We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Is the retropharyngeal lymph node the first echelon node for carcinoma tonsil? Prospective evaluation and literature review.
- Authors
Panda, Smriti; Thakar, Alok; Kakkar, Aanchal; Kumar, Rakesh; Seenu, V.; Singh, Chirom Amit; Sharma, Suresh C.
- Abstract
Purpose: Tonsil cancer being predominantly treated by non-surgical means, there is a paucity of data on lymph nodal drainage pathways and histo-pathologically confirmed metastatic rates. This study assesses the retropharyngeal lymph node (RPLN) in N0 squamous cell carcinoma tonsil as a possible first echelon node and a site for occult metastasis. Methods: Prospective study involving treatment naïve N0 carcinoma tonsil treated by primary surgery and adjuvant treatment from June 2017 to March 2019. In-vivo lymph nodal drainage patterns were assessed by sentinel node mapping by preoperative SPECT-CT and intra-operative hand-held Gamma probe. All patients had a subsequent Level I–III/IV sampling neck dissection supplemented with RPLN dissection. Histological evaluation of sentinel nodes and RPLN involved step-serial sectioning and pan-cytokeratin immunohistochemistry. A comprehensive literature review was performed with keywords "retropharyngeal lymph node", "oropharynx", "tonsil", "squamous cell carcinoma" to determine the incidence of RPLN positivity in previously published series. Results: Sentinel node was successfully identified by SPECT-CT in all 17 patients (ipsilateral level 2a-13/17, 2b-1/17, 3-1/17; bilateral 2a-1/17; isolated contralateral retropharyngeal node-1/17). 8/17 had occult neck metastasis. In no patient was an ipsilateral RPLN identified as the sentinel node. Histological sampling did not indicate metastatic tumor in the RPLN in any patient (0/17). A systematic literature review further confirmed that RPLN metastasis in oropharyngeal cancer is noted only in the presence of pN + disease at other neck levels, and isolated RPLN metastasis is extremely rare (1.2%). Conclusion: The ipsilateral RPLN is not identified either as the first echelon node or as a site of occult metastatic disease in N0 tonsil cancer. CTRI registration: CTRI/2019/06/019551.
- Subjects
LYMPH nodes; LITERARY criticism; TONSILS; SENTINEL lymph nodes; HEAD &; neck cancer; TONSILLITIS
- Publication
European Archives of Oto-Rhino-Laryngology, 2021, Vol 278, Issue 10, p3995
- ISSN
0937-4477
- Publication type
Article
- DOI
10.1007/s00405-020-06585-5