OBJECTIVETo investigate the regularity of cervical lymph-node metastasis in oral squamous cell carcinoma patients and determine the treatment principle to cN0 patients.

METHODS1,024 oral squamous cell carcinoma cases who underwent neck dissection between 1980-2001 were investigated retrospectively.

RESULTSThe total rate of cervical lymph-node metastasis of oral squamous cell carcinoma was 36.62% (375/1,024), the metastasis rate of cancer in tongue, buccal, gingival, and floor of mouth was 42.82%, 31.93%, 32.76%, and 25.00%, respectively; the rate of occult metastasis was 20.94%(71/339), the incidence of occult metastasis was closely related to the location of primary lesion and T stage.

CONCLUSIONThe results in this study revealed that the therapy regime of the oral squamous cell carcinoma should be based on carefully clinical examination and compositive analysis on primary lesion related to size, location and cervical lymph-node.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; pathology ; surgery ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Mouth Neoplasms ; pathology ; surgery ; Neck Dissection ; Neoplasm Staging ; Retrospective Studies ; Tongue Neoplasms ; pathology ; surgery

OBJECTIVEThe purpose of this study was to discuss the principle in neck treatment of cN0 patients with squamous cell carcinoma of buccal mucosa.

METHODS101 patients of squamous cell carcinoma of buccal mucosa at the stage of cN0, who had hospitalized in West China College of Stomatology, Sichuan University from 1980 to 2000, were investigated retrospectively. All the patients received a comprehensive therapy consisting of surgical procedures combined with chemotherapy and radiotherapy. The combining radical therapy of buccal, mandible and neck was the main surgical method. Lymph nodes were cleared after operation and examined by pathological method. The patients had been followed up for more than 3 years.

RESULTS17 patients had lymph nodes metastasis, the occult metastasis (OM) rate was 16.83%. It increased in the high stage of original lesion, the OM rate of T3 and T4 was 18.18% and 52.00%, respectively. The metastasized lymph nodes were mainly located in submandible and superior deep cervix lymph nodes, their respective metastasis rate was 41.18% and 29.41%.

CONCLUSIONThe rate of occult metastasis of squamous cell carcinoma of buccal mucosa is high, and then we should adopt actively selective neck dissection for the cN0 patients of squamous cell carcinoma of buccal mucosa.

Carcinoma, Squamous Cell ; surgery ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Mouth Mucosa ; surgery ; Mouth Neoplasms ; surgery ; Neck Dissection ; methods ; Neoplasm Staging ; Retrospective Studies

Objective:To establish a rapid method to detect the minimum inhibitory concentration (MIC) of imipenem in Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) based on ompK36 gene′s GD mutation. Methods:This was a methodological evaluation study. A total of 258 isolates of Klebsiella pneumoniae were collected from Lishui Municipal Central Hospital from March 2011 to December 2019. Porin gene ompK36 and carbapenemase genes blaKPC, blaNDM, blaIMP and blaOXA-48 were amplified by PCR and confirmed by sequencing. The MIC was detected and confirmed by microbroth dilution susceptibility test, and the corresponding patterns of genotype and MIC were constructed. Based on the patterns, a method for rapid detection of imipenem MIC by real-time fluorescence PCR (RT-PCR) was designed and established. The 159 isolates of non-repetitive Klebsiella pneumoniae collected by Lishui Disease Prevention and Control Center (CDC) from 2017 to 2019 were used for further verification. The sensitivity and specificity were calculated by fourfold table. Kappa test was used to compare the consistency between RT-PCR and microbroth dilution susceptibility test. Results:Among 258 isolates, 109 isolates did not carry carbapenemase gene, 65 isolates carried ompK36 gene GD mutation, 127 isolates carried blaKPC, 15 isolates carried blaNDM, 9 isolates carried blaIMP, and blaOXA-48 was not detected. With mircobroth dilution susceptibility test as the standard, there were 3 corresponding patterns between the drug resistance gene and the imipenem MIC of Kp: when all the 4 carbapenemase genes were negative, MIC≤1 mg/L, the sensitivity was 100% (107/107) and the specificity was 98.4% (125/127); when blaKPC was positive and ompK36 gene GD mutation was negative, 4 mg/L≤MIC≤16 mg/L, the sensitivity was 88.2% (60/68) and the specificity was 98.8% (164/166); when blaKPC and ompK36 gene GD mutation were both positive, MIC≥32 mg/L, the sensitivity was 96.6% (57/59) and the specificity was 96.6% (169/175). RT-PCR detected blaKPC, blaNDM, blaIMP, blaOXA-48 genes accurately.The RT-PCR results of ompK36 gene GD mutation in the KPC-producing isolates were 100% consistent with the sequencing results. In the 159 isolates from Lishui CDC, the sensitivity and specificity of imipenem MIC detected by RT-PCR were higher than 95% in all 3 patterns with mircobroth dilution susceptibility test as the standard, and Kappa value was 0.971. Conclusion:The RT-PCR based on ompK36 gene GD mutation was helpful to quickly determine the MIC range of imipenem in KPC-Kp.