The new staging system does a better job of moving those thicker lesions out of T1 and into either T2 or T3, which follows how things have been done for many years for melanoma. —Erich M. Sturgis, MD, MPH
Explore This Issue
October 2021
In a pilot study, the authors reported that there was excellent correlation between sonographic and histologic measurements for both tumor thickness and DOI: The mean sonographic tumor thickness was 7.5 ± 3.5 mm versus 7.0 ± 4.2 mm histologic tumor thickness; mean sonographic DOI and histologic DOI were 6.6 ± 3.4 and 6.4 ± 4.4 mm, respectively (AJNR Am J Neuroradiol. 2020;41:1245-1250).
Impact on Clinical Practice
The integration of the 8th edition staging into national cancer registries occurred in 2018, but when guidelines change, there’s a significant lag before the changes become common clinical practice, Dr. Teng noted. How long does it take for an established medical guideline to become common practice? “The answer might surprise you—it’s an average of 17 years. By that estimate, it would be the year 2035 by the time the ‘new’ AJCC guidelines take full effect, but we will assuredly have another staging update by then. It’s incumbent upon all of us to stay current with guidelines so that our patients receive the best possible care.”
“Because we have always incorporated tumor depth in making treatment decisions, I don’t think the new staging system has changed the way that we treat our patients, but it has refined the staging. Having a better staging of T1, T2, and T3 allows us to make decisions about lymph node risk,” said Dr. Sturgis.
Dr. Moore agreed. “It’s hoped that the new staging system will capture the more aggressive tumors. There may have been some tumors in the past that would have been staged lower because the depth of invasion wasn’t considered. These lesions are now upstaged and the patients may receive a more intense therapy, including the addition of radiation therapy.”
Nikki Kean is a freelance medical writer based in New Jersey.
Sentinel Node Biopsies for Oral Cancer?
Although elective neck dissection continues to be the gold standard in assessing for the presence of occult regional disease, the optimal management strategy continues to evolve, according to Erich M. Sturgis, MD, MPH, professor and vice-chair of clinical affairs in the department of otolaryngology–head and neck surgery and the Brown Foundation Endowed Chair of head, neck, and thyroid cancer at Baylor College of Medicine in Houston. Although well accepted in Europe, sentinel lymph node biopsy is being recognized in the United States as a viable alternative to elective neck dissection for early-stage oral cavity cancer. Dr. Sturgis is currently working with Stephen Y. Lai at MD Anderson Cancer Center in Houston on a clinical trial. “It’s a good option for some patients.”
There’s a growing body of evidence that sentinel lymph node biopsy may be just as effective at identifying tumor spread and may allow these patients to have less morbid surgery by avoiding the formal neck resection, added Michael Moore, MD, Arilla Spence DeVault Professor of Otolaryngology–Head and Neck Surgery and medical director of the Indiana University Health Joe and Shelly Schwarz Cancer Center in Carmel. “In my practice, we still do elective neck dissection, removing lymph nodes in levels 1, 2, 3, and sometimes 4. Sentinel lymph node biopsy is a nice option if it’s done well by a surgeon and nuclear medicine team with experience in this technique.”