Salvage Neck Dissection for Cervical Recurrence of Nasopharyngeal Carcinoma

Residual cervical lymphadenopathy after definitive treatment of nasopharyngeal carcinoma: fine needle aspiration cytology, computed tomography and histopathological findings

“…Most published studies have combined this patient group with patients with recurrent nodal disease. [6][7][8][9] In our clinical practice, however, we encountered a substantial number of negative neck dissections in this group of patients, and felt that such cases should be addressed separately; we therefore undertook the present study.…”

“…11 Yen et al studied four patients with suspected persistent nodal disease, and reported waiting for two consecutive months to allow a more objective assessment of the disease state of the neck, before performing salvage neck dissection at nine to 10 weeks. 7 Wei et al reported waiting three months after completion of radiotherapy before undertaking salvage surgery in five patients with persistent nodal disease. 8 Other authors have not stated how long they would observe residual lymphadenopathy before instituting treatment.…”

“…Yen et al reported a sensitivity of 83 per cent for FNAC performed for 12 patients with suspected recurrent nodal disease. 7 Wei et al found that 20 of 33 FNAC samples from patients with residual and recurrent nodal disease showed malignant cells, while histopathological examination found tumour cells in 45 of 51 patients' neck dissection specimens. 9 In a separate study, we published data on 42 patients presenting with suspected recurrent cervical nodal disease; we found a sensitivity, specificity, positive predictive value and negative predictive value of 75, 75, 93.8 and 37.5 per cent, respectively, for the use of FNAC to identify disease.…”

“…12 Rates as low as 57 per cent have been reported for the sensitivity of FNAC to detect recurrent nodal disease. 7 Whether FNAC is needed in the first place, or should be repeated if negative, is controversial. In our department, if the CT scan shows pathological lymphadenopathy we will undertake treatment regardless of the FNAC result.…”

“…Some centres have advocated repeated radiotherapy for the treatment of such persistent cervical lymphadenopathy, while others have recommended surgery. [6][7][8][9][10][11] Previously, we have published data on the use of fine needle aspiration cytology (FNAC) and computed tomography (CT) scanning in assessing recurrent cervical nodal disease, together with data on the incidence of negative neck dissection in cases of recurrent nodal disease. 12 We believe that residual cervical lymphadenopathy represents a distinct clinical challenge and should be addressed separately.…”