Rationale for elective neck dissection in 1990

Abstract

Elective neck dissection has long been a subject of debate among surgeons. The proponents of elective neck dissection base their rationale on studies that show a 30% incidence of occult disease in those situations for which elective neck dissection is recommended. One hundred eighty-two patients with advanced stages of squamous cell carcinoma of the head and neck were studied. All patients had preoperative computed tomography or magnetic resonance imaging, and all patients had some form of radical neck dissection. The sensitivity of clinical exam was compared with the sensitivity of computed tomography or magnetic resonance imaging in ability to detect nodal disease. The sensitivity of clinical exam alone was 71.7%, while the sensitivity of computed tomography or magnetic resonance imaging was 91.1%. Based on physical exam alone, there would be a 39% rate of occult disease; if computed tomography or magnetic resonance imaging data is combined with physical exam, the occult disease rate would drop to 12%. All centers performing elective neck dissection must reassess their rationale or restudy their occult disease rate with computed tomography or magnetic resonance imaging.

Regional metastasis in head and neck squamous cell carcinoma: revised value of US with US-guided FNAB.

“…The specificity, however, was comparable. Compared with other diag nostic imaging techniques, the sensitiv ity of US with US-guided FNAB found in our study is in the range of that re ported for CT (4,6,9,12,13,15,16) and MR imaging (5,9). The high specificity of up to 100% found in the present and previ ous studies (13,20) compares favorably with that of CT and MR imaging.…”

“…Studies with a high number of patients having metastasis or advanced-stage disease will show higher sensitivity rates for the studied diagnostic techniques. For example, in studies with a relatively high number of cases with clinically or histologi cally positive nodes, higher sensitivity rates for CT were obtained, up to 91 % (6,12,15), whereas in studies with more cases with negative nodes, sensitivity rates for CT were lower (eg, 60%) (4). The only study, to our knowledge, in which the results of US with US-guided FNAB, CT, and MR imaging were com pared in the same study population showed superior results of US wi th USguided FNAB (13).…”

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

“…less than 4mm in primary tumor of the tongue), and favorable histologic differentiation [41,135]. They proposed a reliance on the radiological evaluation of the neck to take decision on the extent of treatment [55] and emphasized on the importance of frozen section as a guide on whether or not to proceed to neck dissection [122].…”

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).…”