1. Eur Arch Otorhinolaryngol. 2013 Mar;270(3):1085-92. doi:
10.1007/s00405-012-2094-4. Epub 2012 Jul 5.

Cytokeratin immunohistochemically detected nodal micrometastases in N0 laryngeal 
cancer: impact on the overall occult metastases.

Negm H(1), Mosleh M, Fathy H, Hareedy A, Elbattawy A.

Author information: 
(1)Department of Otolaryngology Head and Neck Surgery, Kasr El-Aini University
Hospital, Cairo University, Cairo, Egypt. drnegment@hotmail.com

The objective of this study is to evaluate the incidence of occult nodal
micrometastases in N0 laryngeal squamous cell carcinoma using cytokeratin
immunohistochemical analysis (CKIHA) and its influence on the overall occult
metastatic rate. This is a prospective cohort study. A total number of 30
patients with N0 stage laryngeal cancer underwent 46 selective neck dissections
for elective treatment of the neck. Nodes found to be negative using routine
histopathological examination were evaluated for the presence of micrometastasis 
using CKIHA. The occult micrometastasis rate for all cases was 26.7 % which
significantly increased the overall occult metastasis rate to 50 % (P = 0.014).
The micrometastasis rate was 30.8, 25 and 20 % for glottic, supraglottic and
transglottic tumors, respectively, which increased the overall occult metastasis 
rate to 53.8, 50 and 40 % but without statistical impact. The micrometastasis
rate was 35.7 and 23.1 % in T3 and T4 tumors, respectively, and this increased
the overall occult metastasis rate to 50 and 61.5 % with statistical influence in
T3 tumors (P = 0.046). Micrometastasis upstaged the neck in 7 (23.3 %) patients
with statistical impact on the PN stage (P = 0.007). The overall occult nodal
metastasis rate in N0 laryngeal cancer is underestimated. Nodal micrometastasis
may be missed during routine histopathological examination and can be detected
using CKIHA.

PMID: 22763427  [PubMed - indexed for MEDLINE]