Occult contralateral nodal disease in oropharyngeal squamous cell carcinoma patients undergoing primary TORS with bilateral neck dissection

Caitlin P. McMullen, Jonathan Garneau, Emillie Weimar, Sana Ali, Joaquim M. Farinhas, Eugene Yu, Peter M. Som, Cathy Sarta, David P. Goldstein, Susie Su, Wei Xu, Richard V. Smith, Brett Miles, John R. de Almeida

Research output: Contribution to journalArticle

Abstract

Background: Knowledge of the rate of occult contralateral nodal disease for oropharynx cancers (OPSCC) in the era of Human Papillomavirus-dominated disease would inform practitioners as to who may be a candidate for unilateral neck management. The objective of this study was to determine the rate of pathologic contralateral positive nodes in patients in OPSCC patients with pT1 and pT2 disease treated with TORS and bilateral neck dissections (BND). Methods: Retrospective review of medical records was performed at Princess Margaret Cancer Center, Toronto; Icahn School of Medicine at Mount Sinai, New York City; and Montefiore Medical Center, New York City. Patients with pT1-2 N0-3 (AJCC 8th Edition) OPSCC disease treated with TORS and BND were included. Results: Thirty-two patients met inclusion criteria. Twelve patients (37.5%) had a tonsil primary site, 19 (59.4%) patients had a base of tongue primary site, and 1 (3.1%) patient had a pharyngeal wall primary. Twenty-four (75%) patients were known to be p16+. Twenty-seven patients (84.4%) were radiographically negative in the contralateral neck preoperatively, and two of these patients had pathologic contralateral positive nodes. The occult pathologic contralateral nodal metastasis rate was 7.4% (2/27). The sensitivity, specificity, positive predictive value, and negative predictive value of suspicious contralateral nodes on preoperative imaging for pathologically positive nodes were 33.3%, 86.2%, 20% and 93% respectively. In the p16+ subgroup, the occult nodal positive rate in the contralateral neck was 5%. Conclusions: pT1-2 OPSCC patients undergoing TORS and elective contralateral neck dissection have a low rate of pathologic contralateral nodal positivity.

Original languageEnglish (US)
Pages (from-to)96-100
Number of pages5
JournalOral Oncology
Volume93
DOIs
StatePublished - Jun 1 2019

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Neck Dissection
Squamous Cell Carcinoma
Neck
Oropharyngeal Neoplasms
Palatine Tonsil
Tongue
Medical Records
Medicine
Neoplasm Metastasis

Keywords

  • Head and neck neoplasms
  • Lymph node dissection
  • Oropharyngeal neoplasms
  • Oropharynx

ASJC Scopus subject areas

  • Oral Surgery
  • Oncology
  • Cancer Research

Cite this

Occult contralateral nodal disease in oropharyngeal squamous cell carcinoma patients undergoing primary TORS with bilateral neck dissection. / McMullen, Caitlin P.; Garneau, Jonathan; Weimar, Emillie; Ali, Sana; Farinhas, Joaquim M.; Yu, Eugene; Som, Peter M.; Sarta, Cathy; Goldstein, David P.; Su, Susie; Xu, Wei; Smith, Richard V.; Miles, Brett; de Almeida, John R.

In: Oral Oncology, Vol. 93, 01.06.2019, p. 96-100.

Research output: Contribution to journalArticle

McMullen, CP, Garneau, J, Weimar, E, Ali, S, Farinhas, JM, Yu, E, Som, PM, Sarta, C, Goldstein, DP, Su, S, Xu, W, Smith, RV, Miles, B & de Almeida, JR 2019, 'Occult contralateral nodal disease in oropharyngeal squamous cell carcinoma patients undergoing primary TORS with bilateral neck dissection', Oral Oncology, vol. 93, pp. 96-100. https://doi.org/10.1016/j.oraloncology.2019.04.017
McMullen, Caitlin P. ; Garneau, Jonathan ; Weimar, Emillie ; Ali, Sana ; Farinhas, Joaquim M. ; Yu, Eugene ; Som, Peter M. ; Sarta, Cathy ; Goldstein, David P. ; Su, Susie ; Xu, Wei ; Smith, Richard V. ; Miles, Brett ; de Almeida, John R. / Occult contralateral nodal disease in oropharyngeal squamous cell carcinoma patients undergoing primary TORS with bilateral neck dissection. In: Oral Oncology. 2019 ; Vol. 93. pp. 96-100.
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title = "Occult contralateral nodal disease in oropharyngeal squamous cell carcinoma patients undergoing primary TORS with bilateral neck dissection",
abstract = "Background: Knowledge of the rate of occult contralateral nodal disease for oropharynx cancers (OPSCC) in the era of Human Papillomavirus-dominated disease would inform practitioners as to who may be a candidate for unilateral neck management. The objective of this study was to determine the rate of pathologic contralateral positive nodes in patients in OPSCC patients with pT1 and pT2 disease treated with TORS and bilateral neck dissections (BND). Methods: Retrospective review of medical records was performed at Princess Margaret Cancer Center, Toronto; Icahn School of Medicine at Mount Sinai, New York City; and Montefiore Medical Center, New York City. Patients with pT1-2 N0-3 (AJCC 8th Edition) OPSCC disease treated with TORS and BND were included. Results: Thirty-two patients met inclusion criteria. Twelve patients (37.5{\%}) had a tonsil primary site, 19 (59.4{\%}) patients had a base of tongue primary site, and 1 (3.1{\%}) patient had a pharyngeal wall primary. Twenty-four (75{\%}) patients were known to be p16+. Twenty-seven patients (84.4{\%}) were radiographically negative in the contralateral neck preoperatively, and two of these patients had pathologic contralateral positive nodes. The occult pathologic contralateral nodal metastasis rate was 7.4{\%} (2/27). The sensitivity, specificity, positive predictive value, and negative predictive value of suspicious contralateral nodes on preoperative imaging for pathologically positive nodes were 33.3{\%}, 86.2{\%}, 20{\%} and 93{\%} respectively. In the p16+ subgroup, the occult nodal positive rate in the contralateral neck was 5{\%}. Conclusions: pT1-2 OPSCC patients undergoing TORS and elective contralateral neck dissection have a low rate of pathologic contralateral nodal positivity.",
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T1 - Occult contralateral nodal disease in oropharyngeal squamous cell carcinoma patients undergoing primary TORS with bilateral neck dissection

AU - McMullen, Caitlin P.

AU - Garneau, Jonathan

AU - Weimar, Emillie

AU - Ali, Sana

AU - Farinhas, Joaquim M.

AU - Yu, Eugene

AU - Som, Peter M.

AU - Sarta, Cathy

AU - Goldstein, David P.

AU - Su, Susie

AU - Xu, Wei

AU - Smith, Richard V.

AU - Miles, Brett

AU - de Almeida, John R.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Background: Knowledge of the rate of occult contralateral nodal disease for oropharynx cancers (OPSCC) in the era of Human Papillomavirus-dominated disease would inform practitioners as to who may be a candidate for unilateral neck management. The objective of this study was to determine the rate of pathologic contralateral positive nodes in patients in OPSCC patients with pT1 and pT2 disease treated with TORS and bilateral neck dissections (BND). Methods: Retrospective review of medical records was performed at Princess Margaret Cancer Center, Toronto; Icahn School of Medicine at Mount Sinai, New York City; and Montefiore Medical Center, New York City. Patients with pT1-2 N0-3 (AJCC 8th Edition) OPSCC disease treated with TORS and BND were included. Results: Thirty-two patients met inclusion criteria. Twelve patients (37.5%) had a tonsil primary site, 19 (59.4%) patients had a base of tongue primary site, and 1 (3.1%) patient had a pharyngeal wall primary. Twenty-four (75%) patients were known to be p16+. Twenty-seven patients (84.4%) were radiographically negative in the contralateral neck preoperatively, and two of these patients had pathologic contralateral positive nodes. The occult pathologic contralateral nodal metastasis rate was 7.4% (2/27). The sensitivity, specificity, positive predictive value, and negative predictive value of suspicious contralateral nodes on preoperative imaging for pathologically positive nodes were 33.3%, 86.2%, 20% and 93% respectively. In the p16+ subgroup, the occult nodal positive rate in the contralateral neck was 5%. Conclusions: pT1-2 OPSCC patients undergoing TORS and elective contralateral neck dissection have a low rate of pathologic contralateral nodal positivity.

AB - Background: Knowledge of the rate of occult contralateral nodal disease for oropharynx cancers (OPSCC) in the era of Human Papillomavirus-dominated disease would inform practitioners as to who may be a candidate for unilateral neck management. The objective of this study was to determine the rate of pathologic contralateral positive nodes in patients in OPSCC patients with pT1 and pT2 disease treated with TORS and bilateral neck dissections (BND). Methods: Retrospective review of medical records was performed at Princess Margaret Cancer Center, Toronto; Icahn School of Medicine at Mount Sinai, New York City; and Montefiore Medical Center, New York City. Patients with pT1-2 N0-3 (AJCC 8th Edition) OPSCC disease treated with TORS and BND were included. Results: Thirty-two patients met inclusion criteria. Twelve patients (37.5%) had a tonsil primary site, 19 (59.4%) patients had a base of tongue primary site, and 1 (3.1%) patient had a pharyngeal wall primary. Twenty-four (75%) patients were known to be p16+. Twenty-seven patients (84.4%) were radiographically negative in the contralateral neck preoperatively, and two of these patients had pathologic contralateral positive nodes. The occult pathologic contralateral nodal metastasis rate was 7.4% (2/27). The sensitivity, specificity, positive predictive value, and negative predictive value of suspicious contralateral nodes on preoperative imaging for pathologically positive nodes were 33.3%, 86.2%, 20% and 93% respectively. In the p16+ subgroup, the occult nodal positive rate in the contralateral neck was 5%. Conclusions: pT1-2 OPSCC patients undergoing TORS and elective contralateral neck dissection have a low rate of pathologic contralateral nodal positivity.

KW - Head and neck neoplasms

KW - Lymph node dissection

KW - Oropharyngeal neoplasms

KW - Oropharynx

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