Department of Otorhinolaryngology, Head and Neck Surgery, Radboud University, Nijmegen Medical Centre, The Netherlands.
Oral Oncol. 2010 Feb;46(2):87-91. doi: 10.1016/j.oraloncology.2009.11.015. Epub 2010 Jan 8.
Estimating the value of our preoperative workup in the treatment of patients with clinically N0 (cN0) squamous cell carcinoma of the oral cavity. Retrospective analysis. Results of preoperative palpation, ultrasound (US) and ultrasound-guided fine needle aspiration cytology (FNAC) were compared to the histological findings after unilateral or bilateral elective selective neck dissection of level I-III (SND I-III) in patients with cN0 squamous cell carcinoma of the oral cavity. Occult metastases were detected by in 50 (22%) out of the 224 cN0 patients. No metastases were found beyond level III in extended neck dissections. T1N0M0 tumors and T2N0M0 tumors metastasized in 8 out of 77 cases (10%) and 32 out of 112 (29%) cases, respectively. Staging of the cN0 neck by palpation and US (+/-ultrasound-guided FNAC) missed occult lymph node metastases in 22% of the patients with oral cavity squamous cell carcinoma. The use of SND I-III therefore still is warranted. Frozen section sampling seemed to be redundant in this selected group of patients, because no additional metastases were found in extended neck dissection specimens. It might not be necessary to perform elective neck dissection in patients with T1 tumors.
评估我们在治疗临床 N0（cN0）口腔鳞状细胞癌患者中的术前检查的价值。回顾性分析。将术前触诊、超声（US）和超声引导下细针穿刺细胞学检查（FNAC）的结果与 cN0 口腔鳞状细胞癌患者单侧或双侧选择性颈清扫术 I-III 水平（SND I-III）的组织学结果进行比较。在 224 例 cN0 患者中，有 50 例（22%）检测到隐匿性转移。在扩大的颈部清扫术中，未发现超过 III 级的转移。T1N0M0 肿瘤和 T2N0M0 肿瘤分别有 8 例（10%）和 32 例（29%）转移。触诊和 US（+/-超声引导下 FNAC）对 cN0 颈部的分期在 22%的口腔鳞状细胞癌患者中遗漏了隐匿性淋巴结转移。因此，仍然需要进行 SND I-III。在这组选定的患者中，冷冻切片取样似乎是多余的，因为在扩大的颈部清扫标本中没有发现额外的转移。对于 T1 肿瘤患者，可能不需要进行选择性颈部清扫。
