title: Value of minimal residual disease in patients with early cancer of the tongue.
abstract: OBJECTIVE
  The clinical course of patients with squamous cell carcinoma (SCC) of the tongue is often unpredictable. Some patients have a fair course with good response to treatment, whereas others have aggressive locoregional disease despite diagnosis at an early stage. The purpose of the present study was to determine if histochemical staining for cytokeratins of the negative neck nodes obtained in prophylactic neck dissection could predict treatment failure in patients with SCC of the tongue.
  
  
  METHODS
  Between 1990 and 2000, 18 patients with early squamous cell carcinoma of the tongue (T1,T2N0M0) underwent partial glossectomy with neck dissection at the Rabin Medical Center in Israel. All had clear resection margins and no evidence of neck metastasis and were expected to do well. Nevertheless, 6 patients had an aggressive course and died of disease shortly after presentation because of local or regional failure. In an attempt to predict failure of treatment and patients' outcome, paraffin-embedded blocks from the pathologically negative lymph nodes were subjected to immunohistochemical staining for cytokeratin using polyclonal antibodies. The antigen-antibody complex was identified by using the biotinylated secondary antibody and followed by the streptavidin-peroxidase detection method.
  
  
  RESULTS
  None of the 142 sections from pathologically negative lymph nodes stained positive for keratin. On multivariate analysis, a statistically significant relationship was found between disease-free survival, early recurrence (P =.03), and metastasis to the neck (P =.008).
  
  
  CONCLUSIONS
  Keratin staining failed to yield evidence of micrometastasis. Further studies with more samples are needed to confirm these findings.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah, Tikva, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Ulanovski
authors.forename: Yoram
authors.initials: Y
authors.lastname: Stern
authors.forename: Pepy
authors.initials: P
authors.lastname: Roizman
authors.forename: Tamara
authors.initials: T
authors.lastname: Druzd
authors.forename: Thomas
authors.initials: T
authors.lastname: Shpitzer
authors.forename: Dan
authors.initials: D
authors.lastname: Gutman
authors.forename: Raphael
authors.initials: R
authors.lastname: Feinmesser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D005927:Glossectomy; D006801:Humans; D007150:Immunohistochemistry; D007633:Keratins / Q000032:analysis*; D008198:Lymph Nodes / Q000737:chemistry* / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D018365:Neoplasm, Residual; D011379:Prognosis; D014062:Tongue Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D017211:Treatment Failure
chemical_list: D007633:Keratins