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PubMed2005

Neoadjuvant chemoradiotherapy followed by esophagectomy for initially resectable squamous cell carcinoma of the esophagus with multiple lymph node metastasis.

Neoadjuvant chemoradiotherapy (CRT) was expected to improve surgical curability and prognosis for advanced esophageal cancer. However, the clinical efficacy of neoadjuvant CRT followed by esophagectomy with three-field lymphadenectomy (3FL) for initially resectable esophageal squamous cell carcinoma (SCC) remains unclear. Since 1998, we have defined the status of metastases to five or more nodes, or nodal metastases present in all three fields as multiple lymph node metastasis, which was previously shown to be associated with poor prognosis. Between 1998 and 2002, 83 patients with initially resectable esophageal SCC were prospectively allocated into two groups, according to the clinical status of nodal metastasis. Nineteen patients clinically accompanied by multiple lymph node metastasis initially underwent neoadjuvant CRT followed by curative esophagectomy with 3FL (CRT group). The other 64 patients clinically without multiple lymph node metastasis immediately received curative esophagectomy with 3FL (control group). Although the overall morbidity rate was significantly higher in the CRT group, no in-hospital death occurred in either group. Patients without pathologic multiple lymph node metastasis in the CRT group showed a significantly better disease-free survival rate than either patients pathologically with multiple lymph node metastasis in the control group or those in the CRT group. However, the differences in the overall survival rate among the groups were not significant. Thus, the significant survival benefit by neoadjuvant CRT in addition to esophagectomy with 3FL was not confirmed, although it may have been advantageous, without increase in mortality, to at least some patients who responded well to neoadjuvant CRT. Therefore, neoadjuvant CRT can be an initial treatment of choice for resectable esophageal SCC clinically with multiple lymph node metastasis. The prediction of response to CRT and the development of alternative treatment for hematogenous recurrence could achieve a further survival benefit of this trimodality treatment.

Adult↗

PubMed2004

Model for paraaortic lymph node metastasis produced by orthotopic implantation of ovarian carcinoma cells in athymic nude mice.

Lymph node metastasis through the lymphatic vessels is a critical step in determining the outcome of ovarian cancer patients, and prognosis should be improved by preventing lymph node metastasis. However, experimental models for lymph node metastasis of ovarian carcinoma are not available. We developed an orthotopic transplantation model to study this process in nude mice using the human ovarian carcinoma cell lines, KF and MH. Highly metastatic sublines (KF-LN3 and MH-LN3) were selected in vivo in nude mice by repeated orthotopic transplantation, lymph node metastasis formation and culturing the tumour cells in vitro. Because this model seems to correspond to the advanced clinical stage of ovarian carcinomas, it should be useful in understanding the molecular biology of ovarian carcinomas and in the development of therapeutic modalities against lymph node metastasis.

Animals↗

PubMed2003

[Characteristics of occult cervical lymph node metastasis in squamous cell carcinoma of tongue and their influence on prognosis].

BACKGROUND & OBJECTIVE: Occult cervical lymph node metastasis in squamous cell carcinoma of tongue has regularity and influence on the prognosis of patients. This study was designed to investigate the characteristics of occult cervical lymph node metastasis in squamous cell carcinoma of tongue and their influence on the prognosis to provide clinical bases for elective supraomohyoid neck dissection. METHODS: The data of 164 patients with squamous cell carcinoma of tongue who were treated in cancer center, Sun Yat-sen University, from 1990 to 1996 were reviewed. The characteristics of occult cervical lymph node metastasis in squamous cell carcinoma of tongue and their influence on the prognosis were analyzed. RESULTS: The rate of occult cervical lymph node metastasis of squamous cell carcinoma of tongue was 25.71%. The most common site of occult cervical lymph node metastasis was ipsilateral level II, and followed by ipsilateral level I and III. 82.98% of the lymph nodes of occult metastasis occurred in the above three levels. Most cervical lymph nodes of occult metastasis were found within two years after the first operation (33/36). There was significant difference of the prognosis between the group of dominant or occult cervical lymph node metastasis and the group of without cervical lymph node metastasis in squamous cell carcinoma of tongue (log-rank,P< 0.01); whereas there was no significant difference of the prognosis between the group of dominant cervical lymph node metastasis and the group of occult cervical lymph node metastasis according to log-rank test (P >0.05). CONCLUSION: The ipsilateral level I to level III were the common regions where occult cervical lymph node metastasis occurred. The authors suggest that elective supraomohyoid neck dissection may be applied to clinically negative neck of the patients with squamous cell carcinoma of tongue who were prone to metastasize latently. Occult cervical lymph node metastasis influences the prognosis of patients with squamous cell carcinoma of tongue significantly.

Adult↗

PubMed2004

Lymph node metastasis of early oral tongue cancer after interstitial radiotherapy.

PURPOSE: To examine the prognostic factors for lymph node metastasis after brachytherapy for early (T1-T2N0M0) oral tongue cancer. METHODS AND MATERIALS: We reviewed the records of 571 patients (500 low dose rate and 71 high dose rate) treated at Osaka University Hospital between 1967 and 1999. RESULTS: Patients with lymph node metastasis had tumor with an average diameter of 26 +/- 8 mm and a thickness of 9 +/- 5 mm; for patients without lymph node metastasis, the corresponding dimensions were 23 +/- 8 mm and 7.5 +/- 4 mm (p = 0.0004 and 0.001, respectively). After 5 years, the ulcerative (48%) and indurative/infiltrative (39%) types showed a higher ratio of nodal involvement than the exophytic (31%) and superficial (19%) types (p <0.0001). Multivariate analysis showed ulceration (p = 0.006) and a thickness of <or =6 mm (p = 0.04) to be statistically significant predisposing factors for lymph node metastasis. The lymph node control rate was 68% in 1967-1979, 71% in 1980-1990, and 66% in 1990-1999; the corresponding successful salvage rates for lymph node metastasis were 43%, 33%, and 58% (p = 0.04). CONCLUSION: The appearance of the tumor, especially the presence or absence of ulceration and the diameter and thickness, are useful prognostic indicators for lymph node metastasis. Although the rates of lymph node metastasis did not change, the salvage outcome for recurrence after interstitial radiotherapy has recently improved.

Adult↗

PubMed2006

[Distribution of cervical lymph node metastasis in well-differentiated thyroid carcinoma].

OBJECTIVE: To study the distribution of cervical lymph nodes metastases in patients with differentiated thyroid carcinoma, explore the surgical modality of the neck of cN + cervical node metastasis and evaluate the role of preoperative ultrasonography in detecting of cervical metastases of differentiated thyroid carcinoma. METHODS: Data were reviewed retrospectively from medical records between July 2003 and July 2005, in which 93 patients (113 sides) of differentiated thyroid carcinoma patients with cN + cervical lymph nodes metastasis. Patients were divided into 2 groups: group 1, 64 cervical sides with preoperative palpable cervical lymph nodes; group 2, 49 cervical sides with impalpable node but preoperative ultrasonic positive nodal metastasis. All the pathologic specimens were reviewed by pathologists counting the numbers of pathologic positive nodes and mapping localization of positive nodes in level II, III, IV, V and VI respectively. RESULTS: In 93 patients 21.5% (20/93) of those metastasize bilaterally. In those 113 sides specimens 92 sides (81.4%) involved multi-sites in the neck. The distribution of metastasized nodes were; level II, 60.2% (68/113); level III, 70.8% (80/113); level IV,61.9% (70/113); level VI, 58.4% (66/113); level V, 22.5% (25/113). The numbers of positive nodes of group 1 were more than the number of group 2 (10.1 vs 6.9) and the involved levels of group 1 was also more than the levels of group 2 (3.18 level vs 2.61 level). Preoperative ultrasonography could detect 43.4% (49/113) of lymph nodes metastasis that were missed by palpation in the physical examination. CONCLUSIONS: The distribution of the cervical nodes in patients with differentiated thyroid carcinoma were multi-levels in the neck and mainly localized in level II , level III, level IV and level VI. Preoperative ultrasonography is a mainstay in detecting of cervical lymph nodes metastasis in thyroid cancer. For patients with differentiated thyroid carcinoma of cN + cervical lymph nodes should be undergone modified neck dissection, includes level II, III, IV, V, VI.

Adolescent↗

PubMed2001

Animal model of para-aortic lymph node metastasis.

The purpose of this study was to establish a model of experimental lymph node metastasis by intra-rectal implantation of human cancer cells in nude mice. Four types of human cancer cell lines (TE-1, MKN-45, HT-29, and MIAPaca-2) were investigated. Tumor cells suspended in Matrigel were injected into the submucosal layer of the rectum. All cancer cell lines produced locally aggressive rectal tumors and, subsequently, para-aortic lymph node metastasis. We were unable to produce other distant metastases in the dying state in such locations as the liver, spleen, lung, and peritoneum. However, using this method, we were able to evaluate the effect of the anti-cancer agent uracil/tegafur (UFT) on primary tumor growth and lymph node metastasis. Oral intake of UFT significantly suppressed implanted tumor volume and inhibited lymph node metastasis. We expect that the process of lymph node metastasis shown in this model will be studied as an experimental model of lymph node metastasis simulating human cancers.

Adenocarcinoma↗

PubMed1993

A retrospective study on the clinical and biological prediction of axillary lymph node metastasis in breast cancer.

If axillary lymph node metastases were able to be accurately predicted, dissection could be avoided in some patients with breast cancer whose axillary nodes are clinically negative. In this study, we assessed the relationships between histological axillary lymph node metastases and clinical axillary nodal status, tumor size, DNA-ploidy, c-erbB-2 expression, and the score of the argyrophilic nucleolar organizer region. We then attempted to evaluate their predictive values for axillary lymph node metastasis in 173 patients with invasive breast cancer, retrospectively. The clinical and biological variables were significantly correlated with the presence and degree of axillary lymph node metastases. A metastatic index, calculated from the clinical and biological variables, proved especially useful for predicting axillary lymph node metastases in patients whose axillary nodes were clinically negative. However, the predictive abilities were still limited and thus it was concluded that as yet, only axillary dissection can provide accurate information on axillary lymph node metastases.

Adult↗

PubMed2006

[Lymph node metastasis and prognosis in T1 and T2 rectal carcinoma].

OBJECTIVE: To investigate the characteristics of lymph node metastasis and prognosis of T1/T2 rectal carcinoma. METHODS: The clinical data of 241 patients with T1 or T2 rectal carcinoma were retrospectively analyzed. The factors relative to lymph node metastasis were analyzed using Chi-square test. The survival data were analyzed using Kaplan-Meier method. The factors influencing survival were analyzed using univariate (Long-rank) and multivariate (Cox model) methods. RESULTS: Of the 241 patients, 132 received Mile's operation and 109 underwent sphincter preserving operation. The over-all lymph node metastasis rate was 22.0% (53/241). The lymph node metastasis was significantly correlated with histological differentiation as revealed by Chi-square test. The over-all 5-year survival rate for the whole series group was 91.5%. Univariate analysis revealed that tumor histological type, intramural infiltration, differentiation, lymph node metastasis, radiation therapy were significant predictors of survival; however, only intramural infiltration was the most important prognostic predictor by multivariate analysis. CONCLUSION: Even though lymph node metastasis can be observed either in T1 or T2 rectal carcinoma, histological differentiation is significantly related to the lymph node metastasis. As radical resection achieve better survival than local resection, it should be suggested as the chief treatment for T1/T2 rectal carcinoma.

Adenocarcinoma, Mucinous↗

PubMed1999

Evaluation of the ratio of lymph node metastasis as a prognostic factor in patients with gastric cancer.

BACKGROUND: Lymph node metastasis in patients with gastric cancer is one of the important prognostic factors. However, there is no consensus concerning the best classification for lymph node metastasis as a prognostic factor. So, to evaluate the ratio of the number of metastatic lymph nodes to the total number of dissected lymph nodes (the ratio of LN meta) as a prognostic factor, we compared the ratio of LN meta with lymph node status according to the Japan Classification of Gastric Carcinoma and the total number of metastatic lymph nodes with multivariate analysis.METHODS: Between 1991 and 1997, a total of 360 patients with primary gastric cancer who underwent gastrectomy with D2 or more extended lymph node dissection were included in this study. Ten kinds of prognostic factors and three types of different classifications for lymph node metastasis were analyzed by multivariate analysis using the Cox regression.RESULTS: The average number of dissected lymph nodes and metastatic lymph nodes were 55.0 (range, 11-184) and 2.6 (range, 0-86), respectively. There were significant differences of the 5-year cumulative survival rates among each group of the ratio of LN meta (0%, 1%-9%, 10%-24%, and more than 25%). Age, tumor size, curability, and the ratio of LN meta were selected as independent prognostic factors by forward stepwise selection. The ratio of LN meta showed the highest hazard ratio by Cox regression.CONCLUSION: The ratio of LN meta appears to be an important prognostic factor and the best classification factor for lymph node metastasis.

Journal Article↗

PubMed1989

Multivariate evaluation of determinants affecting regional lymph node metastasis and survival in bladder cancer patients who underwent radical cystectomy.

To elucidate the relative importance of clinicopathologic factors affecting regional lymph node metastasis and survival in bladder cancer patients, multivariate analyses by the logistic regression model and proportional hazards model were performed for 86 patients who underwent radical cystectomy between 1978 and 1988. Clinicopathologic factors included in the analysis were sex, age, prior tumor history, time from onset of symptoms to cystectomy, and tumor characteristics (size, number, growth pattern, grade, stage, infiltration pattern, lymphatic invasion, lymphocytic infiltration around tumors, and lymph node metastasis). Nineteen of eighty-six patients (22%) had regional lymph node metastasis. Univariate analysis showed that lymph node metastasis was related to stage (p = 0.0006), lymphatic invasion (p = 0.006) and infiltration pattern (p = 0.02). Multivariate analysis revealed that stage is the only determinant of statistical significance for lymph node metastasis. High-stage tumors (pT3a-pT4) had 15 times higher risk for lymph node metastasis than low-stage tumors (pTis-pT2). The 5-year survival rates were 25 and 75% for patients with and without lymph node metastasis, respectively. Proportional hazards model revealed that stage is the most significant determinant (p = 0.0001) for survival, followed by lymph node metastasis with borderline significance (0.005 less than p less than 0.1). A two-factor model consisting of stage and lymph node metastasis yielded corrected hazard ratios of 14.7 for stage and 2.3 for lymph node metastasis. The present study quantitatively confirms previous univariate analyses of factors affecting lymph node metastasis and survival in patients undergoing radical cystectomy.

Adult↗

PubMed2005

Curative resection of T1 colorectal carcinoma: risk of lymph node metastasis and long-term prognosis.

PURPOSE: The features of T1 colorectal adenocarcinoma and the risk determination of lymph node metastasis were reviewed. Prognostic factors were assessed to verify whether the risk of lymph node metastasis would influence the long-term prognosis. METHODS: Patients undergoing curative resection of T1 colorectal adenocarcinoma at the Taipei Veterans General Hospital from December 1969 to August 2002 were retrospectively studied. Patients with synchronous colorectal cancer, distant metastasis, familiar adenomatous polyposis, or inflammatory bowel disease were excluded. The associations between lymph node metastasis and clinicopathologic variables were evaluated univariately using chi-squared test, Fisher's exact test, or Student's t -test, and multivariately using logistic regression. Univariate analysis by the log-rank test and multivariate analysis by Cox regression hazards model determined the factors influencing the overall survival. RESULTS: A total of 159 patients were included. Sixteen patients (10.1 percent) had lymph node metastasis. The risk of lymph node metastasis included histologic grade (P = 0.005), lymphatic vessel invasion (P = 0.023), inflammation around cancer (P = 0.049), and budding at the invasive front of tumor (P = 0.022). Age (P = 0.001) and number of total sampling lymph nodes (P < 0.0001) were found to be the factors influencing the overall survival. CONCLUSIONS: Variables that predict lymph node metastasis in surgically resected T1 colorectal carcinoma may not impact the long-term prognosis.

Adenocarcinoma↗

PubMed1986

Adenoid cystic carcinoma of the breast: a case with axillary lymph node metastasis.

A breast tumour with proven lymph node metastasis is conclusively characterized as an adenoid cystic carcinoma using immunocytochemistry and electron microscopy. The majority of tumour cells showed certain of the characteristic features of myoepithelial cells while the pseudocystic spaces contained large amounts of reduplicated basal lamina. A small proportion of tumour cells, however, showed epithelial differentiation with the formation of true lumina.

Aged↗

PubMed2005

Evaluation of tumor cell dissociation as a predictive marker of lymph node metastasis in submucosal invasive colorectal carcinoma.

PURPOSE: Tumor cell dissociation-the histologic finding of small solid carcinoma cell clusters and groups of dissociated dedifferentiated carcinoma cells at the invasive front-is related to tumor metastasis and patient prognosis. However, few previous reports have examined tumor cell dissociation in submucosal invasive colorectal carcinoma. We investigated the relation between tumor cell dissociation and lymph node metastasis in submucosal invasive colorectal carcinoma. We also examined immunohistochemical expression of E-cadherin and beta-catenin in submucosal invasive colorectal carcinoma. METHODS: Submucosal invasive colorectal carcinoma tissue samples from 20 patients with lymph node metastasis and 100 patients without lymph node metastasis were evaluated. Sections stained with hematoxylin and eosin were evaluated for tumor cell dissociation. Immunohistochemistry was used to determine the expression and cellular distribution of E-cadherin and beta-catenin. RESULTS: Tumor cell dissociation was more frequently identified in submucosal invasive colorectal carcinoma cases with lymph node metastasis than in those without lymph node metastasis (P = 0.0001). Decreased membranous expression of E-cadherin occurred more frequently in submucosal invasive colorectal carcinoma cases with lymph node metastasis than in those without lymph node metastasis (P = 0.025). Nuclear expression of beta-catenin tended to be present in submucosal invasive colorectal carcinoma cases with lymph node metastasis (P = 0.063). Decreased membranous expression of E-cadherin occurred more frequently in submucosal invasive colorectal carcinoma cases with tumor cell dissociation than in those without tumor cell dissociation (P = 0.0023). CONCLUSIONS: Our results suggest that there is a relation between tumor cell dissociation and lymph node metastasis in submucosal invasive colorectal carcinoma. Tumor cell dissociation formation might be related to abnormal expression patterns of E-cadherin and beta-catenin in submucosal invasive colorectal carcinoma. Tumor cell dissociation and decreased membranous expression of E-cadherin would be important predictive markers for lymph node metastasis in submucosal invasive colorectal carcinoma.

Cadherins↗

PubMed1999

An evaluation of malignancy and prognostic factors based on mode of lymph node metastasis in esophageal carcinoma.

This study was conducted to evaluate lymph node metastasis as a key prognostic factor in esophageal cancer. Metastatic lesions in lymph nodes were grouped by histological morphology as intracapsular or extracapsular, and the significance of lymph node metastasis was evaluated by relating metastatic lesions to clinical pathologic factors and patient prognosis. In our hospital, 46 of 81 patients who underwent resection of esophageal cancer developed lymph node metastasis. These 46 patients were enrolled in a study analyzing the relationship between the metastatic mode and the clinicopathological factors. The frequency of extracapsular metastasis was significantly high in patients with a profound depth of cancer, three or more metastases, distant metastasis (n3 and n4), or severe lymphatic invasion. The prognosis was significantly worse in patients with extracapsular metastasis, and this tendency was also seen even in patients with three or more metastases, limited metastasis (n1 and n2), or mild lymphatic invasion (ly0 and ly1). These findings suggest that the metastatic mode reflects the degree of esophageal cancer progression and is an important prognostic factor.

Aged↗

PubMed1994

Flow cytometric analysis of nuclear DNA content in tongue squamous cell carcinoma: relation to cervical lymph node metastasis.

The relationship between DNA ploidy and the incidence of cervical lymph node metastasis in 36 patients with tongue squamous cell carcinoma (SCC) was investigated. The aneuploidy rate of tongue carcinomas was 15/36 (42%), and the mean DNA index (DI) was 1.23, with a range from 0.87 to 3.54. Histologically identified cervical lymph node metastasis was observed in 11 cases, and the incidence of the cervical lymph node metastasis was significantly (P < 0.02) higher in the aneuploid cases (8/15) than in the diploid cases (3/21). Recurrence of the primary lesions was seen in nine cases 0.3-2.5 years after the initial treatment. No obvious difference in the incidence of the recurrence was noted, however, between the diploid (5/21) and the aneuploid (4/15) cases. These results indicate a significant relationship between aneuploidy and incidence of the regional lymph node metastasis, in contrast to the absence of a positive relationship between aneuploidy and recurrence of tongue SCC.

Aneuploidy↗

PubMed1983

[Chemotherapy of small cell carcinoma of the lung in relation to lymph node metastasis and extending pattern of tumor].

Chemotherapeutic effects on the lymph node metastasis were studied in relation to the predominancy of T or N factor, extending patterns of tumor, histologic subtype, and cytologic characteristics, using cyclophosphamide, vincristine and 5-FU. N2, N3, N4 indicate ipsi-lateral, contra-lateral mediastinal, and supra-clavicular node, respectively. Chemotherapy was equally effective to the lymph node metastasis regardless a degree of progression, but survivals depended on the progression. Predominancy of both primary tumor (T) and involved lymph node (N) was analysed on chest X-rays. The Deffer response was observed in Type N than in Type T. Extending patterns of primary tumor were classified on X-ray films according to Suzuki's criteria: a longitudinal submucosal spreading along the bronchus (I): infiltration beyond the bronchial wall, extending to the depth, and fusing into a mass (III): and intermediate (II). In type I, the tumor was seen like an assembly of clubs extending along the bronchial tree, and Type III tumor showed a mass-like shadow with relatively high density and clear margin. Overall response rates were remarkably higher in Type I and lower in Type III. Type I was more frequently accompanied by large lymph node involvement than Type III. The highest response rate was obtained in Type I with N-predominancy and the lowest in Type III with T-predominancy. Responses to chemotherapy of lymph node metastasis depended upon these extending patterns. A half of Type III cases were polygonal cell type, which showed the lowest response rate in our institute. Regarding to cytologic classification by Horai, 67% response of good was found in Type I and 65% of response poor in Type III. These biological characteristics are considered to be a useful indicator for the selection of treatment modalities.

Carcinoma, Small Cell↗

PubMed2004

Comparison of frozen section and touch imprint cytology for evaluation of sentinel lymph node metastasis in breast cancer.

BACKGROUND: Sentinel lymph node metastasis of breast cancer is evaluated by frozen section (FS) or touch imprint cytology (TIC). However, which of the two methods is superior remains controversial. Here we directly compared the sensitivity of these methods prospectively. METHODS: The study included 208 SNs harvested from 107 consecutive patients with breast cancer who underwent sentinel lymph node biopsy. SNs were serially sectioned at 2-mm intervals, and two sections were subjected to intraoperative evaluation of FS with hematoxylin and eosin staining. TIC specimens were prepared from all cut surfaces and analyzed by Papanicolaou (TIC) and cytokeratin (TIC with immunohistochemistry; TIHC) immunohistochemistry. RESULTS: Thirty-five SNs from 27 patients were positive by final histopathology. The sensitivity per sentinel lymph node of FS was 89%; it was 86% for TIC and 89% for TIHC. Among 173 negative SNs, the results of FS were concordant with final histopathology, but TIC and TIHC were positive in 1 and 5 histopathology-negative SNs, respectively. The sensitivity per patient of FS was 85%; it was 85% for TIC and 89% for TIHC. Among 80 patients with node-negative disease, the results of FS and TIC were concordant with final histopathology, whereas TIHC was positive in 3 patients (3.8% were upstaged). A slight improvement of sensitivity per patient was achieved by the combination of FS and TIC (to 89%) or FS and TIHC (to 93%). CONCLUSIONS: The sensitivity of FS was almost equivalent to that of TIC. TIHC had a better sensitivity than FS and TIC, but it upstaged a few node-negative patients.

Adult↗

PubMed2005

Application of fuzzy inference to European patients to predict cervical lymph node metastasis in carcinoma of the tongue.

In head and neck cancers, the presence of cervical lymph node metastasis is an important determinant of outcome. Many attempts have been made to predict cervical lymph node metastasis, but the accuracy of currently available techniques remains inadequate. We used fuzzy inference to predict cervical lymph node metastasis retrospectively in 75 patients with squamous cell carcinoma of the tongue and prospectively in 23 patients. Our model was based on three variables: tumor size, keratinization, and mode of invasion. The accuracy of fuzzy inference for the prediction of cervical lymph node metastasis in the 75 patients studied retrospectively was 86.7%, the sensitivity was 70.8%, and the specificity was 94.1%. In the 23 patients studied prospectively, the accuracy was 91.3%, the sensitivity was 50.0%, and the specificity was 95.2%. The accuracy obtained in this European series of patients was similar to that previously obtained in Japanese patients. We conclude that fuzzy inference may be a useful method for predicting cervical lymph node metastasis. Its high specificity is likely to reduce the number of unnecessary neck dissections. However, the current level sensitivity is inadequate for routine clinical use. Therefore, other predictors of lymph node metastasis should be identified to refine the current model.

Carcinoma, Squamous Cell↗