Micrometastases and isolated tumour cells in sentinel lymph nodes in oral and oropharyngeal squamous cell carcinoma

Background: The occurrence of micrometastases (MMs) and isolated tumor cells (ITCs) in oral sentinel lymph node (SLN) biopsy is poorly known, and the definitions and clinical significance of MMS and ITCs in SLN biopsy are controversial. We compared the UICC/TNM definitions of MMs and ITCs with our previously published sentinel node protocol to assess how the adoption of the UICC/TNM criteria would affect the staging of nodal micrometastatic disease. Methods; Of 107 patients who had a SLN biopsy and pathology at 150 mu m intervals, 35 with metastatic tumour were included. Eighty-six SLNs were reassessed using the UICCC/TNM definitions for MMs and ITCs. Findings were linked to the final pathology in the subsequent neck dissection. Results: Initial H&E sections showed metastases in 24 patients (in 34 out of 61 SLN), 8 of whom (9 SLNs) had MMS. Additional step serial sections revealed metastatic deposits in a further 11 patients (15 out of 25 SLNs were positive) which were reassessed as MMS (6 patients) or ITCs (5 patients). Subsequent neck dissection revealed additional metastases in 46% of patients with MM, whilst one of the ITC patients had subsequent neck metastases (20%). Conclusion: Despite sonic limitations, the UICC/TNM classification provides an objective. uniform method of detecting MMs and ITC's. Unlike in cases with ITC, metastases in other non-SLNs were common when a micrometastasis was detected in a SLK indicating need for further treatment of the neck. (C) 2009 Elsevier Ltd. All rights reserved.