Level IIB lymph node metastasis in oropharyngeal squamous cell carcinoma

Abstract

This study uniquely demonstrated a statistically significant association between clinical tumor stage and tonsil subsite with level IIB metastasis in OPSCC. Considering the predicted incidence of nodal metastasis, we conclude that level IIB neck dissection can be omitted in early stage (T1 or T2) clinically node negative (cN0) OPSCC. In patients with a cN0 neck and advanced OPSCC (T3 or T4), primary tumor in the tonsil, or ipsilateral clinically node positive (cN(+) ) and contralateral cN0 neck, level IIB dissection should be considered. Level IIB dissection should be performed routinely in patients with cN(+) OPSCC.

Current philosophy in the surgical management of neck metastases for head and neck squamous cell carcinoma

“…The risk of metastases to cervical lymph nodes is high in oropharyngeal cancer, with an overall incidence of 92%, and an incidence of 39% for the clinically N0 neck, which suggests the need for elective treatment in the majority of the latter. However, the efficacy of elective neck treatment in clinically N0 oropharyngeal cancer has not yet been demonstrated with prospective studies, and observation is used as an option in some centers.…”

“…Gross et al found that the majority of the metastases were located in levels II and III. However, sublevel IIB metastases range between 2.5% and 6% in oropharyngeal cancers, suggesting that this sublevel can be omitted during elective neck dissection.…”

“…Gross et al found that the majority of the metastases were located in levels II and III. However, sublevel IIB metastases range between 2.5% and 6% in oropharyngeal cancers, suggesting that this sublevel can be omitted during elective neck dissection. In their series of 348 patients with oropharyngeal cancer, metastases were present in sublevel IIB in 2.5% and 25% of patients with clinically N0 and clinically positive necks, respectively .…”

“…However, sublevel IIB metastases range between 2.5% and 6% in oropharyngeal cancers, suggesting that this sublevel can be omitted during elective neck dissection. In their series of 348 patients with oropharyngeal cancer, metastases were present in sublevel IIB in 2.5% and 25% of patients with clinically N0 and clinically positive necks, respectively . The authors concluded that removal of sublevel IIB is not necessary in patients with T1 or T2 tumors with clinically N0 necks.…”

Feasibility and relevance of level I substation node counts in oropharyngeal carcinoma

“…The total node counts for the entire neck specimen varied from 18 up to 119. Within level I, the range of node counts was also wide (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) with a mean number of nodes found in level I of 8.1. Node counts in the necks and node counts in the substations of level I are shown in Tables 3 and 4, respectively ( Figure 6).…”