Detailed topography of cervical lymph-note metastases from oral squamous cell carcinoma

The histologic presence and detailed topography of cervical lymph node metastatic tumours was investigated in a series of neck dissections from 154 previously untreated patients with oral mucosal squamous cell carcinoma. Metastasis was evident in 73 patients (47%), including 13 (8%) with bilateral spread and 14 (9%) with only micrometastases. Multiple positive nodes were recovered from 58 (67%) of the 86 positive sides of neck dissection, and fusion of nodes was seen in 22 dissections (26%). Both direct extracapsular and embolic spread accounted for advanced disease. An orderly progressive ("overflow") involvement of anatomic levels was seen in 85% of positive dissections. "Skipping" of anatomic levels II and/or III was seen in 10% and "peppering" of nodes at multiple levels without any macroscopic focus in 5%. Hence, "fasttracks" may account for the distribution of metastatic carcinoma in 15% of positive necks. Adjuvant radiotherapy was dependent on the pathologic stage. The range of postoperative follow-up was 1-6 years. Death from recurrent regional disease occurred only in patients who had exhibited macroscopic or microscopic extracapsular spread. Survival was similar (75%) for patients with either macroscopic or microscopic metastases confined to lymph nodes or no evidence of metastasis. Hence, with surgery and adjuvant radiotherapy, metastases confined to lymph nodes do not appear to affect the short-term prognosis.