This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Garrel, R. Articles by Boulle, N. Search for Related Content PubMed PubMed Citation Articles by Garrel, R. Articles by Boulle, N.

The Diagnostic Accuracy of Reverse Transcription-PCR Quantification of Cytokeratin mRNA in the Detection of Sentinel Lymph Node Invasion in Oral and Oropharyngeal Squamous Cell Carcinoma: A Comparison with Immunohistochemistry

Authors' Affiliations: Departments of ¹ Head and Neck Surgery, ² Molecular and Cellular Biology, ³ Pathology, ⁴ Medical Statistics, and ⁵ Nuclear Medicine, Montpellier Teaching Hospital, Montpellier, France; and ⁶ Department of Otolaryngology, Ninewells Hospital and Medical School, Dundee, United Kingdom

Requests for reprints: Renaud Garrel, Head and Neck Surgery Department, Montpellier Teaching Hospital, Montpellier, France. Phone: 33-4-67-33-68-03; E-mail: r-garrel{at}chu-montpellier.fr.

Purpose: The main goal of sentinel lymph node (SLN) detection in head and neck squamous cell carcinomas is to limit neck dissections to pN+ cases only. However, intraoperative + diagnosis cannot be routinely done using the current gold standard, serial step sectioning with immunohistochemistry. Real-time quantitative reverse transcription-PCR (RT-PCR) is potentially compatible with intraoperative use, proving highly sensitive in detecting molecular markers. This study postoperatively assessed the accuracy of quantitative RT-PCR in staging patients from their SLN.

Experimental Design: A combined analysis on the same SLN by serial step sectioning with immunohistochemistry and quantitative RT-PCR targeting cytokeratins 5, 14, and 17 was done in 18 consecutive patients with oral or oropharyngeal squamous cell carcinoma and 10 control subjects.

Results: From 71 lymph nodes examined, mRNA levels (KRT) were linked to metastasis size for the three cytokeratins studied (Pearson correlation coefficient, r = 0.89, 0.73, and 0.77 for KRT 5, 14, and 17 respectively; P < 0.05). Histopathology-positive SLNs (macro- and micrometastases) showed higher mRNA values than negative SLNs for KRT 17 (P < 10^–4) and KRT 14 (P < 10^–2). KRT 5 showed nonsignificant results. KRT 17 seemed to be the most accurate marker for the diagnosis of micrometastases of a size >450 µm. Smaller micrometastases and isolated tumor cells did not provide results above the background level. Receiver operating characteristic curve analysis for KRT 17 identified a cutoff value where patient staging reached 100% specificity and sensitivity for macro- and micrometastases.

Conclusion: Quantitative RT-PCR for SLN staging in cN₀ patients with oral and oropharyngeal squamous cell carcinoma seems to be a promising approach.