Occult lymph node metastases rate in sinonasal carcinoma

Introduction Due to the rarity of sinonasal carcinomas and the many data on the occurrence of lymph node metastases, some of which differ significantly, it is difficult to establish a gold standard for the course and implementation of treatment of the clinically inconspicuous neck. Usually, the need for prophylactic therapy of the lymph nodes is deduced from the presence of so-called micro or occult lymph node metastases.

Methods Using the electronic patient record of the ENT clinic of the University Hospital Ulm (Ulmer ePA) and the i.s.h.med. system (SAP), 215 patients were selected for analysis after screening 596 patients. Statistical analysis was done with SPSS v26 (IBM), graphical representation with SPSS and Excel 2013 (Microsoft).

Results Neck dissection was performed in 56 patients (26%) as part of primary therapy. Of these, 38 patients (67.9%) had a cN0 neck. As expected, the majority of cN0 patients received no treatment of the lymph nodes (n=147; 68.4 %). In the specimens of the cN0 patients, one solitary lymph node metastasis was confirmed in each of three cases, of which two cases were classified as pT2 and one as pT4a. An isolated lymph node recurrence occurred in 3 cases, each without previous neck dissection (ND). Thus, occult lymph node metastasis was present in a total of 3% of cases.

Conclusion With a low rate of occult lymph node metastases, elective ND for cN0 status does not seem justified. A possible alternative is sentinel lymph node biopsy or enhanced imaging by PET-MRI. Both modalities are currently being investigated in a feasibility study in Ulm.

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Artikel online veröffentlicht:
24. Mai 2022