Sridhar Sindhura, Larson Daniel P, Raj Sweeya, Jin Whitney, Zhu Vivian L, Hicks Melanie, Mannion Kyle, Topf Michael C
Department of Otolaryngology-Head and Neck Surgery Vanderbilt University Medical Center Nashville Tennessee USA.
Vanderbilt University School of Medicine Nashville Tennessee USA.
Laryngoscope Investig Otolaryngol. 2025 May 24;10(3):e70150. doi: 10.1002/lio2.70150. eCollection 2025 Jun.
ENE is an important prognostic factor in p16-positive OPSCC and is an indication for adjuvant chemoradiation. A recent single institution retrospective study demonstrated that core needle biopsy (CNB) was independently associated with ENE, potentially due to disruption of the lymph node capsule. In this study, we investigate the association between the type of preoperative nodal biopsy and ENE at our institution.
Retrospective cohort study.
Patients with p16-positive OPSCC who underwent primary surgical resection (transoral robotic surgery and neck dissection) from October 2011 to March 2025 were identified. Univariate logistic regression analysis was performed to determine the association between the type of preoperative biopsy and ENE. The impact of confounding variables was assessed using a multivariate logistic regression model.
We identified 123 patients with a mean age of 60.9 years (range 38-80). Sixteen patients underwent preoperative CNB (13.0%), 74 patients underwent preoperative FNA (60.2%), and 33 patients did not undergo preoperative biopsy of a lymph node (26.8%). ENE was present in 43 patients (35.0%) including 7/16 (43.8%) CNB, 28/74 (37.8%) FNA, and 8/33 (27.2%) no preoperative biopsy. CNB was not associated with ENE (univariate OR 2.43, 95% CI 0.68-8.84, multivariate OR 2.34, 95% CI 0.50-11.74). Preoperative CNB was not associated with receipt of adjuvant treatment. Patients who presented with more than one clinically positive lymph node (cN2b) had a 48.6% chance of pathological ENE.
In this single institution study of patients with surgically treated p16-positive OPSCC, preoperative CNB was not associated with ENE. Level 4.
包膜外侵犯（ENE）是p16阳性口咽鳞状细胞癌（OPSCC）的一个重要预后因素，也是辅助放化疗的指征。最近一项单机构回顾性研究表明，粗针穿刺活检（CNB）与ENE独立相关，可能是由于淋巴结包膜破裂所致。在本研究中，我们调查了我院术前淋巴结活检类型与ENE之间的关联。
回顾性队列研究。
确定2011年10月至2025年3月期间接受初次手术切除（经口机器人手术和颈部清扫）的p16阳性OPSCC患者。进行单因素逻辑回归分析以确定术前活检类型与ENE之间的关联。使用多因素逻辑回归模型评估混杂变量的影响。
我们确定了123例患者，平均年龄60.9岁（范围38 - 80岁）。16例患者接受了术前CNB（13.0%），74例患者接受了术前细针穿刺抽吸活检（FNA，60.2%），33例患者未进行术前淋巴结活检（26.8%）。43例患者（35.0%）存在ENE，包括16例中的7例（43.8%）接受CNB者、74例中的28例（37.8%）接受FNA者以及33例中未进行术前活检的8例（27.2%）。CNB与ENE无关（单因素比值比2.43，95%置信区间0.68 - 8.84，多因素比值比2.34，95%置信区间0.50 - 11.74）。术前CNB与接受辅助治疗无关。出现一个以上临床阳性淋巴结（cN2b）的患者病理ENE发生率为48.6%。
在这项针对接受手术治疗的p16阳性OPSCC患者的单机构研究中，术前CNB与ENE无关。证据等级：4级。
