Evidence map›Paper›PMID 33521862›Full record

Trial reportJournal of cancer research and clinical oncology2021

Is the prediction of one or two ipsilateral positive lymph nodes by computerized tomography and ultrasound reliable enough to restrict therapeutic neck dissection in oral squamous cell carcinoma (OSCC) patients?

Karl Christoph Sproll, Sabina Leydag, Henrik Holtmann, Lara K Schorn, Joel Aissa, Patric Kröpil, Wolfgang Kaisers, Csaba Tóth, Jörg Handschel, Julian Lommen

Abstract readClinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of cancer research and clinical oncology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  5. Review
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Karl Christoph SprollDepartment of Oral and Maxillofacial Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University, Düsseldorf, Germany. christoph.sproll@med.uni-duesseldorf.de.ORCID http://orcid.org/0000-0002-8637-9255
Sabina LeydagDepartment of Oral and Maxillofacial Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University, Düsseldorf, Germany.
Henrik HoltmannDepartment of Oral and Maxillofacial Surgery, Protestant Hospital Bethesda, Mönchengladbach, Germany.
Lara K SchornDepartment of Oral and Maxillofacial Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University, Düsseldorf, Germany.
Joel AissaDepartment of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of the Heinrich-Heine-University, Düsseldorf, Germany.
Patric KröpilDepartment of Radiology, BG Clinic Duisburg, Duisburg, Germany.
Wolfgang KaisersDepartment of Anesthesiology, Medical Faculty of the University of Witten-Herdecke, Helios University Hospital Wuppertal, Wuppertal, Germany.
Csaba TóthDepartment of Pathology, Medical Faculty, Heidelberg University Hospital, Heidelberg, Germany.
Jörg HandschelClinic for Oral and Maxillofacial Surgery, Klinik Am Kaiserteich, Düsseldorf, Germany.
Julian LommenDepartment of Oral and Maxillofacial Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University, Düsseldorf, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionProper management of the clinically involved neck in OSCC patients continues to be a matter of debate. Our aim was to analyze the accuracy of computerized tomography (CT) and ultrasound (US) in anticipating the exact location of lymph node (LN) metastases of OSCC patients across the AAO-HNS (American Academy of Otolaryngology-Head and Neck Surgery) levels ipsi- and contralaterally. Furthermore, we wanted to assess the suitability of therapeutic selective neck dissection (SND) in patients with one or two ipsilateral positive nodes upon clinical staging (cN1/cN2a and cN2b(2/x) patients).

methodsWe prospectively analyzed the LN status of patients with primary OSCC using CT and US from 2007 to 2013. LNs were individually assigned to a map containing the AAO-HNS levels; patients bearing a single or just two ipsilateral positive nodes (designated cN1/cN2a or cN2b(2/x) patients either by CT (CT group) or US alone (US group) or in a group combining findings of CT and US (CTUS group)) received an ipsi-ND (I-V) and a contra-ND (I-IV). 78% of the LNs were sent individually for routine histopathological examination; the remaining were dissected and analyzed per neck level.

resultsUpon the analysis of 1.670 LNs of 57 patients, the exact location of pathology proven LN metastases in cN1 patients was more precisely predicted by US compared to CT with confirmed findings only in levels IA, IB und IIA. Clearly decreasing the number of missed lesions, the findings in the CTUS group nearly kept the spatial reliability of the US group. The same analysis for patients with exactly two supposed ipsilateral lesions (cN2b(2/x)) yielded confirmed metastases from levels I to V for both methods individually and in combination and, therefore, render SND insufficient for these cases.

conclusionOur findings stress the importance of conducting both, CT and US, in patients with primary OSCC. Only the combination of their findings warrants the application of therapeutic SND in patients with a single ipsilateral LN metastasis (cN1/cN2a patients) but not in patients with more than one lesion upon clinical staging (≥ cN2b).

Indexed as

Carcinoma, Squamous CellMouth NeoplasmsNeck DissectionPatient SelectionAdultAgedFemaleHumansLymphatic MetastasisLymph NodesMaleMiddle AgedMultimodal ImagingNeoplasm StagingPredictive Value of TestsPrognosiscN1-Oral squamous cell carcinoma (OSCC)cN2a-OSCCcN2b-OSCCComputerized tomography (CT)Head and neck ultrasoundIpsilateral lymph node metastasisNeck dissection (ND)Selective neck dissection (SND)

Identifiers

PMID33521862
PMCPMC11801960

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.