Extent Of Neck Dissection Research Articles

Overview of the ASCO 2024 data on head and neck surgery

At the 2024 international cancer congress of the American Society of Clinical Oncology (ASCO), studies on immuno-oncological therapeutic approaches for head and neck cancers once again took center stage. Following the trend of recent years, neoadjuvant immunotherapy has now reached acentral role, and purely surgical studies have become increasingly scarce. This review article summarizes abstracts presented at the 2024 ASCO Annual Meeting that focus on surgical therapy or in which surgery was asignificant component of the study protocol. As part of the combination therapies, study results on neoadjuvant treatment strategies are also presented. Additionally, promising new developments are discussed, including the treatment of laryngeal papillomatosis, new considerations on the necessary extent of neck dissection, follow-up care for human papillomavirus (HPV)-positive head and neck squamous cell carcinoma (HNSCC), and the prevention of platinum-induced inner ear hearing loss.

Prognostic factors and treatment responses among patients with gross residual disease in differentiated thyroid cancer.

Various postoperative staging systems were developed to assess the outcome of differentiated thyroid cancer from initial risk after surgery to dynamic changing prognosis during follow-up. The objective of our retrospective cohort study was to identify risk factors contributing to macroscopic positive surgical margin (R2 resection) and parameters in discriminating the treatment responses and prognosis among R2 patients. In total, 242 differentiated thyroid cancer patients with extrathyroidal extension who underwent a thyroidectomy at Kaohsiung Chang Gung Memorial Hospital between January 2013 and July 2018, were included. The patients were grouped according to the presence or absence of gross residual disease (R2). The R2 patients were further classified into two categories according to their treatment response into excellent and nonexcellent groups. The parameters and treatment outcomes were compared between these groups. The mean follow-up time was 45.3 months. Two hundred seven (85.5%) patients had either surgery-free or microscopic margins (R0/R1), while 35 (14.5%) had R2 resection. In the R2 group (n = 35), 15 (42.9%) patients achieved an excellent response, while 20 (57.1%) achieved a nonexcellent response. Statistically significant differences were observed in the extent of neck dissection, TSH-Tg level, post-RAI Tg level, nodal status, and recurrence between the two groups. The Kaplan-Meier curves for 5-year local and distant recurrence-free survival of R0/R1 versus R2 patients were 90.0% versus 66.3%, and 98.4% versus 90.7%, respectively ( p < 0.001). Among the R2 patients, the excellent responders had a higher local recurrence-free survival than nonexcellent responders (93.3% vs. 45.1%, p = 0.008). There are significant disparities in recurrence-free survival among R2 patients with different treatment responses. The nodal status of papillary thyroid cancer and thyroglobulin level after thyroidectomy and RAI were factors contributing to difference in their treatment responses.

Role of methylene blue dye in sentinel node biopsy in N0 oral cavity squamous cell carcinoma

Abstract Background: Presence of neck nodes in cases of head neck squamous cell cancers is an adverse prognostic factor. Elective neck dissection is traditionally recommended along with primary disease resection. Sentinel lymph node (SLN) is the first draining node. Sentinel lymph node biopsy (SNB) is a minimally invasive technique to identify occult nodal metastasis in early HNSCC. Methods: The objective of this study is to determine the identification rate of SNB using methylene blue dye (MBD) in N0 neck of Oral Squamous cell carcinoma (OSCC) and estimating specificity, sensitivity, negative predictive value and positive predictive value of SNB with frozen section (FS) analysis and in comparison to post-operative histopathological examination (HPE). It is a cross-sectional study conducted at a tertiary care centre, Lucknow, India. 21 patients of N0 OSCC from January 2019 to May 2020, were included. All patients underwent peritumoral injection with MBD. Sentinel nodes were harvested and sent for FS. Depending on FS findings, appropriate neck dissection was performed. Results: SLN was identified at level Ib and II in 19 patients (90.47%). The sensitivity, specificity, PPV and NPV in identifying SLN using MBD versus FS were 100.00%, 11.11%, 15.79% and 100.00% respectively. Whereas, SLN using MBD versus HPE specimens were 100.00%, 10.52%, 10.52% and 100.00% respectively. Conclusion: Despite having 100% sensitivity, MBD alone has poor specificity. With this poor discriminatory power, it is unlikely to be employed as a diagnostic test alone. It is recommended to rely on per-operative FS for taking decision as far as extent of neck dissection in N0 neck is concerned.

Parathyroid gland preservation in laryngectomy patients with total thyroidectomy

BackgroundPostoperative hypocalcemia in laryngectomy patients can occur when part or whole of the thyroid gland has been removed. Preservation of the parathyroid glands in situ is considered one of the initial measures to prevent postoperative hypocalcemia even if all thyroid gland is removed. Our study aims to assess the efficacy of parathyroid gland preservation in situ to prevent postoperative hypocalcemia in cases where total laryngectomy is done with total thyroidectomy.MethodsThe study included all laryngectomy patients done during a period from April 2020 to May 2021. Parathyroid gland preservation was done in both primary (12 cases) and salvage (16 cases). Both PTH and corrected calcium level were measured at different time points and used as a guide for further replacement.ResultsWe studied the association between outcome including recovery from transient hypocalcemia and certain variables like age, type of surgery, stage of tumor, and extent of neck dissection. Regarding type of surgery, all patients that underwent primary laryngectomy were totally recovered (n = 12, 100%); however, salvage cases were partially recovered (n = 10, 62.5%).ConclusionParathyroid preservation is achievable in cases of salvage laryngectomy in addition to primary laryngectomy with total thyroidectomy. Early monitoring of the patients PTH and Ca during their hospital stay is a good indicator of successful preservation. Long-term follow-up is advised for potential recovery from transient hypoparathyroidism.

Patterns of Lymph Node Metastasis in Parotid Cancer and Implications for Extent of Neck Dissection.

The role and extent of neck dissection in primary parotid cancer are controversial. Herein, we characterize patterns of lymph node metastasis in parotid cancer. Retrospective analysis. National Cancer Database. Patients with the 6 most common histologic subtypes of parotid cancer were selected. Primary outcomes were the distribution of positive lymph nodes by level and overall survival assessed by Cox analysis. Secondary outcomes included predictors of extended lymph node involvement (≥3 lymph nodes or Level IV/V involvement), via logistic regression. Six thousand nine hundred seventy-sevenpatients with acinic cell carcinoma, adenocarcinoma, adenoid cystic carcinoma, carcinoma ex pleomorphic adenoma (CExPA), mucoepidermoid carcinoma, and salivary duct carcinoma (SDC) were included. Among cN0 patients, 8.2% of low-grade tumor patients had occult nodal metastasis versus 30.9% in high-grade tumor patients. Elective neck dissection was not associated with an overall survival benefit (adjusted hazard ratio: 1.10; 0.94-1.30, p = .238). Among cN+ tumors, CExPA (odds ratio [OR]: 1.88, 1.05-3.39, p = .034) and high-grade pathology (OR: 3.03, 1.87-4.93, p < .001) were predictive of having ≥3 pathologic nodes. CExPA (OR: 2.13, 1.22-3.72, p = .008), adenocarcinoma (OR: 1.60, 1.11-2.31, p = .013), SDC (OR: 1.92, 1.17-3.14, p < .01), and high-grade pathology (OR: 3.61, 2.19-5.97, p < .001) were predictive of Level IV/V neck involvement. In parotid malignancy, nodal metastasis distribution is dependent on histology and grade. High-grade tumors and certain histologies (SDC and adenocarcinoma) had a higher incidence of occult nodes. Comprehensive neck dissection should also be considered for node-positive high-grade tumors, SDC, and adenocarcinoma.

Evaluation of the Role of Neck Dissection in Patients with Verrucous Squamous Cell Carcinoma of the Oral Cavity: A Cohort Study

Introduction: Verrucous Carcinoma (VC), a well-differentiated Squamous Cell Carcinoma (SCC), commonly presents in the oral cavity, accounting for 2-16% of oral carcinomas. Though rare, it poses a challenge in establishing a pathological diagnosis, even in adequate biopsies, as 20% of Oral Cavity Verrucous Carcinoma (OVC) contains concomitant SCC. VC is primarily treated by surgery, similar to oral SCC. The role of neck dissection in oral SCC is well-established, but there is limited data on VC. Aim: To evaluate the role of neck dissection in the management of OVC. It also aimed to evaluate the clinicopathological demographics of OVC and identify predictors for survival outcomes. Materials and Methods: A retrospective cohort study was conducted using medical records of 2312 patients with oral carcinoma treated from January 2010 to December 2020 at Department of Surgical Oncology, Malabar Cancer Centre, Kannur, Thalassery, Kerala, India, a tertiary cancer centre under the Government of Kerala. Among 116 patients identified with VC, 49 patients met the inclusion criteria. The collected data was analysed using Statistical Package for Social Sciences (SPSS) version 20.0. The primary outcomes were overall survival rate and disease-free survival rate. Kaplan-Meier curves were constructed based on the survival data and compared using the log-rank test. Results: The mean age of the entire population was 62.8 years, with an age range of 40-90 years. Among the 2312 patients who underwent surgery for oral carcinoma, 49 (2.11%) patients were diagnosed with VC based on the final histopathology report. The majority of patients were diagnosed with early-stage disease on histopathological examination 36/49 (73.5%). A total of 34 patients received neck dissections, of which 13 patients (38.3%) had palpable nodes on presentation. All patients were node negative (PN0). On univariate analysis, neck dissection was not found to be a predictor of mortality or locoregional recurrence. There was no significant difference in overall survival rate (p=0.160) or disease-free survival rate (p=0.67) when comparing patients who underwent primary resection with neck dissection to those whose necks were kept under observation. Conclusion: The OVC has an excellent prognosis, and surgery remains the mainstay of treatment. The decision on neck dissection and the extent of neck dissection should be judiciously made based on the surgical approach and the procedure’s morbidity.

Surgical site complications of isolated salvage neck dissection post-radiotherapy and post-chemoradiotherapy – A cohort analysis (1997–2017)

IntroductionThis study aims to quantify surgical site complications (SSC) after isolated salvage neck dissection (ND) compared with primary ND. Patients and methodsBetween 1997 and 2017 in the Netherlands Cancer Institute - Antoni van Leeuwenhoek, a total of 323 isolated NDs were performed in 308 patients: primary ND (n = 144), post-radiotherapy (RT) ND (n = 53) and post-chemoradiotherapy (CRT) ND (n = 126). Patient, tumor and therapy characteristics were recorded. SSCs were scored according to the Clavien-Dindo Classification (CDC). Results101 NDs (31%) were complicated by at least one SSC. In total, 189 different SSCs occurred. Translated to CDC, 45 complications were grade 2, 25 grade 3a and 31 grade 3b. No significant difference in occurrence of SSC (CDC >1) was found between all groups. However, post-CRT, selective (SND) and modified radical ND and radical ND (MRND/RND) (p = 0.005), resection of sternocleidomastoid muscle (SCM) (p = 0.039) and duration of super selective ND surgery (p = 0.048) were significantly associated with more SSC. SCM muscle removal was associated with more surgical site infection (p = 0.045) and necrosis (p = 0.036). From week 10 post-RT/CRT, no difference in complication frequency with primary ND was seen. ConclusionPost-CRT SND, MRND/RND and SCM muscle resection were associated with an increased incidence of SSCs. If oncologically possible, limit the extent of ND and when an MRND is inevitable, preserve the SCM muscle for optimal prevention of SSC. Concerning SSC, optimal timing of salvage ND is minimal 10 weeks after RT/CRT.

Node Count as a Quality Indicator in Surgically Treated Mucosal Head and Neck Squamous Cell Cancer.

A yield of ≥18 nodes from neck dissection has been shown to be associated with improved locoregional recurrence rates and survival. We sought to determine factors associated with lymph node yields below this threshold. A retrospective review of patients who underwent neck dissection as part of definitive surgical treatment for mucosal head and neck squamous cell carcinoma (SCC) between January 2015 and December 2018 at an academic tertiary referral center was performed. Patients with a history of prior radiation or neck dissection were excluded. There were 412 neck dissections performed in 323 patients. Specimens containing <18 nodes decreased from 16.2% in 2015-2016 to 7.4% of neck dissections in 2017-2018. The proportion of neck dissections removing <3 levels decreased from 9.1% of neck dissections in 2015-2016 to 4.0% in 2017-2018. Multivariable regression analysis demonstrated that dissection of ≥3 levels (OR=0.2 [0.1-0.4]) and neck dissection in 2017-2018 compared to 2015-2016 (OR=0.4 [0.2-0.8]) were significantly associated with a lower odds of <18 nodes. Stage, site, race, sex, human papillomavirus status, positive nodes, surgeon volume, and pathologist volume were not associated with neck dissection specimens with <18 nodes, after controlling for all other variables. Increased recognition of the importance of node count as a quality indicator, and the extent of neck dissection is associated with increased nodal yield from neck dissection. These data suggest that node count can be used as a quality measure of neck dissection for mucosal SCC. 4 Laryngoscope, 133:2160-2165, 2023.

Extent of Neck Dissection and Cervical Lymph Node Involvement in Oral Squamous Cell Carcinoma.

IntroductionTumor resection combined with neck dissection (ND) or radiotherapy are established methods for the treatment of patients with oral squamous cell carcinoma (OSCC). However, the extent of ND can lead to postoperative complications. Therefore, for the first time, this study aims to identify lymph node involvement in OSCC performed in a bilateral systematic approach based on oncologic board meetings relying on presurgical magnetic resonance imaging (MRI) and computed tomography (CT).Materials and MethodsIn a retrospective single-center study, patients with primary OSCC resection and systematic ND performed in 4 different manners (MRND III bilateral, MRND III left and SND right, MRND III right, SND left, and SND bilateral) were examined. Lymph node involvement allocated to levels was evaluated depending on primary localization and T-stage.ResultsA total of 177 consecutive patients (mean age 63.64; 92 female, male 85) were enrolled in this study. A total of 38.98% showed cervical lymph node involvement, and metastases were found in levels 1–4. The distribution of positive lymph node metastases (n=190 LNs) was 39.47% in level 1, 38.95% in level 2, 10.53% in level 3, and 11.05% in level 4.DiscussionIn a cohort of OSCC patients with systematic bilateral ND, levels 1 and 2 had positive lymph node involvement, and no lymph node involvement was seen at level 5. Without any clinical or imaging suspicion, ND expanding 5-level MRND should be avoided regardless of the primary tumor localization, T-stage and intraoperative proof of cervical metastases.

Selective Neck Dissection for Node-Positive Oral Cavity Squamous Cell Carcinoma: A Retrospective Cohort Study

Introduction Selective neck dissection in clinically node-negative neck is considered the standard of care for oral squamous cell carcinomas (SCCs). Controversy still prevails in node-positive disease regarding the extent of neck dissection. In our part of the world, comprehensive neck dissection is mostly considered to be the minimal optimal treatment for palpable neck disease. Objective To compare regional control and disease-specific survival between clinically node-positive and node-negative patients undergoing selective neck dissection for oral SCC. Methods This was a retrospective cohort study conducted in the department of ENT, Head and Neck surgery at a tertiary care hospital. All patients with biopsy-proven oral and lip SCC, with or without nodal disease, who underwent selective neck dissection between April 2006 and July 2015 were included in the study. Results During the study period, 111 patients with oral SCC underwent selective neck dissection, of whom 71 (62%) were clinically node-negative and 40 (38%) patients had clinically positive nodes in the neck. The mean follow-up was 16.62 months (standard deviation [SD]: 17.03). The overall regional control rates were 95 versus 96% for clinical negative versus positive nodes, respectively ( p = 0.589). The disease-specific survival was 84.5% in the node negative group versus 82.5% in the node-positive group ( p = 0.703). Conclusion Selective neck dissection in node-positive neck oral SCC has similar regional control rates when compared with node-negative neck SCC. The difference in disease-specific survival between the two groups is also not significant.

Lymph Node Dissection for Papillary Thyroid Carcinoma.

Cervical lymph node metastasis is frequent in patients with papillary thyroid carcinoma. In addition to the extent of thyroidectomy, the need as well as the extent of concomitant lymphadenectomy has been a subject of controversy and debate. The central compartment is the most frequent site of metastasis followed by the lateral compartment although skip metastasis in the lateral compartment can occur. Papillary thyroid carcinoma can also present with cervical lymph node metastasis, while the primary tumor remains clinically undetectable. Surgical removal of clinically involved nodal metastasis should be mandatory to prevent recurrence and improve disease prognosis. However, despite a low accuracy of preoperative imaging for microscopic disease and the frequent microscopic metastasis to the central compartment, routine prophylactic neck dissection has not been shown to haveany relevance to prevent recurrence or improve disease cure. Routine or prophylactic central compartment dissection is generally not recommended unless in the presence of high-risk tumors. The potential benefit of reducing central compartment recurrence or avoiding high-risk reoperation probably outweighs the risk of inducing surgical complication including hypoparathyroidism during routine central neck dissection. Therapeutic lateral neck dissection is performed for clinically involved nodes detected by preoperative imaging confirmed by needle biopsy, while prophylactic lateral neck dissection is contraindicated. The extent of neck dissection has been de-escalated, and compartmental nodal dissection aiming at preservation of function is performed to achieve a complete surgical resection. Postoperative adjuvant radioiodine is frequently administered for patients with positive nodal metastasis (intermediate-risk group) to avoid future recurrence. Routine central neck dissection may also upstage patients with microscopic nodal metastases and increase the use of postoperative adjuvant radioiodine.

Indications of Superselective Neck Dissection in Patients With Lateral Node Metastasis of Papillary Thyroid Carcinoma.

The extent of neck dissection in papillary thyroid carcinoma (PTC) patients with lateral neck metastasis is controversial. This work aims to screen the patients suitable for superselective neck dissections including only levels III-IV. Prospective observational cohort study. The study was conducted in a high-volume tertiary care setting. A total of 134 consecutive previously untreated PTC patients with lateral neck metastases and subjected to 154 therapeutic lateral neck dissections (including levels II, III, IV, and VB) between June 2018 and March 2021 were enrolled. Fine-needle aspiration was performed preoperatively at each suspicious neck level. Clinical predictors were analyzed for occult lymph node metastases at levels II and VB. As a result, 44.8% and 5.8% of neck specimens exhibited metastatic lymph nodes at levels II and VB. In addition, univariate and multivariate analyses showed that the primary tumor in the ipsilateral thyroid upper lobe (P = .016, odds ratio = 3.528) and clinically multiple metastatic lymph nodes in level III-IV (P = .005, odds ratio = 6.414) were independent predictive factors for occult level II metastases. All 3 (1.9%) occult metastases at level VB were found in necks with preoperative multiple lymph node metastases. A superselective lateral neck dissection including levels III to IV may be considered in patients with PTC when the preoperative evaluation identifies a single lymph node metastasis located at levels III to IV and the primary tumor is not in the upper lobe of the ipsilateral thyroid.

Prediction of risk factors for pharyngo-cutaneous fistula after total laryngectomy using artificial intelligence

ObjectivesPharyngocutaneous fistula (PCF) is one of the major complications following total laryngectomy (TL). Previous studies about PCF risk factors showed inconsistent results, and artificial intelligence (AI) has not been used. We identified the clinical risk factors for PCF using multiple AI models. Materials & methodsPatients who received TL in the authors’ institution during the last 20 years were enrolled (N = 313) in this study. They consisted of no PCF (n = 247) and PCF groups (n = 66). We compared 29 clinical variables between the two groups and performed logistic regression and AI analysis including random forest, gradient boosting, and neural network to predict PCF after TL. ResultsThe best prediction performance for AI was achieved when age, smoking, body mass index, hypertension, chronic kidney disease, hemoglobin level, operation time, transfusion, nodal staging, surgical margin, extent of neck dissection, type of flap reconstruction, hematoma after TL, and concurrent chemoradiation were included in the analysis. Among logistic regression and AI models, the neural network showed the highest area under the curve (0.667 ± 0.332). ConclusionDiverse clinical factors were identified as PCF risk factors using AI models and the neural network demonstrated highest predictive power. This first study about prediction of PCF using AI could be used to select high risk patients for PCF when performing TL.

Extent of salvage neck dissection following chemoradiation for locally advanced head and neck cancer.

Salvage neck dissection (ND) is the only treatment modality for persistent or recurrent nodal disease after chemoradiotherapy (CRT) for locally advanced head and neck cancer. However, the optimal extent of ND at salvage surgery after definitive CRT is controversial. Our salvage ND procedure is targeted extirpation of nodal disease with resection of only involved areas of nonlymphatic structures. A retrospective analysis of the data indicated a total of 28 targeted NDs performed in 28 patients following definitive CRT. The efficacy of targeted ND was evaluated based on survival rate, regional control rate, complications, and shoulder syndromes. Over a median follow-up period of 30 months, cervical disease recurred in 7 patients but did not lead to death, and 2 patients died of pulmonary metastasis. The 3-year disease-specific survival rate was 66%. The targeted ND procedure was effective as an intervention for patients with cervical disease recurrence (149/150).

SENTINEL LYMPH NODE BIOPSY AS A PROGNOSTIC TOOL IN EARLY ORAL CANCER USING METHYLENE BLUE DYE

Introduction: Limited availability of lymphoscintigraphy facilities in Egypt and developing countries requires exploration of alternative methods of SLN detection. Sentinel Lymph Node (SLN) biopsy using a combination of radioisotopes and methylene blue dyes (MBD) have a good accuracy rate in predicting subclinical neck nodal metastases in head and neck cancers. Objectives: Evaluation of the effectiveness of SLN using MBD alone and frozen section of early oral cancer with N0 neck patients in the identification of occult neck micrometastasis and confirmation of the role of SLN in post-surgical follow up. Materials and methods: 12 Patients with cN0 early (T1, T2) oral squamous cell cancers underwent SLN biopsy using peri tumoural MBD injection. Stained SLN nodes were sent for frozen section analyses. Patients had microscopic metastases in SLN underwent modified radical neck dissections and the rest underwent selective neck dissections. Paraffin sections were performed in all cases and immune-histochemistry (IHC) studies were performed on negative lymph nodes. Results: Three cases (25%) SLN couldn't be detected, while nine cases (75%) the blue sentinel lymph node could be identified. Preoperative ultrasound examination of only two cases were not similar to the intraoperative frozen histopathology which reveals the presence of micrometastasis, therefore functional neck dissection was indicated in these two cases and all the frozen sections histopathology were similar to the postoperative paraffin sections. Considering HPE on paraffin fixed blocks as the gold standard, FS had a sensitivity, specificity, and NPV of 95.8 %. IHC with cytokeratin increased the sensitivity (100 %) and NPV (100 %) of histopathology at the loss of specificity (87.5 %) and PPV (62.5 %). Conclusion: SLN biopsy is useful and reliable for patients with early oral cancer that can benefit from reducing unnecessary functional and esthetic complications for N0 patients by reducing the incidence or extent of neck dissection.

What Is the Extent of Neck Dissection in Medullary Thyroid Carcinoma?

What Is the Extent of Neck Dissection in Medullary Thyroid Carcinoma?

Controversies in the surgical management of sporadic medullary thyroid carcinoma.

Medullary thyroid carcinoma (MTC) represents a wide spectrum of tumours with differing biology, behaviour and natural history. The only current available curative treatment is surgery in the form of thyroidectomy with or without ipsilateral or bilateral neck dissection. There is a lack of consensus in the available published guidelines on the optimum extent of initial surgery, and there is significant variation in clinical practice. This review focuses on the most recently published evidence. Many patients with limited disease do not receive total thyroidectomy and central neck compartment dissection as recommended by international guidelines. Despite this, 5-year disease-specific survival is over 90% in those without distant metastases at presentation. Over 20% of patients may harbour occult lateral compartment nodal metastases, and baseline calcitonin alone (>1000 pg/ml) is not a good predictor of nodal metastasis. Although delayed lateral neck compartment dissection results in similar survival outcomes to prophylactic neck dissection for clinically node-negative patients, there is an underappreciated psychological effect of having biochemical evidence of persistent disease following limited surgery. No single currently available prognostic indicator is sufficient to predict disease behaviour and evidence of occult nodal metastases. In clinically ad radiologically node-negative patients, the extent of neck dissection at initial operation, therefore, needs to be planned and executed on an individual patient basis.

Extent of neck dissection for patients with clinical N1 oral cancer

BackgroundNo clear consensus has been reached on the indication of supraomohyoid neck dissection (SOHND) for clinically positive lymph-node metastasis.PatientsConsecutive 100 patients with previously untreated oral cancer treated at Kobe University Hospital were included in this study. All patients were clinically staged as anyTN1M0 and underwent radical dissection of the primary site and level I–V neck dissection as the initial treatment.ResultsNone of the 100 patients had pathological lymph-node metastasis (pLN) to level V. pLN to level IV was observed in two patients with tongue cancer in whom clinical lymph-node metastasis was preoperatively observed at level II.ConclusionsLevel V may be excluded in the neck dissection for patients with N1 oral cancers. Level IV dissection should be considered in the patient with tongue cancer and clinical lymph-node metastasis at level II.

Diagnostic evaluation of PET CT, USG neck &amp; FNAC in clinically N0 neck

Introduction : Extent of neck dissection is determined by the neck nodal positivity and indirectly has a bearing on neck dissection related morbidity. The current study prospectively compares the accuracy of these imaging techniques and FNAC to final histopathology. 31 patients of Oral cavity squamous cell carcinoma with no palpable lymphadenopathy were prospectively included in the study. Methodology : Thirty-one patients of oral cavity SCC who did not have any clinical lymphadenopathy treated at our centre from January 2018 to July 2018 were recruited for the study. All these patients underwent a whole body PET with contrast enhanced CT followed by a high-resolution ultrasound of the neck. Patients then underwent a US guided FNAC of the most suspicious lymph node. Results: 14 of the 31 patients had pathologically positive neck node. PET CT had 100 % negative predictive value. USG Neck diagnosed 22 patients to have suspicious lymph node with a negative predicitve value of 66.7% and positive predictive value of 50%. The combined yield of PET CT and USG Neck could produce a PPV of 100% and NPV of 68%. Conclusion : None of the test individually could predict the neck nodal positivity with absolute accuracy in our study. The best accuracy was when a combination of these tests were done.

Surgical management of the neck in patients with metastatic melanoma in parotid lymph nodes.

The role and extent of neck dissection in patients with parotid metastatic cutaneous head and neck melanoma remain unclear. The aims of this study were to determine the incidence and patterns of cervical node involvement in patients with parotid metastatic melanoma, and to determine if a limited lymphadenectomy of the clinically negative neck is appropriate. Patients who underwent parotidectomy and neck dissection for clinically apparent parotid metastatic melanoma, irrespective of neck status, were identified from two prospectively maintained databases. A total of 276 patients fulfilled the study criteria. Median follow-up was 23 months. A total of 185 necks were clinically negative, 82 were clinically positive. A total of 36 elective neck-dissection specimens harbored occult metastases; these were found in levels I (16.7%), II (58.3%), III (36.1%), IV (13.9%), and V (30.6%). Regional recurrence occurred in 32 patients with a clinically negative neck, the majority being in-transit metastases (n = 15). Only one case of recurrence could have potentially been avoided by a comprehensive lymphadenectomy. In patients with clinically apparent parotid melanoma metastases, elective comprehensive neck dissection reduces failure rates in cervical nodes, and provides more accurate staging and prognostic information. However, our findings support the emerging trend for more limited elective neck dissection. Levels I and IV can probably be safely omitted.