Jørgen Kirkegaard

Prospective study of 18FDG‐PET in the detection and management of patients with lymph node metastases to the neck from an unknown primary tumor. Results from the DAHANCA‐13 study

The benefit of a complementary fluorodeoxyglucose‐positron emission tomography (FDG‐PET) scan to standard workup for carcinoma of unknown primary (CUP) and metastatic neck lesions was prospectively studied.

The role of SPECT-CT in the lymphoscintigraphic identification of sentinel nodes in patients with oral cancer

Conclusion: SPECT-CT may improve the localization of sentinel nodes (SNs) in patients with oral squamous cell carcinoma (OSCC). Compared with planar lymphoscintigraphy SPECT-CT detected more SNs and provided additional anatomical and spatial information about their localization. New generation SPECT with higher resolution CT scanners are expected to provide more accurate information about the localization of SNs. Objective: To assess the role of combined SPECT-CT in SN identification in the clinically negative neck of patients with OSCC. Materials and methods: Lymphoscintigraphy comprising planar and SPECT-CT acquisition was performed in 34 consecutive patients with OSCC stage I and II (T1-2N0M0) prior to sentinel node biopsy (SNB) and selective neck dissection. The number of SNs and anatomical location was recorded according to lymphoscintigraphy and operative findings. Results: SNB was conducted in 33 patients. SNs were identified in 94% (32/34) of the patients using SPECT-CT. In 91% (29/32) of the patients SNs were harvested from all of the levels involved on SPECT-CT. SPECT-CT imaging demonstrated extra SNs compared with planar lymphoscintigraphic imaging in 47% (15/32) of patients. In seven cases the anatomical level of SN according to SPECT-CT was reclassified during surgery. The overall incidence of lymph node metastases was 19% (6/32). There were no false negative SNs.

Need for Intensive Histopathologic Analysis to Determine Lymph Node Metastases When Using Sentinel Node Biopsy in Oral Cancer

Objective: To determine the predictive value of sentinel node biopsy (SNB)‐assisted neck dissection in patients with oral squamous cell carcinoma (SCC) stage T1 to 2N0M0 and to determine the incidence of subclinical metastases.

Thyroperoxidase (TPO) immunostaining of the solitary cold thyroid nodule

To evaluate the value of immunostaining using the monoclonal antibody (MoAB47) against thyroperoxidase (TPO) in distinguishing between benign and malignant tumour cells in fine needle aspiration cytology (FNAC) samples obtained from a solitary cold nodule of the thyroid gland for the purpose of strengthening the indication for thyroid surgery.

Cancer of the Nasal Cavity and Paranasal Sinuses' Prognosis and Outcome of Treatment

A retrospective study of 121 patients, 77 men and 44 women, with sino-nasal cancer, admitted to the National University Hospital, Rigshospitalet, during the period 1983 1993, is presented. The median follow-up time was 21 months, (range 3 124). Forty-six percent of the tumors originated from the nasal cavity, 29% from the maxillary sinuses and 5% from the ethmoid sinuses. In 18% of the cases, the site of origin was not clear due to advanced local growth. Sixty-five patients received primary radiation therapy with curative intention of whom 5 underwent secondary surgery. Forty-nine patients underwent primary surgery, 38 of them received postoperative radiation therapy. The overall 5-year survival rate in this material was 35% and the disease-specific 5-year survival was 45%. Patients with well-differentiated squamous cell carcinomas had a significantly higher 5-year survival rate than patients with poorly differentiated carcinomas and patients with regional metastases had a significantly poorer 5-year survival than patients without. The 5-year local control was 48% (41/121). Six of 9 patients with regional metastases at admission were controlled locally, whereas 16 patients developed regional metastases after primary treatment.

The Danish national guidelines for treatment of oral squamous cell carcinoma

The treatment strategy for oral squamous cell carcinoma in Denmark has traditionally varied between the different head and neck oncology centres. A study group within the Danish Society for Head and Neck Oncology (DSHHO) was formed with the aim of optimising and standardising the treatment strategy. The approach was to use single modality treatment for stage I, stage II and some stage III and combined modality treatment for stage III and IV. Surgery was the preferred treatment when it was considered possible to perform a radical excision of the tumour and possible lymph node metastases with acceptable aesthetic and functional outcome. The implementation of a recognised national guideline facilitates prospective studies on a large well-characterised cohort. This increases the possibility of obtaining valid data on parameters such as morbidity, loco-regional control and survival. In addition the establishment of a reference program facilitates national monitoring of the treatment using defined indicators and standards.

Immunohistochemical staining for thyroid peroxidase (TPO) of needle core biopsies in the diagnosis of scintigraphically cold thyroid nodules

Background  Cold thyroid nodules are common, in particular in iodine‐deficient areas, but only a minority of them are malignant requiring surgery. Thyroid peroxidase (TPO) immunostaining of fine‐needle aspiration cytology (FNAC) material has proven helpful in diagnosing cells from malignant lesions, but the procedure has its limitations in a routine setting.

Oral Cancer—Results of Treatment in the Copenhagen University Hospital

During the period 1992-96, 304 patients with malignant tumours of the oral cavity were treated in Copenhagen University Hospital. The female:male ratio was 1:2. Age ranged between 20 and 96 years, median 61 years. Ninety-five percent of the tumours were squamous cell carcinomas. Twenty-two percent were in stage I, 21% were in stage II, 21% were in stage III and 36% were in stage IV. Sixty percent of the patients underwent primary surgical resection, combined with reconstructive procedures if necessary. In 39% of all cases, surgery was followed by radiotherapy, while 21% of the patients, mainly stage I and II patients, were only treated surgically. Radiotherapy alone was received by 36% of the patients, mainly stage III and IV. Four percent of the patients received no treatment due to advanced disease or general poor condition. The overall recurrence rate was 42%, ranging from 23% in stage I to 61% in stage IV. Thirty-eight percent of these patients were treated for recurrence, almost exclusively by surgery. The survival rate 1 year after treatment of recurrence was 90%, 60% and 50% for patients in stage I, II and III respectively, while only 1 of 16 patients in stage IV was alive after 1 year. Three-year crude survival for the whole material was 42%, ranging from 58% in stage I to 18% in stage IV. This is an improvement of 12% compared with a similar group of patients treated in our departments in the period 1978-82, when the primary treatment of choice was external irradiation. The survival rate was, as expected, closely related to T- and N-stage at time of diagnosis. In conclusion, we recommend primary surgery followed by irradiation therapy for patients in stages II, III and IV. Surgical treatment of recurrence in patients who were formerly treated by irradiation therapy should be reserved for patients in good general condition and in a low TNM stage, stage IV patients will only benefit from salvage surgery in a few exceptional cases.