title: Does tumor depth affect nodal upstaging in squamous cell carcinoma of the head and neck?
abstract: 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.
authors: Plastic Surgery Unit, Canniesburn Hospital, Glasgow, United Kingdom. lee_alkureishi@hotmail.com
authors: Lee W T
authors: LW
authors: Alkureishi
authors: Gary L
authors: GL
authors: Ross
authors: Taimur
authors: T
authors: Shoaib
authors: David S
authors: DS
authors: Soutar
authors: A G
authors: AG
authors: Robertson
authors: Jens A
authors: JA
authors: Sorensen
authors: Jorn
authors: J
authors: Thomsen
authors: Annelise
authors: A
authors: Krogdahl
authors: Julio
authors: J
authors: Alvarez
authors: Luis
authors: L
authors: Barbier
authors: Joseba
authors: J
authors: Santamaria
authors: Tito
authors: T
authors: Poli
authors: Enrico
authors: E
authors: Sesenna
authors: Adorján F
authors: AF
authors: Kovács
authors: Frank
authors: F
authors: Grünwald
authors: Luigi
authors: L
authors: Barzan
authors: Sandro
authors: S
authors: Sulfaro
authors: Franco
authors: F
authors: Alberti
mesh_terms: 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
chemical_list: D004396:Coloring Agents