might be responsible for such lesions. This case report clearly demonstrates the distinctive draining course of the lateral lingual nodes, which may potentially be left untreated by a neck dissection. A 63-year-old Japanese male with T2 squamous cell carcinoma of the oral tongue showed multiple metastatic involvements of the lateral lingual nodes; three nodes in close contact with the sublingual gland, and one node at the root of the lingual artery. A systematic inspection of lymph nodes along the draining course of the lateral lingual nodes should be included, because a neck dissection in continuity with the primary tumor (a pull-through approach) is still inadequate for the removal of the lymph nodes at the root of the lingual artery.
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Affiliation(s)
- Mizuo Ando
- Department of Otorhinolaryngology, School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
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Huang SF, Kang CJ, Lin CY, Fan KH, Yen TC, Wang HM, Chen IH, Liao CT, Cheng AJ, Chang JTC. Neck treatment of patients with early stage oral tongue cancer. Cancer 2008; 112:1066-75. [DOI: 10.1002/cncr.23278] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hornstra MT, Alkureishi LWT, Ross GL, Shoaib T, Soutar DS. Predictive factors for failure to identify sentinel nodes in head and neck squamous cell carcinoma. Head Neck 2008; 30:858-62. [DOI: 10.1002/hed.20787] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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35
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Woolgar J, Triantafyllou A. Neck dissections: A practical guide for the reporting histopathologist. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.cdip.2007.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Okura M, Iida S, Aikawa T, Adachi T, Yoshimura N, Yamada T, Kogo M. Tumor thickness and paralingual distance of coronal MR imaging predicts cervical node metastases in oral tongue carcinoma. AJNR Am J Neuroradiol 2007; 29:45-50. [PMID: 17947369 DOI: 10.3174/ajnr.a0749] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The presence of cervical lymph node metastases is an important prognostic factor for oral tongue cancer. The accurate preoperative assessment is essential for treatment. Several studies have suggested that histologic tumor thickness is related to the metastases. The aim of this study was to determine whether MR images of oral tongue tumor have the potential to predict cervical lymph node metastases. MATERIALS AND METHODS A total of 43 patients with squamous cell carcinoma of the oral tongue were investigated. Tumor thickness, sublingual distance between tumor and sublingual space, and paralingual distance between tumor and paralingual space, as determined from coronal MR imaging, were preoperatively estimated. Logistic regression analysis was used to identify independent predictors of lymph node metastases. RESULTS Univariate logistic regression analysis showed that T classification, N classification, and 3 measured MR imaging distances (millimeters) were significantly associated with lymph node metastases. Multivariate logistic regression analysis showed that tumor thickness (odds ratio, 1.34; 95% confidence interval [CI], 1.11-1.63; P < .005) and paralingual distance (odds ratio, 0.53; 95% CI, 0.35-0.82; P < .005) were significant predictors for lymph node metastases. The probability of metastases was estimated with these models. The preoperative decision (20% probability) as to whether to perform neck dissection could be based on tumor thickness of >9.7 mm and paralingual distance of <5.2 mm. CONCLUSION MR images provide satisfactory accuracy for the preoperative estimation of the tumor thickness and the paralingual distance, which are valuable for predicting cervical lymph node metastases.
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Affiliation(s)
- M Okura
- First Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, Osaka, Japan
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37
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Affiliation(s)
- Jochen A Werner
- Department of Otolaryngology, Head and Neck Surgery, Philipps-University Marburg, Marburg, Germany
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38
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Amar A, Franzi SA, Curioni OA, Carvalho MBD, Rapoport A. Esvaziamento cervical seletivo no tratamento do carcinoma epidermóide do andar inferior da boca. Rev Col Bras Cir 2005. [DOI: 10.1590/s0100-69912005000600007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: O esvaziamento cervical seletivo, removendo apenas os linfonodos com maior probabilidade de metástases, pode ser adequado para o tratamento do pescoço nos carcinomas epidermóides do andar inferior da boca. O objetivo deste estudo é avaliar os níveis linfonodais acometidos por metástases em uma série de pacientes tratados em uma única instituição. MÉTODO: Foram avaliados os registros de 416 pacientes com câncer de lábio, língua oral, soalho de boca, gengiva inferior, região jugal e trígono retromolar, submetidos à 519 esvaziamentos cervicais entre 1977 e 2001, quanto ao níveis linfonodais acometidos por metástases. RESULTADOS: O nível I estava acometido em 107/519 (20%) esvaziamentos, o nível II em 147/519 (28%), o nível III em 75/519 (14%), o nível IV em 32/419 (7%) e o nível V em 22/419 (5%). A taxa de falso-negativos e de falso-positivos foi de 36% e 30%, respectivamente. Os pacientes com metástases nos níveis I e/ou II, III, IV ou V tiveram uma média 2,2; 4,8; 6,5 e 7,5 linfonodos comprometidos, respectivamente (p < 0.0001). As metástases no nível IIb foram diagnosticadas em 21 (5%) pacientes, sendo que 11 (52%) deles tinham metástases no nível V (p < 0,0001). CONCLUSÃO: O esvaziamento cervical dos níveis I a IV remove quase todos os linfonodos com risco de metástases no carcinoma epidermóide do andar inferior da boca. O esvaziamento seletivo com esta extensão é adequado para o tratamento eletivo do pescoço (N0), onde ocorrem aproximadamente 30% de casos falso-negativos, e também pode ser suficiente no esvaziamento terapêutico (N+). Quando ocorrem metástases no nível IIb, aumenta significativamente o risco de metástases no nível V.
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Ross GL, Shoaib T. Role of sentinel node biopsy in the management and staging of the N0 neck. Odontology 2005; 93:1-6. [PMID: 16170469 DOI: 10.1007/s10266-005-0045-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2004] [Accepted: 11/01/2004] [Indexed: 10/25/2022]
Abstract
Sentinel node biopsy is being increasingly used as a staging tool for mucosal head and neck cancer. This review of the literature summarizes the results of research into the procedure when it has been performed in three main contexts: as part of an ipsilateral neck dissection, as a stand-alone procedure to stage the neck for positive or negative disease, and as a means of investigating the non-involved or contralateral neck in tumors close to or crossing the midline. The role of the procedure is discussed and the difficulties encountered are expanded, with a particular emphasis on pitfalls of the technique, caveats, and its potential role for the future.
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Affiliation(s)
- Gary L Ross
- Canniesburn Plastic Surgery Unit, Jubilee Building, Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK.
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40
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Dimitrijević M, Dukić V, Trivić A. [Evaluation of local and regional spread of malignant tumors of the tongue and floor of the mouth]. VOJNOSANIT PREGL 2004; 61:507-12. [PMID: 15551803 DOI: 10.2298/vsp0405507d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Malignant tumors of the oral cavity grow rapidly, frequently and early metastazing to the surrounding regional lymph nodes. The aim of this study was to evaluate the correlation between clinically confirmed local and regional spread and intraoperatively and histopathologically verified local spread. A series of 74 patients with carcinoma of the tongue and floor of the mouth were analyzed. All the patients were surgically treated during the period 1991-1995. Clinical evidence of local spread (cT) was in high accord with intraoperatively and histopathologically evidenced spread (pT) amounting to 83.8%. The degree of correlation decreased with the increase of T stage. Clinically observed regional spread (cN) and intraoperatively and histopathologically confirmed regional spread (pN) was lower, amounting to 56.8% in comparison to the corresponding T categories.
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Affiliation(s)
- Milovan Dimitrijević
- Klinicki centar Srbije, Institut za otorinolaringologiju i maksilofacijalnu hirurgiju, Beograd, Srbija i Crna Gora.
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Werner JA, Dünne AA, Myers JN. Functional anatomy of the lymphatic drainage system of the upper aerodigestive tract and its role in metastasis of squamous cell carcinoma. Head Neck 2003; 25:322-32. [PMID: 12658737 DOI: 10.1002/hed.10257] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although there is a significant understanding of the vascular anatomy of the upper aerodigestive tract (UADT), there is less detailed knowledge of the architecture and drainage patterns of the lymphatic system. Detailed knowledge of the lymphatic system is critical for understanding the role of sentinal node identification in the management of different cancers. METHODS We have combined microscopic techniques with in vivo and in vitro lymphographic studies to survey the architecture and drainage patterns of the lymphatic system of the UADT in 850 organ specimens. RESULTS These studies show an interaction of superficial and deep lymphatic networks that vary in density but have a constant distribution characterized by predictable patterns of lymph drainage into the regional lymph nodes. CONCLUSIONS Detailed knowledge of the lymphatic system of the UADT contributes to a better understanding of the patterns of metastatic spread of carcinomas of the UADT and provides a strong rationale for the practice of sentinel node identification in the management of these tumors.
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Affiliation(s)
- Jochen A Werner
- Department of Otolaryngology, Head and Neck Surgery, Philipps University Marburg, Deutschhausstr. 3, 35037 Marburg, Germany.
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Dutton JM, Graham SM, Hoffman HT. Metastatic cancer to the floor of mouth: the lingual lymph nodes. Head Neck 2002; 24:401-5. [PMID: 11933183 DOI: 10.1002/hed.10026] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The upper level of a cervical lymphadenectomy is anatomically defined at its anterior extent by the lower border of the mandible and, in surgical practice, by the lingual nerve. A neck dissection completed below this level is generally considered adequate for removal of lymph nodes at risk for metastases from oral cavity cancer. Traditional discontinuous neck dissections do not provide for removal of floor of mouth tissue along with the primary and neck specimens. METHODS A case report presenting biopsies from a T2N2bM0 squamous cell carcinoma of the mobile tongue and adjacent floor of the mouth in a 73-year-old man. RESULTS Deep biopsy of a ventral tongue and floor of mouth squamous cell carcinoma revealed occult metastatic cancer to lymph nodes located in the superficial floor of mouth associated with the sublingual gland above the lingual nerve. This report identifies floor of mouth lymph nodes that can be involved with cancer and missed through the standard practice of discontinuous neck dissection.Conclusions. This finding offers evidence that, in certain cases, a traditional discontinuous neck dissection may not address all lymph nodes at risk in the treatment of oral cavity cancer. Further investigation into lymph node distribution within the oral cavity is warranted to reappraise the upper limits of cervical lymphadenectomy.
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Affiliation(s)
- Jay M Dutton
- Department of Otolaryngology and Bronchoesophagology, Rush Medical College, 1725 W. Harrison, Suite 340, Chicago, Illinois 60612, USA.
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Abstract
The histological characteristics and extent of tumour spread at the primary site and in the neck are described in a series of 50 patients with a T2 squamous cell carcinoma of the oral tongue. The likely site of origin was lateral tongue in 29 cases and ventral tongue in 21 cases. Simultaneous tumours were evident in four resections and multifocal dysplasia in a further 13. Lymph node metastasis was diagnosed histologically in 27 cases, including one case with bilateral metastases. Comparison of the groups, with and without metastasis, showed significant differences in tumour thickness, tumour diameter, multifactorial histological malignancy grade, vessel invasion and nerve invasion. The number of positive lymph nodes per patient ranged from 1 to 16 (mean 3), and 17 dissections showed spread beyond the nodal capsule. Postoperative follow-up ranged from 1 to 6 years and, at the time of analysis, 18 patients had died of or with disease. Loco-regional failure was related to 'high-risk' features at the primary site and extracapsular spread in the neck.
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Affiliation(s)
- J A Woolgar
- Oral Pathology Laboratory, Liverpool University Dental Hospital, UK
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44
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Woolgar JA. Histological distribution of cervical lymph node metastases from intraoral/oropharyngeal squamous cell carcinomas. Br J Oral Maxillofac Surg 1999; 37:175-80. [PMID: 10454023 DOI: 10.1054/bjom.1999.0036] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The histological frequency and distribution of cervical lymph node metastases was studied in 326 neck dissections from 253 patients with an intraoral/oropharyngeal squamous cell carcinoma. Metastasis was evident in 118 patients (47%) and 18 had bilateral metastasis. For primary sites other than the tongue, metastasis developed initially in a node(s) in the first drainage group (level I or II) with progressive involvement of neighbouring nodes ('overflow'). Simultaneous bilateral metastases were seen in some tumours of the floor of mouth, tongue and oropharynx which involved the midline. An erratic distribution of metastases suggestive of 'fast-tracking' (skip lesions and peppering) was only seen in tongue tumours. The pattern of metastatic spread indicates that level IV nodes must be included in staging and therapeutic neck dissections in tongue cancer. Metastasis to 'accessory' lymph nodes (lingual, buccal) occurs infrequently but may explain some 'local' recurrences.
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Affiliation(s)
- J A Woolgar
- University of Liverpool School of Dentistry, UK
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45
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Kurita H, Kurashina K, Minemura T, Kotani A. Pitfalls in the treatment of delayed lymph-node metastases after control of small tongue carcinomas. Int J Oral Maxillofac Surg 1995; 24:356-60. [PMID: 8627102 DOI: 10.1016/s0901-5027(05)80491-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Between 1985 and 1992, 13 patients were treated for delayed lymph-node metastases that developed after obtaining control of primary lesions of the tongue. These lesions were treated primarily by radiotherapy or surgical resection; cervical metastases were treated mainly by delayed radical neck dissection (RND). Seven of the 13 patients survived with no evidence of recurrence. The other six patients developed tumors in the neck, and five of these patients died due to uncontrollable disease. In all but one patient, recurrence appeared between the site of the primary lesion and the region of RND, the oral floor and/or the parapharyngeal space. None of the patients with recurrence received radiotherapy in the area between the primary lesion and the site of RND. In contrast, there was no recurrence in patients who received external irradiation to the primary lesion and upper cervical lymph nodes. This review emphasizes the need to direct more attention to the area between the site of the primary lesion and the regional lymph nodes in patients receiving treatment for delayed metastases associated with small carcinomas of the tongue.
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Affiliation(s)
- H Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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