Evaluation of cervical lymph node metastases in squamous cell carcinoma of the head and neck

Abstract

Although computed tomography and magnetic resonance imaging have contributed to the ability to identify metastatic disease in head and neck cancer, inadequacies in evaluating lymphadenopathy still exist. This study was undertaken to estimate the accuracy of radiological criteria used to detect cervical lymph node metastases. The morphological characteristics of 957 lymph nodes from 36 neck dissections from patients with squamous cell cancer were examined microscopically. A large number of malignant nodes were found to have diameters of less than 10 mm. Extranodal spread also occurred in a substantial percentage of smaller nodes. Because the present radiological criteria for assessing cervical lymph node status are based largely on size, findings indicate major limitations in the capabilities of detecting metastatic disease. New modalities to improve the staging of head and neck cancer are discussed.

Disparity in pathologic and clinical lymph node staging in oral tongue carcinoma

“…Although it is believed that ECS occurs mainly in larger lymph nodes, some studies have identified ECS in lymph nodes as small as 2 mm. 52 Consistent with this observation, 12 of 186 (6%) patients with clinically negative neck dissections in the current study had histologic ECS in our pathologic review.…”

A meta-analysis of the randomized controlled trials on elective neck dissection versus therapeutic neck dissection in oral cavity cancers with clinically node-negative neck

“…The great challenge that is being faced by the head and neck oncologists and surgeons is the correct identification of the subset of head and neck cancer patients, of which oral carcinoma constitutes about 30% [90], without micro metastases to the cervical lymph nodes. Clinical palpation of the neck combined with the radiological investigative tools has not been able to correctly identify all these patients [39,102,130]. Despite the increase in knowledge and advancement in cancer management, there is still no method to determine correctly the real micro metastatic disease free neck.…”

“…Some large nodes may be inflammatory while some impalpable nodes may be carcinomatous [32,108]. Clinical palpation of the neck is not adequate for the correct identification of patients with neck node metastasis [39,102,130]. Factors such as neck fat thickness, neck stiffness or contraction, pain and swelling may affect the identification of neck node by palpation.…”

“…Ultrasound guided fine needle aspiration cytology is reliable to some extent at identifying lymph node metastases in carcinoma of the oral cavity and other head and neck cancers which were previously impossible. In [27,39,68,102,154]. However, these radiological investigative tools are not without limitations.…”

“…However, these radiological investigative tools are not without limitations. Small areas of necrosis are not always depicted clearly and adipose metaplasia or area of hypovascularity could mimic necrosis on CT scan [39]. An estimated 50% of cervical metastases are less than 5.0 mm [39].…”