Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Author:
Dimonitsas Emmanouil
Dissertation committee:
Ειρήνη Θυμαρά, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Αλέξανδρος Στρατηγός, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Νικόλαος Παπαδόπουλος, Καθηγητής, Ιατρική Σχολή, ΔΠΘ
Πηνελόπη Κορκολοπούλου, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Νικόλαος Καβατζάς, Καθηγητής, Ιατιρκή Σχολή, ΕΚΠΑ
Δέσποινα Κακαγιά, Καθηγήτρια, Ιατρική Σχολή, ΔΠΘ
Ελευθερία Λακιωτάκη, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Αναδρομική επιδημιολογική μελέτη στα ακανθοκυτταρικά καρκινώματα δέρματος των τελευταίων 10 ετών με βάση το αρχείο των χειρουργικών επεμβάσεων και προοπτική μελέτη για την σημασία του υπερήχου λεμφαδένων (US), της βιοψίας με λεπτή βελόνη (FNAc) και της βιοψίας του λεμφαδένα φρουρού (SLNB) για την σταδιοποίηση του ακανθοκυτταρικού καρκινώματος υψηλού κινδύνου του δέρματος
Translated title:
Retrospective epidemiological study on cutaneous squamous cell carcinomas of the last 10 years based on the record of surgical operations and a prospective study on the importance of lymph node ultrasound (US), fine needle biopsy (FNAc) and sentinel lymph node biopsy (SLNB) for the staging of high-risk cutenous squamous cell carcinoma of the skin
Summary:
Background: Cutaneous squamous cell carcinoma (cSCC) constitutes 20% of non-melanoma skin cancers and is the most common after basal cell carcinoma. Although most are curable after their surgical removal, there is a subgroup of cSCC (high risk) characterized by specific clinicopathological characteristics that give them a more aggressive behavior, i.e. an increased risk of local recurrence (10-47.2% vs. 10% of low risk), distant metastasis (15-38% vs. 5% of low risk) and present a positive sentinel lymph node (SLN) in about 14%.
Aim of the study: To search and highlight the prognostic factors of patients with cSCC related to the positivity of the sentinel lymph node, the increased possibility of recurrence and metastasis, but also the survival of the patients. Also, a new management algorithm for high-risk cSCC patients is proposed using three imaging techniques to detect lymph node micro-metastases at an earlier stage (US, US-FNAc, SLNB).
Methods: This is a two-arm study. The first part concerns a retrospective study for the period 2004-2014, in which the epidemiological data from 1,524 patients with cSCC (high and low risk), enrolled by 2 centers in Greece (Athens-Alexandroupoli), are described and analyzed. Patients were re-staged and assessed for risk factors for positive SLN, recurrence, metastasis and survival. The second part concerns a prospective study for the period 2015-2021, in which 81 patients with high-risk cSCC from 2 centers in Greece (Athens-Alexandroupoli) are included. In this study a comparison of the three imaging methods was made as well as an analysis of the risk factors for positive SLN, recurrence, metastasis and death from squamous cell carcinoma.
Results: In the retrospective study of 1524 patients with cSCC, 9 of 36 (25%) who underwent SLNB showed a positive SLN, with tumor diameter ≥ 2 cm being the only independent risk factor. The rates of recurrence and metastasis that the patients showed, 7% and 5.5% respectively, are similar to the international literature. In the prospective study out of 81 patients with high-risk cSCC we had 10 positive SLNs (12.3%). Perinevral invasion and infiltration beyond subcutaneous fat appear to be marginally associated with sentinel lymph node positivity. The sensitivity of ultrasound and cytological examination of suspicious ultrasound lymph nodes in the detection of micrometastases was 60%, much lower than SLNB (95%). The rates of high risk cSCC patients for recurrence and metastasis are 14.8% and 19.8% respectively, according to the international literature.
Conclusion: The staging of high-risk squamous cell carcinomas by detecting lymph node metastases at an earlier stage with as few invasive techniques as possible will lead to an increase in the survival expectancy of patients and to the avoidance of surgical interventions that burden functionally and financially both the patient and the health system.
Main subject category:
Health Sciences
Keywords:
Squamous cell carcinoma, High risk, Sentinel lymph node, Recurrence, Metastasis
Number of references:
188
