Sharma Aditi, Jaiswal Ashwin Ashok, Umredkar Girish, Barle Ratiram, Sharma Neeta, Banerjee Praveer Kumar, Garg Amrish Kumar, Membally Ravindranath
Department of ENT and Head Neck Surgery, J.L.N. Hospital and Research Centre, Sector 9, Bhilai, District Durg, 490009 Chhattisgarh India.
Department of Pathology, J.L.N. Hospital and Research Centre, Sector 9, Bhilai, District Durg, 490009 Chhattisgarh India.
Indian J Otolaryngol Head Neck Surg. 2017 Sep;69(3):323-332. doi: 10.1007/s12070-017-1131-4. Epub 2017 Apr 10.
The aim of this study is to investigate the relationship between the presence of the cervical lymph node with central necrosis as on the preoperative imaging and postoperative histopathological identification of the lymph node extra capsular spread. This study is a prospective study conducted at J.L.N. Hospital and Research Centre, Bhilai (C.G), from August 2011 to January 2014. Thirty patients with metastatic head and neck squamous cell carcinoma were enrolled. All candidates were subjected to a detailed history taking and clinical examination. Their preoperative computed tomography (CT) scans were assessed with attention to the presence and absence of lymph node, lymph node size, shape, level, presence or absence of the lymph node central necrosis and other signs of the ECS such as thick walled enhancing nodal margin, loss of margin definition, alteration of adjacent fat planes. These patients then underwent surgery which included resection of the primary with the neck dissection. The preoperative records of the lymph node size and location were observed radio-graphically and analyzed with the resected lymph node histopathologically. These data was used for finding out correlation. Of the total 30 patients studied, 24 patients were male and 6 patients female with ratio of 4:1. The most common group of the patients were of malignancy of gingivobuccal sulcus. Out of the 30 patients 19 patients had the radiographic evidence of the central necrosis, out of which 11 had the extra capsular spread on the histological analysis. In no patients did we found histopathology extra capsular spread without central necrosis. Thus the central necrosis on the CT has the high sensitivity for detection of the extra capsular spread. Out of the 19 lymph node without extra capsular spread, 11 lymph nodes had no central necrosis on the preoperative CT, remaining 8 lymph node were having central necrosis on CT whereas post op histopathology of these 8 lymph nodes showed metastatic deposit, indicating the low specificity of the central necrosis in detection of the ECS. Lymph node central necrosis on pre-operative CT is sensitive indicator with a high negative predictive value for lymph node extra capsular spread. Future studies focusing on identifying molecular mediator involved in ECS to determine targets for adjuvant therapies in this subset of patients are recommended.
本研究的目的是探讨术前影像学检查显示的伴有中央坏死的颈部淋巴结与术后病理组织学鉴定的淋巴结包膜外扩散之间的关系。本研究是一项前瞻性研究，于2011年8月至2014年1月在比莱（恰蒂斯加尔邦）的J.L.N.医院和研究中心进行。纳入了30例转移性头颈部鳞状细胞癌患者。所有受试者均接受了详细的病史采集和临床检查。对他们的术前计算机断层扫描（CT）进行评估，重点关注淋巴结的有无、淋巴结大小、形状、位置、有无淋巴结中央坏死以及包膜外扩散的其他征象，如增厚强化的淋巴结边缘、边缘清晰度丧失、相邻脂肪平面改变。这些患者随后接受了手术，包括原发灶切除和颈部清扫。术前通过影像学观察淋巴结大小和位置记录，并与切除的淋巴结进行病理组织学分析。这些数据用于找出相关性。在总共研究的30例患者中，男性24例，女性6例，比例为4:1。最常见的患者组是牙龈颊沟恶性肿瘤。30例患者中，19例有中央坏死的影像学证据，其中11例在组织学分析中有包膜外扩散。我们未发现无中央坏死的患者出现病理组织学包膜外扩散。因此，CT上的中央坏死对检测包膜外扩散具有较高的敏感性。在19个无包膜外扩散的淋巴结中，11个淋巴结在术前CT上无中央坏死，其余8个淋巴结在CT上有中央坏死，而这8个淋巴结的术后病理组织学显示有转移灶，表明中央坏死在检测包膜外扩散方面特异性较低。术前CT上的淋巴结中央坏死是淋巴结包膜外扩散的敏感指标，具有较高的阴性预测价值。建议未来开展研究，重点识别参与包膜外扩散的分子介质，以确定该亚组患者辅助治疗的靶点。
