Department of Otolaryngology-Head and Neck Surgery, Rigshospitalet, Copenhagen University Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Laryngoscope. 2011 Feb;121(2):294-8. doi: 10.1002/lary.21375. Epub 2011 Jan 13.
To examine the prevalence of isolated tumor cells (ITC) and micrometastases (MM) in nonsentinel lymph nodes (NSN) using additional step-serial sectioning and immunohistochemistry (IHC) as for sentinel lymph nodes (SN).
Prospective, consecutive, and clinically controlled trial.
Fifty-one patients with oral cavity squamous cell carcinoma (OSCC) T1-T2 and clinically N0 neck underwent surgical treatment including sentinel-node biopsy (SNB) assisted selective neck dissection (SND). The location of the SN was determined using dynamic and planar lymphoscintigraphy and SPECT-CT. The harvested NSN from the neck dissections underwent the same histopathologic examinations as the SN using step-serial sectioning (SSS) at 150-micron intervals. Two sections from each level were stained with hematoxylin-eosin (H&E) and cytokeratin antibodies (AE1/AE3) and examined for tumor deposits. Results were compared with the previous routine examination of the NSN.
A total of 403 NSN were examined with a median of 8 per patient. A total of 1/51 patients (2%) had involvement of an additional NSN not found on routine examination. This was the only lymph node with involvement not detected previously. However, this patient had metastases in SN and in another NSN detected on routine examination. The overall incidence of occult metastasis (SN + NSN) was 21.6% (11/51) as previously reported.
The incidence of occult metastases in NSN after additional SSS and IHC was 2%. The risk of NSN involvement would seem to be extremely low in patients with early OSCC and negative SN. This study further validates SNB as an accurate staging tool for cN0 early OSCC.
使用额外的连续切片和免疫组织化学（IHC）检查非前哨淋巴结（NSN）中孤立肿瘤细胞（ITC）和微转移（MM）的患病率，方法与前哨淋巴结（SN）相同。
前瞻性、连续和临床对照试验。
51 例口腔鳞状细胞癌（OSCC）T1-T2 且临床 N0 颈部患者接受手术治疗，包括前哨淋巴结活检（SNB）辅助选择性颈部解剖（SND）。SN 的位置通过动态和平面淋巴闪烁显像术和 SPECT-CT 确定。颈部解剖中采集的 NSN 采用相同的组织病理学检查，使用 150 微米间隔的连续切片（SSS）进行 SN。对每个水平的两个切片进行苏木精-伊红（H&E）和细胞角蛋白抗体（AE1/AE3）染色，并检查肿瘤沉积物。结果与 NSN 的先前常规检查进行比较。
共检查了 403 个 NSN，每个患者的中位数为 8 个。共有 1/51 例患者（2%）在常规检查中发现了一个额外的未发现的 NSN 受累。这是唯一未被先前发现的淋巴结受累。然而，该患者在 SN 和常规检查中发现的另一个 NSN 中存在转移。先前报道的隐匿性转移（SN+NSN）的总发生率为 21.6%（11/51）。
在进行额外的 SSS 和 IHC 后，NSN 隐匿性转移的发生率为 2%。在前哨淋巴结阴性的早期 OSCC 患者中，NSN 受累的风险似乎极低。这项研究进一步验证了 SNB 作为 cN0 早期 OSCC 准确分期工具的作用。
