HPV-related oropharyngeal carcinoma with Overt Level II and/or III metastases at presentation: The risk of subclinical disease in ipsilateral levels IB, IV and v

Giuseppe Sanguineti, Sara Pai, Harold Agbahiwe, Francesco Ricchetti, William Westra, Maria Pia Sormani, Stefania Clemente, Joseph Califano

Research output: Contribution to journalArticle

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Abstract

Background. To assess the risk of subclinical neck nodal involvement of levels IB, IV and V for early T-stage, node positive, human papilloma virus (HPV)-related oropharyngeal carcinoma. Material and methods. We retrospectively identified the patients with clinically positive and un-violated neck that underwent upfront ipsilateral neck dissection for HPV-related oropharyngeal cancer between 1998 and 2010. From the pathology report we extracted the prevalence rate of involvement of each selected level and then estimated the risk that a level that does not contain any node larger than 10 mm at computed tomography (CT) harbors subclinical disease. Predictors of involvement were investigated as well. Results. Ninety-one patients were analyzed. The risk of subclinical disease in both levels IB and V is <5%, while it is 6.5% (95% CI 3.1-9.9%) for level IV. Level IB subclinical involvement slightly exceeds 5% when 2 + ipsilateral levels besides IB are involved. The risk of occult disease in level IV tends to be <5% when level III is not involved. Conclusion. These data support the exclusion from the elective nodal volume of level V and level IB but when 2 + other levels are involved. Level IV might also be spared when level III is negative. Clinical implementation within a prospective study is justified.

Original languageEnglish
Pages (from-to)662-668
Number of pages7
JournalActa Oncologica
Volume53
Issue number5
DOIs
Publication statusPublished - 2014

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Papillomaviridae
Neoplasm Metastasis
Carcinoma
Neck
Oropharyngeal Neoplasms
Neck Dissection
Tomography
Prospective Studies
Pathology

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Hematology
  • Medicine(all)

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HPV-related oropharyngeal carcinoma with Overt Level II and/or III metastases at presentation : The risk of subclinical disease in ipsilateral levels IB, IV and v. / Sanguineti, Giuseppe; Pai, Sara; Agbahiwe, Harold; Ricchetti, Francesco; Westra, William; Sormani, Maria Pia; Clemente, Stefania; Califano, Joseph.

In: Acta Oncologica, Vol. 53, No. 5, 2014, p. 662-668.

Research output: Contribution to journalArticle

Sanguineti, Giuseppe ; Pai, Sara ; Agbahiwe, Harold ; Ricchetti, Francesco ; Westra, William ; Sormani, Maria Pia ; Clemente, Stefania ; Califano, Joseph. / HPV-related oropharyngeal carcinoma with Overt Level II and/or III metastases at presentation : The risk of subclinical disease in ipsilateral levels IB, IV and v. In: Acta Oncologica. 2014 ; Vol. 53, No. 5. pp. 662-668.
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abstract = "Background. To assess the risk of subclinical neck nodal involvement of levels IB, IV and V for early T-stage, node positive, human papilloma virus (HPV)-related oropharyngeal carcinoma. Material and methods. We retrospectively identified the patients with clinically positive and un-violated neck that underwent upfront ipsilateral neck dissection for HPV-related oropharyngeal cancer between 1998 and 2010. From the pathology report we extracted the prevalence rate of involvement of each selected level and then estimated the risk that a level that does not contain any node larger than 10 mm at computed tomography (CT) harbors subclinical disease. Predictors of involvement were investigated as well. Results. Ninety-one patients were analyzed. The risk of subclinical disease in both levels IB and V is <5{\%}, while it is 6.5{\%} (95{\%} CI 3.1-9.9{\%}) for level IV. Level IB subclinical involvement slightly exceeds 5{\%} when 2 + ipsilateral levels besides IB are involved. The risk of occult disease in level IV tends to be <5{\%} when level III is not involved. Conclusion. These data support the exclusion from the elective nodal volume of level V and level IB but when 2 + other levels are involved. Level IV might also be spared when level III is negative. Clinical implementation within a prospective study is justified.",
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AU - Ricchetti, Francesco

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AU - Sormani, Maria Pia

AU - Clemente, Stefania

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N2 - Background. To assess the risk of subclinical neck nodal involvement of levels IB, IV and V for early T-stage, node positive, human papilloma virus (HPV)-related oropharyngeal carcinoma. Material and methods. We retrospectively identified the patients with clinically positive and un-violated neck that underwent upfront ipsilateral neck dissection for HPV-related oropharyngeal cancer between 1998 and 2010. From the pathology report we extracted the prevalence rate of involvement of each selected level and then estimated the risk that a level that does not contain any node larger than 10 mm at computed tomography (CT) harbors subclinical disease. Predictors of involvement were investigated as well. Results. Ninety-one patients were analyzed. The risk of subclinical disease in both levels IB and V is <5%, while it is 6.5% (95% CI 3.1-9.9%) for level IV. Level IB subclinical involvement slightly exceeds 5% when 2 + ipsilateral levels besides IB are involved. The risk of occult disease in level IV tends to be <5% when level III is not involved. Conclusion. These data support the exclusion from the elective nodal volume of level V and level IB but when 2 + other levels are involved. Level IV might also be spared when level III is negative. Clinical implementation within a prospective study is justified.

AB - Background. To assess the risk of subclinical neck nodal involvement of levels IB, IV and V for early T-stage, node positive, human papilloma virus (HPV)-related oropharyngeal carcinoma. Material and methods. We retrospectively identified the patients with clinically positive and un-violated neck that underwent upfront ipsilateral neck dissection for HPV-related oropharyngeal cancer between 1998 and 2010. From the pathology report we extracted the prevalence rate of involvement of each selected level and then estimated the risk that a level that does not contain any node larger than 10 mm at computed tomography (CT) harbors subclinical disease. Predictors of involvement were investigated as well. Results. Ninety-one patients were analyzed. The risk of subclinical disease in both levels IB and V is <5%, while it is 6.5% (95% CI 3.1-9.9%) for level IV. Level IB subclinical involvement slightly exceeds 5% when 2 + ipsilateral levels besides IB are involved. The risk of occult disease in level IV tends to be <5% when level III is not involved. Conclusion. These data support the exclusion from the elective nodal volume of level V and level IB but when 2 + other levels are involved. Level IV might also be spared when level III is negative. Clinical implementation within a prospective study is justified.

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