Histopathological predictors of occult lymph node metastases in supraglottic squamous cell carcinomas

Lymph node metastasis appears to be the most important factor determining s urvival in patients with squamous cell carcinoma of the larynx. Supraglotti c laryngeal carcinomas have a known tendency to metastasize to cervical lym ph nodes because of the extensive lymphatic network present. This retrospec tive cohort study was conducted to define possible histopathological parame ters affecting cervical lymph node metastasis and then using these paramete rs to create a scale to predict occult lymph node metastasis in supraglotti c squamous cell carcinoma. The pathological slides of 61 operated patients were reevaluated for tumor grade, lymphatic-vascular invasion, invasion pat tern of turner margins, perineural invasion and lymphocytic infiltration. G rade (P < 0.001), lymphatic-vascular invasion (P < 0.001) and tumor margins (P = 0.007) were found to be closely associated with neck metastasis. To d efine the risk factors for occult metastasis, a grading scale was created b y using grade (G), lymphatic-vascular invasion (L) and tumor margin (M) fin dings of patients. None of the patients with a GLM value of zero developed occult metastasis. On the other hand occult metastasis was found in 58.8% o f N0 patients with a GLM value that was more than zero. These findings indi cate that patients with high-grade tumors having infiltrating borders and l ymphatic-vascular invasion have a high risk for occult metastasis so that e lective treatment of the neck either by neck dissection or radiotherapy sho uld be added to therapy. Serial sections of specimens are needed to avoid m issing metastatic loci of disease.