Intraoperative examination versus postoperative histopathological examination of clinically negative neck lymph node in head and neck cancer

Abstract

ObjectiveTo assess the accuracy of clinical intraoperative lymph node examination, and relation between preoperative clinical examination and postoperative histopathological examination of lymph nodes in head and neck cancer. Study designCohort study. Level of evidenceLevel II. SettingTertiary University Hospital, Department of Otolaryngology and National Cancer Institute. Subjects and methodsThe study included 125 patients with head and neck cancer. The patients’ necks were all staged as clinically N0 on the basis of palpation and ultrasonography (USG). All patients underwent surgical excision of the primary tumor and selective neck dissection according to the site of the primary tumor. All lymph node specimens underwent postoperative histopathological examination. ResultsThe patients were 85 males and 40 females with a median age of 56.7years. Intraoperative lymph node examination revealed that 130 (76.5%) of 170 neck dissection (95 patients) were negative for lymph node metastasis and 40 (23.5%) of 170 neck dissection (30 patients) were positive for lymph node metastasis. Postoperative histopathological examination of lymph node specimens revealed that 115 (68%) of 170 neck dissection (85 patients) were negative for lymph node metastasis and lymph nodes were positive for metastasis in 55 (32%) of 170 neck dissection (40 patients). ConclusionThe incidence of occult lymph node metastases in head and neck cancer is high and the neck must be properly managed with the primary tumor.Intraoperative lymph node assessment alone is not an effective method in clinical staging of the neck in patients with head and neck cancer and clinically negative neck lymph nodes.