Abstract
The histological detection of a peritumoral lymphocytic infiltration (PLI) and a sharp tumor border in patients with squamous cell carcinoma (SCC) of the larynx, pharynx or oral cavity is inversely correlated with the development of cervical lymph node metastases and is therefore a favorable prognostic factor. However, preoperative biopsies are often too small for an evaluation of these tumor features. Here, we examined retrospectively whether elevation of peritumoral density values as determined by contrast-enhanced computed tomography (CT) correlates with PLI and the presence of cervical lymph node metastases. A total of 40 patients with primarily resected SCC were studied (pT1=8, pT2=13, pT3=9, pT4=10); 25 patients were pN-positive. All tumors were histologically analyzed regarding PLI (present or not) and the tumor border (sharp or infiltrating). Based on standardized CT examinations (90 ml contrast agent at 1.5 ml/s), repeated region-of-interest (ROI)-based peritumoral density measurements were obtained. Correlations between CT density, PLI, tumor border and metastatic involvement of regional lymph nodes were statistically evaluated. CT densities were significantly higher (P<0.001) in patients with PLI and sharp tumor borders than in patients without PLI and patients with infiltrating tumor borders. Moreover, the presence of PLI, sharp tumor borders and elevated peritumoral CT densities were each correlated with the absence of lymph node metastases (P<0.001). An elevation of peritumoral CT densities is linked to PLI and sharp tumor borders on histology and a lower risk to develop lymph node metastases. For a patient-adapted therapy, these relations have to be prospectively evaluated regarding their prognostic relevance.
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Becker M, Zbären P, Laeng H, Stoupis C, Porcellini B, Vock P (1995) Neoplastic invasion of the laryngeal cartilage: comparison of MR imaging and CT with histopathologic correlation. Radiology 194:661–669
Castelijns JA, van den Brekel MWM, Smit EMT, Tobi H, van Wagtendonk FW, Golding RP, Venema HW, van Schaik C, Snow GB (1995) Predictive value of MR imaging-dependent and non-MR imaging-dependent parameters for recurrence of laryngeal cancer after radiation therapy. Radiology 196:735–739
Cawson RA (1998) Luca's pathology of tumors of the oral tissues, 5th edn. Churchill Livingstone, Harcourt Brace and Co. Ltd., London, pp 229–239
Hermans R, Op de Beeck K, Van den Bogaert W, Rijnders A, Staelens L, Feron M, Bellon E (2001) The relation of CT-determined tumor parameters and local and regional outcome of tonsillar cancer after definitive radiation treatment. Int J Radiation Oncology Biol Phys 50:37–45
Hirota J, Ueta E, Osaki T, Ogawa Y (1990) Immunohistologic study of mononuclear cell infiltrates in oral squamous cell carcinomas. Head Neck 12:118–125
Hoffman HT, Karnell LH, Funk GF, Robinson RA, Menck HR (1998) The national cancer data base report on cancer of the head and neck. Arch Otolaryngol Head Neck Surg 124:951–962
Iro H, Waldfahrer F (1998) Evaluation of the newly updated TNM classification of head and neck carcinoma with data from 3,247 patients. Cancer 83:2201–2207
Keberle M, Kenn W, Tschammler A, Wittenberg G, Hilgarth M, Hoppe F, Hahn D (1999) Current value of double-contrast pharyngography and of computed tomography for the detection and for staging of hypopharyngeal, oropharyngeal and supraglottic tumors. Eur Radiol 9:1843–1850
Keberle M, Tschammler A, Berning K, Hahn D (2001) Spiral CT of the neck—when do neck malignancies delineate best during contrast enhancement? Eur Radiol 11:1986–90
Keberle M, Tschammler A, Hahn D (2002) Single-bolus technique for spiral CT of laryngopharyngeal carcinomas—comparison of different contrast volumes, flow rates and start delays. Radiology 224:171–176
Lee WR, Mancuso AA, Saleh EM, Mendenhall WM, Parsons JT, Million RR (1993) Can pretreatment computed tomography findings predict local control in T3 squamous cell carcinoma of the glottic larynx treated with radiotherapy alone? Int J Radiation Oncology Biol Phys 25:683–687
Magrin J, Kowalski L (2000) Bilateral radical neck dissection: results in 193 cases. J Surg Oncol 75:232–240
Martinez-Gimeno C, Rodriguez EM, Vila CN, Varela CL (1995) Squamous cell carcinoma of the oral cavity: a clinicopathologic scoring system for evaluating risk of cervical lymph node metastasis. Laryngoscope 105:728–733
O-charoenrat P, Rhys-Evans P, Eccles SA (2001) Expression of vascular endothelial growth factor family members in head and neck squamous cell carcinoma correlates with lymph node metastasis. Cancer 92:556–568
Pameijer FA, Mancuso AA, Mendenhall WM, Parsons JT, Mukherji SK, Hermans R, Kubilis PS (1998) Evaluation of pretreatment computed tomography as a predictor of local control in T1/T2 pyriform sinus carcinoma treated with definitive radiotherapy. Head Neck 20:159–168
Rasgon BM, Cruz RM, Hilsinger RL, Sawicki JE (1989) Relation of lymph-node metastasis to histopathologic appearance in oral cavity and oropharyngeal carcinoma: a case series and literature review. Laryngoscope 99:1103–1110
Remmert S, Rottmann T, Reichenbach M, Sommer K, Friedrich HJ (2001) Cervical lymph node metastases of head and neck cancer. Laryngorhinootologie 80:27–35
Rosai J (1996) Ackerman's surgical pathology. Mosby Year Book, St. Louis
Schmidt M, Hoppe F (2000) Molecular biology and immunohistochemical prognostic markers in head and neck squamous epithelial carcinomas. Laryngorhinootologie 79:719–729
Shingaki S, Suzuki I, Nakajima T, Kawasaki T (1988) Evaluation of histopathologic parameters in predicting cervical lymph node metastasis of oral and oropharyngeal carcinomas. Oral Surg Oral Med Oral Pathol 66:683–688
Shoaib T, Soutar DS, MacDonald DG, Camilleri IG, Dunaway DJ, Gray HW, McCurrach GM, Bessent RG, MacLeod TI, Robertson AG (2001) The accuracy of head and neck carcinoma sentinel lymph node biopsy in the clinically N0 neck. Cancer 91:2077–2083
Sobin LH, Wittekind C (eds) (1997) UICC TNM classification of malignant tumours, 5th edn. John Wiley and Sons, New York
Spector JG, Sessions DG, Emami B, Simpson J, Haughey B, Harvey J, Fredrickson JM (1995) Squamous cell carcinoma of the pyriform sinus: a nonrandomized comparison of therapeutic modalities and long-term results. Laryngoscope 105:397–406
Steinkamp HJ, Hosten N, Richter C, Schedel H, Felix R (1994) Enlarged cervical lymph nodes at helical CT. Radiology 191:795–798
Sulfaro S, Barazan L, Querin F, Lutman M, Caruso G, Comoretto R, Volpe R, Carbone A (1989) T-staging of the laryngopharyngeal carcinoma. Arch Otolaryngol Head Neck Surg 115:613–620
Thabet HM, Sessions DG, Gado MH, Gnepp DA, Harvey JE, Talaat M (1996) Comparison of clinical evaluation and CT diagnostic accuracy for tumors of the larynx and hypopharynx. Laryngoscope 106:589–594
Vogl T, Dresel S, Bilaniuk LT, Grevers G, Kang K, Lissner J (1990) Tumors of the nasopharynx and adjacent areas: MR imaging with Gd-DTPA. AJR 154:585–592
Wolfensberger M, Zbaeren P, Dulguerov P, Muller W, Arnoux A, Schmid S (2001) Surgical treatment of early oral carcinoma—results of a prospective controlled multicenter study. Head Neck 23:525–530
Yasumoto M, Shibuya H, Takeda M, Korenaga T. (1995) Squamous cell carcinoma of the oral cavity: MR findings and value of T1- versus T2-weighted fast spin-echo images. AJR 164:981–987
Yilmaz T, Hosal AS, Gedikoglu G, Kaya A (1999) Prognostic significance of histopathological parameters in cancer of the larynx. Eur Arch Otorhinolaryngol 256:139–144
Zbären P, Becker M, Läng H (1997) Staging of laryngeal cancer: endoscopy, computed tomography and magnetic resonance versus histopathology. Eur Arch Otorhinolaryngol 254:117–122
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Marc Keberle and Philipp Ströbel contributed equally to this study.
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Keberle, M., Ströbel, P., Marx, A. et al. CT determination of lymphocytic infiltration around head and neck squamous cell carcinomas may be a predictor of lymph node metastases. Eur Arch Otorhinolaryngol 260, 558–564 (2003). https://doi.org/10.1007/s00405-003-0640-9
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DOI: https://doi.org/10.1007/s00405-003-0640-9