Does tumor depth affect nodal upstaging in squamous cell carcinoma of the head and neck?
OBJECTIVE
The aim of this study was to determine whether tumor depth affects upstaging of the clinically node-negative neck, as determined by sentinel lymph node biopsy with full pathologic evaluation of harvested nodes including step-serial sectioning (SSS) and immunohistochemistry (IHC).


METHODS
One hundred seventy-two patients with cT1/2 N0 squamous cell carcinoma (SCC) of the oral cavity/oropharynx undergoing primary resection and either sentinel node biopsy (SNB) or SNB-assisted neck dissection as a staging tool for the cN0 neck. Harvested nodes were examined with hematoxylin-eosin staining, SSS, and IHC. Patients upstaged by SSS/IHC were denoted pN1mi.


RESULTS
One hundred one of 172 patients were staged pN0, with 71 (41%) patients upstaged. Increasing tumor depth was associated with higher likelihood of upstaging (P < .001). Tumor depth showed a positive correlation with nodal stage according to TNM classification (P < .001). Tumor depth greater than 4 mm appears to be the most appropriate cutoff for risk stratification, although tumors in the oropharynx may require a lower value.


CONCLUSIONS
Tumor depth is an important prognostic factor for patients with SCC of the oral cavity or oropharynx. Tumors greater than 4 mm are associated with greater risk of upstaging; however, this optimum cutoff value may vary between primary tumor sites.
Alkureishi
Lee W T
LW
Plastic Surgery Unit, Canniesburn Hospital, Glasgow, United Kingdom. lee_alkureishi@hotmail.com
Ross
Gary L
GL
Shoaib
Taimur
T
Soutar
David S
DS
Robertson
A G
AG
Sorensen
Jens A
JA
Thomsen
Jorn
J
Krogdahl
Annelise
A
Alvarez
Julio
J
Barbier
Luis
L
Santamaria
Joseba
J
Poli
Tito
T
Sesenna
Enrico
E
Kovács
Adorján F
AF
Grünwald
Frank
F
Barzan
Luigi
L
Sulfaro
Sandro
S
Alberti
Franco
F
D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D004396:Coloring Agents; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D008867:Microtomy; D009060:Mouth Floor / Q000473:pathology; D009062:Mouth Neoplasms / Q000473:pathology*; D037981:Neck Dissection; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology*; D011379:Prognosis; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D014062:Tongue Neoplasms / Q000473:pathology
D004396:Coloring Agents