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Pathologic evaluation of sentinel lymph nodes in oral squamous cell carcinoma
Nirav P Trivedi1, Hiran Kattilaparambil Ravindran, Shanmugham Sundram
1Head and Neck Oncology Service, Mazumdar Shaw Cancer Center, Bangalore, India.
Background:
The objective of this study was to determine the relative efficacy of different methods of pathologic evaluation of sentinel lymph nodes.
Methods:
In this prospective study, sentinel nodes were evaluated for occult metastasis using frozen section, imprint-cytology, hematoxylin-eosin staining, serial step sectioning (SSS) with hematoxylin-eosin, and immunohistochemistry (IHC). Metastases were classified into macrometastasis (>2.0 mm), micrometastasis (0.2 mm-2.0 mm), isolated tumor cells (<0.2 mm).
Results:
Occult metastasis was detected in 20 of 80 patients. Frozen section and imprint cytology identified metastasis in 10 of 20 patients, hematoxylin-eosin stain in 13 patients; SSS upstaged the disease in a further 7 patients (9%). Frozen section detected macrometastasis in 7 of 8 cases but failed to detect smaller metastases (missed micrometastasis in 4 of 7 and isolated tumor cells in 5 of 5). SSS upstaged the disease by 10%, and sensitivity and negative predictive value of SSS with hematoxylin-eosin stain were 90% and 97%, respectively.
Conclusion:
Frozen section and imprint cytology are not effective in identifying occult metastasis. IHC and SSS are required to identify micrometastasis and isolated tumor cells.
