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Level IIB lymph node metastasis in oropharyngeal squamous cell carcinoma
Author(s) -
Gross Brian C.,
Olsen Steven M.,
Lewis Jean E.,
Kasperbauer Jan L.,
Moore Eric J.,
Olsen Kerry D.,
Price Daniel L.
Publication year - 2013
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.24129
Subject(s) - medicine , neck dissection , tonsil , metastasis , stage (stratigraphy) , lymph node , primary tumor , t stage , incidence (geometry) , dissection (medical) , head and neck squamous cell carcinoma , radiology , retrospective cohort study , oncology , surgery , carcinoma , head and neck cancer , cancer , radiation therapy , paleontology , physics , optics , biology
Objectives/Hypothesis To determine the incidence of level IIB lymph node metastasis in patients with oropharyngeal squamous cell carcinoma (OPSCC) and to evaluate the necessity of level IIB dissection for elective and therapeutic neck dissections. Study Design Retrospective cohort study. Methods Patients with OPSCC (N = 348) were surgically managed at our institution from 2004 through 2010. Neck dissection specimens were reviewed by a pathologist, and level IIB metastases were analyzed with respect to clinical and pathologic data. Results Level IIB lymph node metastases were present in 2.5% and 25% of elective and therapeutic neck dissections, respectively. Level IIA metastasis, clinical tumor stage, clinical nodal stage, extracapsular spread, and primary tumor location in the tonsil were significantly associated with level IIB metastasis. Conclusions 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. Level of Evidence 4. Laryngoscope , 123:2700–2705, 2013