Histopathologically Positive Regional Neck Node Metastasis Among Patients with Laryngeal Squamous Cell Carcinoma

Abstract

Objective: To determine the patterns of regional neck node metastasis in laryngeal squamous cell carcinoma in Filipinos according to subsite and clinical stage, and to determine possible factors associated with level V involvement.
 Methods:
 Design: Retrospective Case Series
 Setting: Tertiary National University Hospital
 Participants: A chart review was conducted for patients diagnosed with laryngeal squamous cell carcinoma who underwent laryngectomy with neck dissection from January 2011 to April 2015. Medical information obtained included demographics, clinical parameters, and histopathologic reports of nodal involvement. The rate and location of positive neck nodes was recorded according to clinical stage and primary subsite. Fisher exact test was used to determine significant risk factors for level V cervical lymph node involvement.
 Results: Of 56 patients included, most were male with an average age of 61 years. Most patients had cancer originating from the glottic subsite, with the majority being staged III and IVA according to the TNM classification. Histopathologically positive neck nodes were centered at levels II to IV. No significant association was seen between level V involvement and the studied clinicopathologic factors (age, sex, tumor differentiation, subsite involvement, involvement of other neck node levels).
 Conclusion: Cervical neck node levels II, III, and IV are the most commonly involved in neck dissection, with many being positive for nodal metastasis for these levels. Level V nodes may be removed when clinically positive, but elective neck dissection may exclude this level. The current practice of neck dissection appears to be appropriate in terms of selecting the most likely locations of metastatic spread. Further study is recommended, with a greater population and standardized levels of neck dissection.
 Keywords: laryngeal cancer, lymphatic metastasis, neck dissection, squamous cell carcinoma

Histopathologic Factors Affecting Metastases to Lymph Nodes in Laryngeal Squamous Cell Carcinoma in the Department of Anatomical Pathology FKUI/RSCM 2015-2019

“…Menurut Austria et al, 12 KSSL sering melibatkan level II, III dan IV dikarenakan lokasi laring secara Anatomiks sejajar dengan KGB level II, banyak saluran limfatik ke area tersebut dimana saluran limfatik dari supraglottis dialirkan melalui membran tirohioid ke saluran jugularis, dan berdasarkan pathway of lymphathic drainage dari level II ke level III dan selanjutnya ke level IV. Soliman et al, 12,13 membuktikan bahwa KGB leher level II, III dan IV merupakan KGB leher yang paling sering ditemukan metastasis tumor KSSL, sehingga pada tindakan bedah laringektomi total di rekomendasikan untuk dilakukan diseksi leher dalam rangka mengantisipasi adanya occult metastase dan mencegah progresifitasnya.…”