The Usefulness of Cytokeratin Immunohistochemistry in Detection of Micrometastasis in Neck Lymph Nodes of Oral Cancer Patients
Date Issued
2008
Date
2008
Author(s)
Hung, Hsien-Yen
Abstract
Background and purposes: Micrometastases (< 3 mm in diameter) in lymph nodes (LNs) are sometimes difficult to detect by routine hematoxylin and eosin (H&E) stain. Our study was designed to find out whether pan-cytokeratin immunostain could have a better detection rate of micrometastasis than H&E stain, to study the characteristic features of micrometastasis in cervical LNs of oral squamous cell carcinoma (OSCC) patients, and to understand the outcome of patients with only micrometastases.aterials and methods: A total of 2486 cervical LNs from 94 OSCC patients were examined by both H&E stain and pan-cytokeratin immunostain. esults: H&E stain detected 15 LNs with micrometastasis and 40 LNs with overt metastasis. Pan-cytokeratin immunostain identified 5 additional LNs with micrometastasis and 1 additional LN with overt metastasis. Pan-cytokeratin immunostain did not have a significantly better detection rate of micrometastasis than H&E stain (P = 0.497). Of these 20 micrometastases detected by pan-cytokeratin immunostain, 9 occurred in 8 patients with only micrometastases and 11 occurred in 11 patients with both overt metastases and micrometastases. Two (25%) of the 8 patients with only micrometastases developed recurrent disease in the neck and one of the 8 died of neck metastasis. Fourteen (70%) of the 20 micrometastases occurred in LNs smaller than 10 mm in diameter, and 10 (50%) occurred in LNs between 5 mm and 10 mm in diameter. Eleven (55%) of 20 micrometastatic foci were located in the marginal sinuses of the LNs, whereas the remaining 9 (45%) micrometastatic foci were observed in the medullary sinuses of the LNs. onclusions: Pan-cytokeratin immunostain can increase the detection rate of micrometastasis but it has no significant diagnostic superiority to H&E stain. Approximately 30% of positive cervical LNs of OSCC patients have only micrometastases. Micrometastases are frequently located in the marginal sinuses of the LNs and often found in the LNs smaller than 10 mm in diameter. Based on our findings, we suggest that micrometastatic foci can subsequently result in a recurrent neck disease or finally cause the mortality of the OSCC patient.
Subjects
micrometastasis
squamous cell carcinoma
clinical outcome
SDGs
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