The Laryngoscope · 2015
Implications of intraglandular lymph node metastases in primary carcinomas of the parotid gland.
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Nisa Lluís, Salmina Cinzia, Dettmer Matthias Stephan, Arnold Andreas, Aebersold Daniel Matthias, Borner Urs, Giger Roland
Аннотация
OBJECTIVES/HYPOTHESIS: Assess the diagnostic and prognostic relevance of intraglandular lymph node (IGLN) metastases in primary parotid gland carcinomas (PGCs).
STUDY DESIGN: Retrospective study at a tertiary referral university hospital.
METHODS: We reviewed the records of 95 patients with primary PGCs, treated at least surgically, between 1997 and 2010. We assessed the clinicopathological associations of IGLN metastases, their prognostic significance, and predictive value in the diagnosis of occult neck lymph node metastases
RESULTS: Twenty-four (25.26%) patients had IGLN metastases. This feature was significantly more prevalent in patients with advanced pT status (P = .01), pN status (P < .01), and overall stage (P < .001); high-risk carcinomas (P = .01); as well as in patients with treatment failures (P < .01). IGLN involvement was significantly associated with decreased univariate disease-free survival (P < .001). Positive and negative predictive values and accuracy for IGLN involvement in the detection of occult neck lymph node metastases were 63.64%, 90.48%, and 84.91%, respectively. The diagnostic values were generally higher in patients with low-risk subtype of PGCs.
CONCLUSIONS: IGLN involvement provides prognostic information and is associated with advanced tumoral stage and higher risk of recurrence. This feature could be used as a potential readout to determine whether a neck dissection in clinically negative neck lymph nodes is needed or not.
LEVEL OF EVIDENCE: 4.
STUDY DESIGN: Retrospective study at a tertiary referral university hospital.
METHODS: We reviewed the records of 95 patients with primary PGCs, treated at least surgically, between 1997 and 2010. We assessed the clinicopathological associations of IGLN metastases, their prognostic significance, and predictive value in the diagnosis of occult neck lymph node metastases
RESULTS: Twenty-four (25.26%) patients had IGLN metastases. This feature was significantly more prevalent in patients with advanced pT status (P = .01), pN status (P < .01), and overall stage (P < .001); high-risk carcinomas (P = .01); as well as in patients with treatment failures (P < .01). IGLN involvement was significantly associated with decreased univariate disease-free survival (P < .001). Positive and negative predictive values and accuracy for IGLN involvement in the detection of occult neck lymph node metastases were 63.64%, 90.48%, and 84.91%, respectively. The diagnostic values were generally higher in patients with low-risk subtype of PGCs.
CONCLUSIONS: IGLN involvement provides prognostic information and is associated with advanced tumoral stage and higher risk of recurrence. This feature could be used as a potential readout to determine whether a neck dissection in clinically negative neck lymph nodes is needed or not.
LEVEL OF EVIDENCE: 4.
Предметные рубрики MeSH
AdultAgedAged, 80 and overBiopsy, Fine-NeedleCarcinoma, Squamous CellDisease-Free SurvivalFemaleFollow-Up StudiesHumansLymph NodesLymphatic MetastasisMaleMiddle AgedNeckNeck DissectionNeoplasm Recurrence, LocalNeoplasm StagingOtorhinolaryngologic Surgical ProceduresParotid NeoplasmsPositron-Emission TomographyPrognosisRetrospective StudiesTomography, X-Ray ComputedYoung Adult