The Utility of Comprehensive Sampling in Cervical Lymph Node Dissection for Head and Neck Squamous Cell Carcinoma: Is...

To evaluate whether comprehensive sampling of cervical lymphadenectomy tissue increases lymph node yield (LNY) and improves staging adequacy beyond standard grossing practice.

At a single academic center, a comprehensive grossing protocol was introduced in which entire cervical lymphadenectomy specimens (levels I-V) were submitted for histologic evaluation rather than only grossly identified lymph nodes. Ninety-one cervical lymphadenectomy specimens from 22 HNSCC patients were analyzed. For each case, standard-protocol LNY was recorded; additional lymph nodes (positive and negative) recovered by the comprehensive protocol were counted, and changes in pathologic stage and adequacy relative to the 18-node benchmark were assessed. Additional prosection time, tissue block usage, and the correlation between standard and added nodes were also evaluated.

The comprehensive protocol increased LNY by a mean of 15.9 ± 12.9 nodes per patient (median 13; 50.1% overall increase), and by 3.8 ± 5.2 nodes per specimen. Only two additional positive nodes (< 0.6%), measuring 1.4 and 4.1 mm, were identified and did not change staging. Two patients with LNY < 18 under the standard protocol exceeded 18 nodes with the comprehensive protocol. Implementation added a mean of 18.5 prosection minutes and 23 extra blocks per case, with poor correlation between standard and added nodes (r² = 0.15).

Comprehensive submission markedly increases lymph node counts and can convert some dissections from inadequate to adequate by numeric criteria. However, in this cohort it produced no staging changes and required substantial laboratory resources. These findings support selective rather than universal use of comprehensive sampling in neck dissection evaluation.