title: Predictors of cervical lymph node involvement in patients with pharyngeal carcinoma undergoing endoscopic mucosal resection.
abstract: OBJECTIVE
  Although detection of pharyngeal carcinoma remaining in the epithelium or subepithelial tissue layer has been difficult by routine examinations, recent advances in endoscopic technology have enabled us to detect these lesions. These patients can receive endoscopic mucosal resection (EMR) and generally have a good prognosis, but some patients have nodal involvement. The purpose was to investigate predictors of nodal involvement in patients with pharyngeal carcinoma undergoing EMR at our hospital.
  
  
  METHODS
  Outcomes research.
  
  
  METHODS
  Lymph node involvement, endoscopic morphology, and tumor thickness were investigated in 152 patients treated between 2001 and 2009.
  
  
  RESULTS
  Pathological examination revealed carcinoma in situ (CIS) for 77 patients and subepithelial invasion (SEPI) for 75 patients. There were no patients with muscular invasion. Nodal involvement was found in none of CIS but in 7 of 75 patients (9.3%) with SEPI. In patients with SEPI, the mean tumor thickness was significantly higher in patients with lymph node involvement (1311.4 ± 300.0 μm) than those without involvement (692.6 ± 495.7 μm) (p=0.002). Significant risk factors for nodal involvement included the tumor thickness over 1000 μm (p<0.001) and the presence of venous or lymphatic invasion (p<0.05). Based on analysis in relation to sensitivity and specificity, the tumor thickness over 1000 μm may serve as the most predictive factor for nodal involvement.
  
  
  CONCLUSIONS
  Tumor thickness can be a simple predictor for nodal involvement in cases of SEPI. Careful follow-up including neck palpation and annual imaging diagnostics such as computed tomography or ultrasonography are recommended for these patients.
authors.affiliation: Department of Otolaryngology, Keiyukai Sapporo Hospital, Kita 1-1, Hondori 14-chome, Shiroishi-ku, Sapporo, Japan
authors.forename: Masanobu
authors.initials: M
authors.lastname: Taniguchi
authors.forename: Akihito
authors.initials: A
authors.lastname: Watanabe
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tsujie
authors.forename: Takayo
authors.initials: T
authors.lastname: Tomiyama
authors.forename: Masahiro
authors.initials: M
authors.lastname: Fujita
authors.forename: Masao
authors.initials: M
authors.lastname: Hosokawa
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Sasaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery; D004724:Endoscopy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery; D009364:Neoplasm Recurrence, Local; D010610:Pharyngeal Neoplasms / Q000473:pathology* / Q000601:surgery; D012680:Sensitivity and Specificity