Labeling of cervical lymph node levels during neck dissection: From ex vivo to in situ mapping

Abstract

To analyze the error rate of ex vivo mapping and to evaluate in situ mapping of lymph node (LN) levels during neck dissection (ND) METHODS: We retrospectively reviewed the pathological data on metastatic LN levels in head and neck cancer patients that had ND and ex vivo mapping of LN levels. Among them, we included the data from 43 patients that had a high risk for metastatic nodes based on both the preoperative CT and PET/CT. We compared the metastatic node levels based on the radiological studies and surgical pathology. In addition, we prospectively evaluated the accuracy of in situ mapping (N = 20). With ex vivo mapping, the discrepancy between the radiological results and the pathological reports was 11.6% (5 out of 43); two side mismatches, two up down mismatches, and one faulty labeling, and in 7.0% (3 out of 43), the adjuvant treatment was redirected. However, in situ mapping of LN levels during ND resulted in no differences between the post-operative pathological and preoperative radiological findings. Ex vivo mapping of LN levels had an error rate of 11.6% in labeling of LN levels. In situ mapping of cervical LN levels during ND provided more accurate results about the status of LN metastasis.