Patterns of cervical node metastases from squamous carcinoma of the oropharynx and hypopharynx

Abstract

A retrospective review of 333 previously untreated patients from 1965 to 1986, with primary squamous cell carcinoma of the oropharynx or hypopharynx, was undertaken to ascertain the prevalence of neck node metastases by neck level. The 333 patients underwent 344 classical radical neck dissections. Patients were grouped by clinical neck status at the time of neck dissection: elective dissection in the N0 neck (N = 71), and immediate therapeutic dissection in the N+ neck (N = 259). Detailed analysis was performed for each group based on the specific primary site. This revealed a predominance of neck node metastases in levels II, III, and IV for both oropharyngeal and hypopharyngeal primaries. Isolated "skip" metastases outside of levels II, III, or IV occurred in only 1 patient (0.3%). Otherwise, level I or V involvement was always associated with nodal metastases at other levels (ie, N2 disease). These data support the trend toward selective limited neck dissection (anterior modified) in N0 patients. Furthermore, they provide the foundation for planning of future prospective trials to assess the efficacy of modifications in the extent of neck dissection for carcinomas of the oropharynx or hypopharynx.

Management of the Patients with Hypopharyngeal Cancer: Eight-Year Experience of Miyagi Cancer Center in Japan

“…Although we presently consider elective contralateral neck dissection to be unnecessary, its advisability shoud be reconsidered based on results of patient follow-up. It is well documented that regional lymph node metastasis of hypopharyngeal cancer is usually located at levels II, III and IV (Candela et al 1990;Wenig and Applebaum 1991). In our results, regional metastasis was mainly located at these levels in the patients who underwent initial neck dissection.…”

Level 5 Lymphadenopathy Warrants Heightened Suspicion for Clinically Significant Pathology

“…There have, however, been studies reviewing biopsies of nodes in the 'supraclavicular' region, particularly regarding the diagnostic yield of FNAC. Such studies have found malignancy rates of between 55 and 71 %, with a higher lymphoma:metastatic carcinoma ratio in subjects younger than 40 when compared to those above 40 years [6][7][8][9][10]. In one of these studies, the actual malignancy rate was found to be as high as 86.5 % (n = 45) on final histology of excisional biopsy [7].…”

Comparison of the efficacy of clinical examination, ultrasound neck and computed tomography in detection and staging of cervical lymph node metastasis in head and neck cancers

“…Its low sensitivity and specificity forced the way to further studies in search of other accurate diagnostic means for detecting neck nodes (9,10,11).…”