Panda Naresh Kumar, Chettuvatti Karthika, Bakshi Jaimanti B
Department of Otorhinolaryngology and Head-Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India.
Indian J Otolaryngol Head Neck Surg. 2024 Dec;76(6):5201-5208. doi: 10.1007/s12070-024-04945-9. Epub 2024 Aug 1.
The study delves into the distribution of cervical nodal metastasis among patients diagnosed with carcinoma of unknown primary who underwent definitive diagnostic surgical management in form of transoral robotic surgery assisted ipsilateral radical tonsillectomy and tongue base mucosal wedge biopsy with concurrent therapeutic open ipsilateral neck dissection. We conducted a prospective study at a tertiary care center over two-years, enrolling patients with unilateral neck swelling histopathologically confirmed as squamous cell carcinoma neck metastasis. For cases where the primary site remained undetected despite evaluation, patients underwent Transoral Robotic Surgery (TORS) assisted ipsilateral radical tonsillectomy and tongue base wedge biopsy, along with concurrent open ipsilateral neck dissection. The study examines the clinicopathological correlation of nodal metastasis in carcinoma of unknown primary and explores the concepts of Lymph node yield (LNY) and Lymph node density (LND). Clinicoradiologically, the majority of patients exhibited N2b disease ( = 10/18, 55.55%). However, histopathological examination of the neck dissection specimen revealed N3b disease in the majority ( = 5/17, 29.4%). Neck dissection was aborted for 1 patient with unresectable N3b nodal metastasis during the procedure. The most commonly affected lymph node level clinicoradiologically was level II ( = 18/18, 100%), which corresponded to level II pathologically in most cases ( = 15/18, 88.2%). Ipsilateral radical neck dissection was required in the majority of cases ( = 10/17, 58.82%). The median Lymph Node Yield (LNY) from ipsilateral neck dissection was 30.78 ± 3.52, with the highest Lymph Node Ratio (LNR) detected from level II (11.1 ± 1.56). In the context of carcinoma of unknown primary with secondary neck metastasis, exploring emerging concepts such as Lymph Node Ratio (LNR) and Lymph Node Density (LND) alongside other clinicopathological parameters is crucial. These concepts provide valuable insights into the metastatic burden and may aid in refining prognostication and treatment strategies for patients with this condition.
本研究深入探讨了经口机器人手术辅助同侧根治性扁桃体切除术及舌根黏膜楔形活检并同期进行治疗性开放性同侧颈部清扫术的不明原发癌患者的颈部淋巴结转移分布情况。我们在一家三级医疗中心进行了为期两年的前瞻性研究，纳入组织病理学确诊为鳞状细胞癌颈部转移的单侧颈部肿胀患者。对于经评估仍未发现原发部位的病例，患者接受经口机器人手术（TORS）辅助同侧根治性扁桃体切除术及舌根楔形活检，并同期进行开放性同侧颈部清扫术。该研究考察了不明原发癌中淋巴结转移的临床病理相关性，并探讨了淋巴结收获量（LNY）和淋巴结密度（LND）的概念。临床放射学检查显示，大多数患者表现为N2b期疾病（10/18，55.55%）。然而，颈部清扫标本的组织病理学检查显示，大多数患者为N3b期疾病（5/17，29.4%）。术中1例出现不可切除的N3b期淋巴结转移患者的颈部清扫术中止。临床放射学上最常受累的淋巴结区域是Ⅱ区（18/18，100%），大多数病例在病理上也对应Ⅱ区（15/18，88.2%）。大多数病例需要进行同侧根治性颈部清扫术（10/17，58.82%）。同侧颈部清扫术的中位淋巴结收获量（LNY）为30.78±3.52，Ⅱ区检测到的淋巴结比值（LNR）最高（11.1±1.56）。在伴有继发颈部转移的不明原发癌背景下，探索诸如淋巴结比值（LNR）和淋巴结密度（LND）等新出现的概念以及其他临床病理参数至关重要。这些概念为转移负担提供了有价值的见解，并可能有助于完善此类患者的预后评估和治疗策略。
