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Predictive factors for posterior triangle metastasis in HNSCC
Chad M McDuffie1, Nazanin Amirghahari, Gloria Caldito
1Department of Otolaryngology-Head and Neck Surgery, Department of Biometry, Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71103, USA.
The Laryngoscope
|December 22, 2005
Summary
Level V lymph node metastasis is uncommon in upper aerodigestive squamous cell carcinoma. However, dissection of level V is recommended if levels II, III, and IV lymph nodes are positive.
Area of Science:
- Head and Neck Surgery
- Surgical Oncology
- Otolaryngology
Background:
- Radical neck dissection (RND) has evolved since 1906, with modifications aimed at sparing structures like the spinal accessory nerve.
- Dissection of level V lymph nodes during RND is controversial due to potential morbidity of the spinal accessory nerve.
Purpose of the Study:
- To investigate the incidence of nodal metastasis across all levels in upper aerodigestive squamous cell carcinoma.
- To determine the indications for level V lymph node dissection in these cancers.
Main Methods:
- Retrospective chart review of radical and modified radical neck dissections.
- Analysis of 94 neck dissections performed between 1996 and 2003 for upper aerodigestive squamous cell carcinoma.
- Univariate and multivariate analyses to identify factors associated with level V metastasis.
Main Results:
- Level V metastasis was present in 7.4% of the analyzed neck dissections.
- Multivariate analysis identified positive lymph nodes in levels II, III, and IV as the sole independent significant predictor of level V metastasis (P = .0003).
Conclusions:
- The prevalence of level V metastasis in upper aerodigestive squamous cell carcinoma is low, consistent with existing literature.
- Positive lymph node involvement in levels II, III, and IV warrants dissection of level V.