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Management of cervical lymph nodes in patients with head and neck cancer

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Summary

The status of the cervical lymph nodes is the single most important prognostic factor in head and neck cancer. Unfortunately, clinical assessment of the neck is not very accurate, although newer imaging techniques such as CT, MRI and ultrasound-guided fine needle aspiration cytology can be used to improve upon the results of clinical palpation alone. While diagnostic techniques remain less than 100% accurate, the risk of occult disease in the neck will remain. If this occurrence is judged to be greater than 15–20%, elective treatment to the neck may then be justified. When the neck is treated surgically, histological information can be gained which has both prognostic and therapeutic implications. Indications for the use of surgery and radiotherapy for the elective and therapeutic management of the neck and the results of such treatment are discussed.

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References

  1. Ali S, Tiwari RM, Snow GB (1985) False positive and false negative neck nodes. Head Neck Surg 8:78–82

    Google Scholar 

  2. Baatenburg de Jong RJ, Rongen RJ, Jong PC de, Lameris JS, Knegt P (1988) Screening for lymph nodes in the neck with ultrasound. Clin Otolaryngol 13:5–9

    Google Scholar 

  3. Baatenburg de Jong RJ, Rongen RJ, Lameris JS, Harthoorn M, Verwoerd CDA, Knegt P (1989) Metastatic neck disease: palpation vs ultrasound examination. Arch Otolaryngol Head Neck Surg 115:689–690

    Google Scholar 

  4. Bartelink H, Breur K, Hart G (1982) Radiotherapy of lymph node metastases in patients with squamous cell carcinoma of the head and neck region. Int J Radiat Oncol Biol Phys 8:983–989

    Google Scholar 

  5. Bartelink H, Breur K, Hart G, Annyas AA, Slooten EA van, Snow GB (1983) The value of postoperative radiotherapy as an adjuvant to radical neck dissection. Cancer 52:1008–1013

    Google Scholar 

  6. Bataini JP, Bernier J, Jaulerry C, Brunin F, Pontvert D, Lave C (1987) Impact of neck node responsiveness on the regional control probability in patients with oropharynx and pharyngolarynx cancers managed by definitive radiotherapy. Int J Radiat Oncol Biol Phys 13:817–824

    Google Scholar 

  7. Bocca E, Pignataro O (1967) A conservative technique in radical neck dissection. Ann Otol Rhinol Laryngol 76:975–988

    Google Scholar 

  8. Bocca E, Pignataro O, Oldini C, Cappa C (1984) Functional neck dissection: an evaluation and reviews of 843 cases. Laryngoscope 94:942–945

    Google Scholar 

  9. Brekel MWM van den, Stel HV, Castelijns JA, Nauta JJ, Waal I van der, Valk J, Meyer CJ, Snow GB (1990) Cervical lymph node metastases: assessment of radiologic criteria. Radiology 177:379–384

    Google Scholar 

  10. Brekel MWM van den, Castelijns JA, Croll GA, Stel HV, Valk J, Waal I van der, Colding RP, Meyer CJLM, Snow GB (1991) Magnetic resonance imaging vs palpation of cervical lymph node metastases. Arch Otolaryngol Head Neck Surg 117:666–673

    Google Scholar 

  11. Brekel MWM van den, Castelijns JA, Stel HV, Luth WJ, Valk J, Waal I van der, Snow GB (1991) Occult metastatic neck disease: detection with ultrasound and ultrasound-guided fine needle aspiration cytology. Radiology 180:457–461

    Google Scholar 

  12. Bruneton JN, Normand F (1987) Cervical lymph nodes. In: Bruneton JN (ed) Ultrasonography of the neck. Springer, Berlin Heidelberg New York, pp 81–91

    Google Scholar 

  13. Bruneton JN, Roux P, Caramella E, Demard F, Vallicioni J, Chauvel P (1984) Ear, nose and throat cancer: ultrasound diagnosis of metastases to cervical lymph nodes. Radiology 152:771–773

    Google Scholar 

  14. Cachin Y, Sancho-Garnier H, Micheau C, Marandas P (1979) Nodal metastases from carcinomas of the oropharynx. Otolaryngol Clin North Am 12:145–154

    Google Scholar 

  15. Carenfelt C, Eliasson K (1981) Radical neck dissection and permanent sequaelae associated with spinal accessory nerve injuries. Acta Otolaryngol (Stockh) 91:155–160

    Google Scholar 

  16. Carter RL (1976) Metastases. In: Symington T, Carter RL (eds) Scientific foundation of oncology. Heinemann, London, pp 172–178

    Google Scholar 

  17. Chow JM, Levin BC, Krivit JS, Applebaum EA (1989) Radiotherapy or surgery for subclinical cervical node metastases. Arch Orolaryngol Head Neck Surg 115:981–984

    Google Scholar 

  18. Close LG, Burns DK, Reisch J, Schaefer SD (1987) Microvascular invasion in cancer of the oral cavity and oropharynx. Arch Otolaryngol Head Neck Surg 113:1191–1195

    Google Scholar 

  19. Cox JD (1985) Management of clinically occult (NO) cervical lymph node metastases by radiation therapy. In: Chretein PB, Johns ME, Shedd DP, Strong EW, Ward PH (eds) Head and neck cancer, vol 1. Decker, Philadelphia, pp 51–155

    Google Scholar 

  20. Crile G (1906) Excision of cancer of the head and neck with special reference to the plan of dissection based on 132 operations. JAMA 47:1780–1786

    Google Scholar 

  21. Dayal VS, Silva AJ da (1971) Functional and radical neck dissection. Arch Otolaryngol 93:413–415

    Google Scholar 

  22. Djalilian M, Weiland LH, Devine KD, Beahrs OH (1973) Significance of jugular vein invasion by metastatic carcinoma in radical neck dissection. Am J Surg 126:566–569

    CAS  PubMed  Google Scholar 

  23. Feinmesser R, Freeman JL, Noyek AM, Birt D (1987) Metastatic neck disease. A clinical/radiographic/pathologic correlation study. Arch Otolaryngol Head Neck Surg 113:1307–1310

    Google Scholar 

  24. Feinmesser R, Freeman JL, Noyek AM, Birt D, Gullane P, Mullen JB (1990) MRI and neck metastases: a clinical, radiological, pathological correlative study. J Otolaryngol 19:136–140

    Google Scholar 

  25. Friedman M, Shelton VK, Mafee M, Bellity P, Grybauskas V, Skolnik E (1984) Metastatic neck disease: evaluation by computed tomography. Arch Otolaryngol 110:443–447

    Google Scholar 

  26. Friedman M, Mafee MF, Pacella BL, Strorigl TL, Dew LL, Toriumi DM (1990) Rationale for elective neck dissection in 1990. Laryngoscope 100: 54–59

    Google Scholar 

  27. Friedman M, Toriumi DM, Mafee MF, Strorigl T (1990) The role of computed tomographic scanning in evaluating the clinically negative neck. In: Fee WE, Goepfert H, Johns ME, Strong EW, Ward PH (eds) Head and neck cancer, vol 2. Decker, Toronto, pp 138–144

    Google Scholar 

  28. Hajec PC, Solomonowitz E, Turk R, Tscholakoff D, Kumpan W, Czembirek H (1986) Lymph nodes of the neck: evaluation with ultrasound. Radiology 158:739–742

    Google Scholar 

  29. Harwood AR, Beale FA, Cummings BJ, Keane TJ, Payne DG, Rider WD, Rawlinson E, Elhakin T (1983) Supraglottic laryngeal carcinoma: an analysis of dose-time-volume factors in 410 patients. Int J Radiat Oncol Biol Phys 9:311–319

    Google Scholar 

  30. Hermanek P, Sobin LH (eds) (1987) TNM classification of malignant tumors. Springer, Berlin Heidelberg New York, p 14

    Google Scholar 

  31. Hibbert J, Marks NJ, Winter PJ, Shaheen OH (1983) Prognostic factors in oral squamous cell carcinoma and their relation to clinical staging. Clin Otolaryngol 8:197–203

    Google Scholar 

  32. Lee JG, Krause CJ (1975) Radical neck dissection. Elective, therapeutic and secondary. Arch Otolaryngol 101: 656–659

    Google Scholar 

  33. Lee AWM, Sham JST, Poon YF, Ho JHC (1989) Treatment of stage I nasopharyngeal carcinoma: analysis of the patterns of relapse and the results of withholding elective neck irradiation. Int J Radiat Oncol Biol Phys 17:1183–1190

    Google Scholar 

  34. Leemans CR, Tiwari R, Waal I van der, Karim ABMF, Nauta JJP, Snow GB (1990) The efficacy of comprehensive neck dissection with or without postoperative radiotherapy in nodal metastases of squamous cell carcinoma of the upper respiratory and digestive tracts. Laryngoscope 100:1194–1198

    CAS  PubMed  Google Scholar 

  35. Leemans CR, Tiwari R, Nauta JJP, Waal I van der, Snow GB (1992) Regional lymph node involvement and its significance in the development of distant metastases in head and neck carcinoma. In: Leemans CR (ed) The value of neck dissection in head and neck cancer — a therapeutic and staging procedure. Elinkwijk, Utrecht, pp 65–74

    Google Scholar 

  36. Lindberg RD (1972) Distribution of cervical lymph node metastases for squamous cell carcinoma of the upper respiratory tract. Cancer 29: 1446–1449

    Google Scholar 

  37. Lingeman RE, Helmus C, Stephens R, Ulm J (1977) Neck dissection: radical or conservative. Ann Otol Rhinol Laryngol 86:737–744

    Google Scholar 

  38. Mancuso AA, Maceri D, Rice D, Hanafee W (1981) CT of cervical lymph node cancer. AJR 136:381–385

    Google Scholar 

  39. Mancuso AA, Harnsberger HR, Muraki AS, Stevens MH (1983) Computed tomography of cervical and retropharyngeal lymph nodes: normal anatomy, variants of normal, and applications in staging head and neck cancer, II. Pathology. Radiology 198:715–723

    Google Scholar 

  40. Mantravadi RVP, Skolnik EM, Haas RE, Applebaum EL (1983) Patterns of cancer recurrence in the postoperatively irradiated neck. Arch Otolaryngol 109:753–756

    Google Scholar 

  41. McGavran MH, Bauer WC, Ogura JH (1961) The incidence of cervical lymph node metastases from epidermoid carcinoma of the larynx and their relatioship to certain characteristics of the primary tumour. Cancer 14:55–66

    Google Scholar 

  42. Medina JE, Byers RM (1989) Supraomohyoid neck dissection: rationale, indications, and surgical technique. Head Neck Surg 11:111–122

    Google Scholar 

  43. Mendenhall WM, Million RR, Cassisi NJ (1980) Elective neck irradiation in squamous cell carcinoma of the head and neck. Head Neck Surg 3:15–20

    Google Scholar 

  44. Merino OR, Lindberg RD, Fletcher GH (1977) An analysis of distant metastases from squamous cell carcinoma of the upper respiratory and digestive tracts. Cancer 40:145–151

    Google Scholar 

  45. Molinari R, Cantu G, Chiesa F, Grandi C (1980) Retrospective comparison of conservative and radical neck dissection in laryngeal cancer. Ann Otol Rhinol Laryngol 89:578–581

    Google Scholar 

  46. Ogura JH, Biller HF, Wette R (1971) Elective neck dissection for pharyngeal and laryngeal cancers: an evaluation. Ann Otol Rhinol Laryngol 80:646–651

    Google Scholar 

  47. Robbins KT, Medina JE, Wolfe GT, Levine PA, Sessions RB, Pruet CW (1991) Standardizing neck dissection terminology — official report of the Academy's Committee for Head and Neck Surgery and Oncology. Arch Otolaryngol Head Neck Surg 117:601–605

    Google Scholar 

  48. Sako K, Pradier RN, Marchetta FC, Pickren JW (1964) Fallibility of palpation in the diagnosis of metastases to the cervical nodes. Surg Gynecol Obstet 118:989–990

    Google Scholar 

  49. Schuller DE, Reiches NA, Hamaker RC, Lingeman RE, Weisberger EC, Suen JY, Conley JJ, Kelly DR, Miglets AW (1983) Analysis of disability resulting from treatment including radical neck dissection or modified neck dissection. Head Neck Surg 6:551–558

    Google Scholar 

  50. Shah JP (1990) Patterns of cervical lymph node metastases from squamous carcinoma of the upper aerodigestive tract. Am J Surg 160:405–409

    Google Scholar 

  51. Snow GB, Annyas AA, Slooten EA van, Bartelink GGM, Hart AAM (1982) Prognostic factors of neck node metastases. Clin Otolaryngol 7:185–192

    CAS  PubMed  Google Scholar 

  52. Snow GB, Balm AIM, Arendse JW, Karim ABMF, Bartelink H, Waal I van der, Tiwari RM (1986) Diagnostic factors in neck node metastases. In: Larson DL, Ballantyne AJ, Guillamondegni OM (eds) Cancer in the neck. Evaluation and treatment. MacMillan, New York, pp 53–63

    Google Scholar 

  53. Spiro RH, Alfonso AE, Farr HW, Strong EW (1974) Cervical node metastases from epidermoid carcinoma of the oral cavity and oropharynx. A critical assessment of current staging. Am J Surg 128:562–567

    Google Scholar 

  54. Spiro RH, Huvos AG, Wong GY, Spiro JD, Gnecco CA, Strong EW (1986) Predictive value of tumour thickness in squamous carcinoma confined to the tongue and floor of the mouth. Am J Surg 152: 345–350

    Google Scholar 

  55. Spiro JD, Spiro RH, Shah JP, Sessions RB, Strong EW (1988) Critical assessment of supraomohyoid neck dissection. Am J Surg 156:286–289

    Google Scholar 

  56. Stern WBR, Silver CE, Zeifer BA, Persky MS, Heller KS (1990) Computed tomography of the clinically negative neck. Head Neck 12:109–113

    Google Scholar 

  57. Stevens MH, Harnsberger HR, Mancuso AA, Davis RK, Johnson LP, Parkin JL (1985) Computed tomography of cervical lymph nodes: staging and management of head and neck cancer. Arch Otolaryngol 111:735–739

    Google Scholar 

  58. Toker C (1963) Some observations on the deposition of metastastic carcinoma within cervical lymph nodes. Cancer 16: 364–374

    CAS  PubMed  Google Scholar 

  59. Vikram B, Strong EW, Shah JP, Spiro R (1984) Failure at distant sites following mutimodality treatment for advanced head and neck cancer. Head Neck Surg 6:730–733

    Google Scholar 

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Snow, G.B., Patel, P., Leemans, C.R. et al. Management of cervical lymph nodes in patients with head and neck cancer. Eur Arch Otorhinolaryngol 249, 187–194 (1992). https://doi.org/10.1007/BF00178467

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  • DOI: https://doi.org/10.1007/BF00178467

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