Redaelli de Zinis L O, Piccioni L O, Ghizzardi D, Mantini G, Antonelli A R
Clinica Otorinolaringoiatrica, Università degli Studi di Brescia.
Acta Otorhinolaryngol Ital. 1998 Feb;18(1):11-5.
The purpose of the present study was to define the indications and extension for the treatment of lymph nodes in clinically NO patients with primary malignant epithelial parotid tumors. A retrospective analysis was performed on 46 cases with such tumor out of 307 parotid neoplasms (246 benign, 61 malignant) consecutively treated from 1985 to 1994. Lymph node metastases were present only in the histotypes with a high degree of malignancy (overall incidence, 24%). Two patients (5%) showed occult metastases. No correlation was found between the size of the neoplasm and the incidence of lymph node metastases. However, the latter were significantly more common in locally highly aggressive neoplasms (class "a"), 8%; class "b" 43%; P = 0.006). Due to the small number of cases, it was not possible to correlate the incidence of occult metastases with neoplasm size or local extension. As regards topographic distribution of lymph node metastases, level II was always involved, level V was never involved, and level i.v was involved only when metastases were found in the upper levels. Occult metastases were found only at level II. Over a follow-up period of 2 to 10 years, no cases were seen with cervical recurrences. Although drawn from a limited series, the results are similar to the data generally reported in the literature, showing that lymph node metastases are rare in neoplasms with a low grade of malignancy whereas there is a significant increase in the incidence of metastatic lymph nodes and occult metastases when the grade of malignancy is high. In conclusion, in clinically NO patients, a suprahomohyoid neck dissection (levels I-II-III) is indicated only when the neoplasm shows a high grade of malignancy or when it is a class "b" malignancy. In the other cases, neck dissection is determined by the clinical evidence of metastasis and can be extended to the lower levels. Neck dissection can be avoided in NO patients whenever ultrasound and fine needle biopsy are both routinely used in the preoperative evaluation of the cervical lymph nodes.
本研究的目的是明确临床NO期原发性腮腺恶性上皮性肿瘤患者淋巴结治疗的指征及范围。对1985年至1994年连续治疗的307例腮腺肿瘤（246例良性，61例恶性）中的46例此类肿瘤患者进行回顾性分析。仅在高度恶性的组织学类型中存在淋巴结转移（总发生率为24%）。2例患者（5%）出现隐匿性转移。肿瘤大小与淋巴结转移发生率之间未发现相关性。然而，后者在局部侵袭性强的肿瘤（“a”类）中明显更常见，为8%；“b”类为43%；P = 0.006）。由于病例数量较少，无法将隐匿性转移的发生率与肿瘤大小或局部范围相关联。关于淋巴结转移的拓扑分布，Ⅱ区总是受累，Ⅴ区从未受累，Ⅳ区仅在上级别发现转移时才受累。隐匿性转移仅在Ⅱ区发现。在2至10年的随访期内，未见颈部复发病例。尽管样本数量有限，但结果与文献中普遍报道的数据相似，表明低恶性肿瘤中淋巴结转移罕见，而恶性程度高时转移性淋巴结和隐匿性转移的发生率显著增加。总之，在临床NO期患者中，仅当肿瘤显示高度恶性或为“b”类恶性时，才建议进行舌骨上颈部清扫术（Ⅰ-Ⅱ-Ⅲ区）。在其他情况下，颈部清扫术由转移的临床证据决定，可扩展至更低区域。只要在术前对颈部淋巴结进行常规超声检查和细针穿刺活检，NO期患者可避免进行颈部清扫术。
