Pathology protocol increases lymph node yield in neck dissection for oral cavity squamous cell carcinoma.
head and neck cancer
histopathology
neck dissection
oral cancer
quality indicators
Journal
Head & neck
ISSN: 1097-0347
Titre abrégé: Head Neck
Pays: United States
ID NLM: 8902541
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
15
10
2019
revised:
11
05
2020
accepted:
30
05
2020
pubmed:
25
6
2020
medline:
22
6
2021
entrez:
25
6
2020
Statut:
ppublish
Résumé
Lymph node yield (LNY) is a proposed quality indicator in neck dissection for oral cavity squamous cell carcinoma (OCSCC). Retrospective series including 190 patients with OCSCC undergoing neck dissection between 2016 and 2018. A change in pathologic grossing protocol was initiated during the study period to assess residual adipose tissue. A generalized linear model was used to assess the impact of multiple variables on LNY. Mean LNY was 28.59 (SD = 17.65). The protocol identified a mean of 10.32 lymph nodes per case. Multivariable analysis identified associations between LNY and use of the pathology protocol (P = .02), number of dissected lymph node levels (P < .001), presence of pathologic lymph nodes (P = .002), body mass index (P = .02), prior neck surgery (P = .001), and prior neck radiation (P = .001). Assessment of residual adipose tissue within neck dissection specimens improves accuracy of LNY. LNY in neck dissection is influenced by multiple factors including methods of pathologic assessment.
Sections du résumé
BACKGROUND
Lymph node yield (LNY) is a proposed quality indicator in neck dissection for oral cavity squamous cell carcinoma (OCSCC).
METHODS
Retrospective series including 190 patients with OCSCC undergoing neck dissection between 2016 and 2018. A change in pathologic grossing protocol was initiated during the study period to assess residual adipose tissue. A generalized linear model was used to assess the impact of multiple variables on LNY.
RESULTS
Mean LNY was 28.59 (SD = 17.65). The protocol identified a mean of 10.32 lymph nodes per case. Multivariable analysis identified associations between LNY and use of the pathology protocol (P = .02), number of dissected lymph node levels (P < .001), presence of pathologic lymph nodes (P = .002), body mass index (P = .02), prior neck surgery (P = .001), and prior neck radiation (P = .001).
CONCLUSIONS
Assessment of residual adipose tissue within neck dissection specimens improves accuracy of LNY. LNY in neck dissection is influenced by multiple factors including methods of pathologic assessment.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2872-2879Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Myers EN, Fagan JJ. Treatment of the N+ neck in squamous cell carcinoma of the upper aerodigestive tract. Otolaryngol Clin North Am. 1998;31(4):671-686.
Kligerman J, Lima RA, Soares JR, et al. Supraomohyoid neck dissection in the treatment of T1/T2 squamous cell carcinoma of oral cavity. Am J Surg. 1994;168(5):391-394.
D'Cruz AK, Vaish R, Kapre N, et al. Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med. 2015;373(6):521-529.
Crile G. Excision of cancer of the head and neck: with special reference to the plan of dissection based on one hundred and thirty-two operations. JAMA. 1987;258(22):3286-3293.
Bocca E, Pignataro O. A conservation technique in radical neck dissection. Plast Reconstr Surg. 1968;42(6):607.
Byers RM. Modified neck dissection: a study of 967 cases from 1970 to 1980. Am J Surg. 1985;150(4):414-421.
Robbins KT, Medina JE, Wolfe GT, Levine PA, Sessions RB, Pruet CW. Standardizing neck dissection terminology: official report of the Academy's Committee for Head and Neck Surgery and Oncology. Arch Otolaryngol Head Neck Surg. 1991;117(6):601-605.
Robbins KT, Clayman G, Levine PA, et al. Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. Arch Otolaryngol Head Neck Surg. 2002;128(7):751-758.
Schilling C, Stoeckli SJ, Haerle SK, et al. Sentinel European Node Trial (SENT): 3-year results of sentinel node biopsy in oral cancer. Eur J Cancer. 2015;51(18):2777-2784.
Suárez C, Rodrigo JP, Robbins KT, et al. Superselective neck dissection: rationale, indications, and results. Eur Arch Otorhinolaryngol. 2013;270(11):2815-2821.
Agrama MT, Reiter D, Cunnane MF, Topham A, Keane WM. Nodal yield in neck dissection and the likelihood of metastases. Otolaryngol Head Neck Surg. 2003;128(2):185-190.
Ebrahimi A, Zhang WJ, Gao K, Clark JR. Nodal yield and survival in oral squamous cancer: defining the standard of care. Cancer. 2011;117(13):2917-2925.
Ebrahimi A, Clark JR, Amit M, et al. Minimum nodal yield in oral squamous cell carcinoma: defining the standard of care in a multicenter international pooled validation study. Ann Surg Oncol. 2014;21(9):3049-3055.
Lemieux A, Kedarisetty S, Raju S, Orosco R, Coffey C. Lymph node yield as a predictor of survival in pathologically node negative oral cavity carcinoma. Otolaryngol Head Neck Surg. 2016;154(3):465-472.
Divi V, Chen MM, Nussenbaum B, et al. Lymph node count from neck dissection predicts mortality in head and neck cancer. J Clin Oncol. 2016;34:3892-3897.
Cramer JD, Speedy SE, Ferris RL, Rademaker AW, Patel UA, Samant S. National evaluation of multidisciplinary quality metrics for head and neck cancer. Cancer. 2017;123(22):4372-4381.
Divi V, Harris J, Harari PM, et al. Establishing quality indicators for neck dissection: correlating the number of lymph nodes with oncologic outcomes (NRG Oncology RTOG 9501 and RTOG 0234). Cancer. 2016;122:3464-3471.
The development of quality of care measures for oral cavity cancer. Arch Otolaryngol Head Neck Surg. 2008;134(6):672-672.
Graboyes EM, Gross J, Kallogjeri D, et al. Association of compliance with process-related quality metrics and improved survival in oral cavity squamous cell carcinoma. JAMA Otolaryngol Head Neck Surg. 2016;142(5):430-437.
Waitman LR et al. Expressing observations from electronic medical record flowsheets in an i2b2 based clinical data repository to support research and quality improvement. AMIA Annu Symp Proc. 2011;2011:1454-1463.
Waitman LR, Waitman LR, Warren JJ, Manos EL, Connolly DW. Expressing observations from electronic medical record flowsheets in an i2b2 based clinical data repository to support research and quality improvement. AMIA Annual Symposium Proceedings. 2011. Washington, DC: American Medical Informatics Association.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381.
Goldstein NS. Lymph node recoveries from 2427 pT3 colorectal resection specimens spanning 45 years: recommendations for a minimum number of recovered lymph nodes based on predictive probabilities. Am J Surg Pathol. 2002;26(2):179-189.
Tepper JE, O'Connell MJ, Niedzwiecki D, et al. Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol. 2001;19(1):157-163.
Caplin S, Cerottini JP, Bosman FT, Constanda MT, Givel JC. For patients with Dukes' B (TNM Stage II) colorectal carcinoma, examination of six or fewer lymph nodes is related to poor prognosis. Cancer. 1998;83(4):666-672.
Agrama MT, Reiter D, Topham AK, Keane WM. Node counts in neck dissection: are they useful in outcomes research? Otolaryngol Head Neck Surg. 2001;124(4):433-435.
Pou JD, Barton BM, Lawlor CM, Frederick CH, Moore BA, Hasney CP. Minimum lymph node yield in elective level I-III neck dissection. Laryngoscope. 2017;127(9):2070-2073.
Wood P, Peirce C, Mulsow J. Non-surgical factors influencing lymph node yield in colon cancer. World J Gastrointest Oncol. 2016;8(5):466-473.
Chou JF, Row D, Gonen M, Liu YH, Schrag D, Weiser MR. Clinical and pathologic factors that predict lymph node yield from surgical specimens in colorectal cancer: a population-based study. Cancer. 2010;116(11):2560-2570.
Safi A-F, Kauke M, Grandoch A, et al. Clinicopathological parameters affecting nodal yields in patients with oral squamous cell carcinoma receiving selective neck dissection. J Craniomaxillofac Surg. 2017;45(12):2092-2096.
Lim RS, Evans L, George AP, et al. Do demographics and tumour-related factors affect nodal yield at neck dissection? A retrospective cohort study. J Laryngol Otol. 2017;131(S1):S36-S40.
Amar A, Chedid HM, Rapoport A, et al. Prognostic significance of the number of lymph nodes in elective neck dissection for tongue and mouth floor cancers. Braz J Otorhinolaryngol. 2012;78(2):22-26.
Lee MC, Plews R, Rawal B, Kiluk JV, Loftus L, Laronga C. Factors affecting lymph node yield in patients undergoing axillary node dissection for primary breast cancer: a single-institution review. Ann Surg Oncol. 2012;19(6):1818-1824.
Thompson RH, Carver BS, Bosl GJ, et al. Body mass index is associated with higher lymph node counts during retroperitoneal lymph node dissection. Urology. 2012;79(2):361-364.