Role of modern imaging in decision‐making for elective neck dissection

Abstract

This study examines patterns of early metastatic spread as recorded in 19 clinically negative, histologically positive (occult) neck dissection specimens. Microscopic metastatic deposits were detected in this study in nodes measuring 10 mm and less. No nodes with extension of tumor beyond the capsule and into adjacent structures were noted. Central necrosis was detected in only one node. We suggest that the first stages of metastatic disease as evaluated by the pathologist in clinically occult nodes are minimal and may easily evade the eyes of both pathologists and radiologists. Imaging proved to be efficacious in upstaging clinically occult necks that were previously irradiated.

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

“…CT and MR imaging allow detection of small structures, such as lymph nodes, with high sensitivity. Although several ra diologic characteristics of metastatic nodes have been defined (size, shape, central necrosis, obliteration of fascial planes, contiguous nodes), several authors have criticized these criteria (4,12,(15)(16)(17)(27)(28)(29). In our opinion, differentiation between benign and metastatic nodes only on the basis of radiologic characteristics remains dif ficult and unreliable.…”

Immunohistochemistry, A Valuable Tool in Detection of Cervical Lymph Node Micrometastases in Head and Neck Squamous Cell Carcinoma: A Prospective Study

“…1 An algorithm for classification of lymph node metastasis [9][10][11][12][13][14] Histopathological examination is the highly sensitive and specific test for detection of metastasis but the earliest stage of metastasis to neck can be difficult to identify by light microscopy [7,8]. Small foci of metastatic cancer called micrometastases are often missed because of sampling problems.…”

“…Small foci of metastatic cancer called micrometastases are often missed because of sampling problems. If a single 5 lm section is required, the 1-cm lymph node has to be sectioned 2,000 times [7,8].…”

“…Histopathological examination of neck dissection specimens is highly sensitive and specific test for detection of metastasis [7,8]. Immunohistochemistry is the gold standard test to detect occult metastasis, micrometastasis or isolated tumor cells in the dissected lymph nodes which show negative metastasis on histopathology.…”

The Pathology of Neck Dissection in Cancer of the Larynx

“…In both instances, this usually translates into a measure of size -cervical nodes 11 cm or so in greatest dimension are clinically suspicious and usually detectable by surgeons and radiologists (macrometastases); nodes measuring !1 cm or so in greatest dimension are, by contrast, less readily detected prior to microscopic study and thus regarded as occult metastases or micrometastases [25]. As a general rule, the pathologist can expect that these clinically occult positive cervical nodes will measure !10 mm in greatest dimension, and usually will show neither extension of tumor beyond the node capsule or central necrosis [25]. Micrometastases should be aggressively sought by the surgical pathologist, as their presence in an otherwise negative neck dissection may have an impact on prognosisalthough this is a controversial area [18,30,[55][56][57][58].…”