The value of elective neck dissection in treatment of cancer of the tongue

Abstract

Purpose: The “adequate” therapy of tongue cancer has not yet been determined. The authors report their experience with 58 N0 patients to elucidate the role of elective neck dissection in surgical treatment of cancer of the tongue. Materials and Methods: The files of 58 N0 patients with tongue cancer were evaluated retrospectively. In every patient, partial glossectomy continuous with neck dissection was the mainstay of the treatment. TNM staging, intraoperative N staging, pathologically confirmed cervical lymph node metastases and their levels, and clinical outcomes (local and regional recurrences) were recorded. The sensitivity and specificity of intraoperative staging was determined. Results: Fifty-four percent (31/58) of the patients presented as T1, and 26% (15/58) as T2. The overall occult metastasis rate was 29.3% (17/58). The occult metastasis rate for T1 and T2 lesions was 19.4% (6/31) and 26.7% (4/15), respectively. The sensitivity of intraoperative staging was 76.5%, and the specificity was 51.2%. Conclusions: The rate of occult metastasis to the neck is too high in all tongue cancer cases to take the risk of regional recurrence, and the surgeon can not solely depend on neck palpation for determination of neck metastasis. Radiologic investigations and fine-needle aspiration decrease, but never reduce to zero the rate of false-negative examination. There is an obvious indication for neck dissection, even in early cases. (Am J Otolaryngol 2001;22:59-64. Copyright © 2001 by W.B. Saunders Company)