Skip to main content
Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 1994 Jul;76(4):237–244.

Pathological findings in clinically false-negative and false-positive neck dissections for oral carcinoma.

J A Woolgar 1, E D Vaughan 1, J Scott 1, J S Brown 1
PMCID: PMC2502251  PMID: 8074384

Abstract

A series of 86 patients presenting with oral cancer underwent neck dissection (114 sides of neck), after preoperative staging by palpation under general anaesthesia and CT imaging. Detailed histopathological assessment of the surgical neck dissection specimens showed the incidence of clinically false-negative and false-positive assessments was 27% and 40%, respectively. Extranodal spread of metastatic carcinoma was present in 16% of clinically negative necks. The pathological findings provided plausible explanations for the clinical misdiagnosis in all 19 of the false-positive necks and in 13 of the 18 false-negative necks, where micrometastases or metastasis to nodes measuring less than 1.7 cm accounted for five and seven misdiagnosed cases, respectively. We conclude that the most stringent clinical protocols, even when supplemented by CT scanning, cannot be expected to achieve 100% accuracy. Detailed histopathological assessment provides the most reliable, currently available method of diagnosing cervical metastatic disease.

Full text

PDF
237

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ali S., Tiwari R. M., Snow G. B. False-positive and false-negative neck nodes. Head Neck Surg. 1985 Nov-Dec;8(2):78–82. doi: 10.1002/hed.2890080204. [DOI] [PubMed] [Google Scholar]
  2. Byers R. M. Modified neck dissection. A study of 967 cases from 1970 to 1980. Am J Surg. 1985 Oct;150(4):414–421. doi: 10.1016/0002-9610(85)90146-1. [DOI] [PubMed] [Google Scholar]
  3. Byers R. M., Wolf P. F., Ballantyne A. J. Rationale for elective modified neck dissection. Head Neck Surg. 1988 Jan-Feb;10(3):160–167. doi: 10.1002/hed.2890100304. [DOI] [PubMed] [Google Scholar]
  4. Cachin Y., Sancho-Garnier H., Micheau C., Marandas P. Nodal metastasis from carcinomas of the oropharynx. Otolaryngol Clin North Am. 1979 Feb;12(1):145–154. [PubMed] [Google Scholar]
  5. Crissman J. D., Gluckman J., Whiteley J., Quenelle D. Squamous-cell carcinoma of the floor of the mouth. Head Neck Surg. 1980 Sep-Oct;3(1):2–7. doi: 10.1002/hed.2890030103. [DOI] [PubMed] [Google Scholar]
  6. Feinmesser R., Freeman J. L., Noyek A. M., Birt B. D. Metastatic neck disease. A clinical/radiographic/pathologic correlative study. Arch Otolaryngol Head Neck Surg. 1987 Dec;113(12):1307–1310. doi: 10.1001/archotol.1987.01860120053007. [DOI] [PubMed] [Google Scholar]
  7. Friedman M., Mafee M. F., Pacella B. L., Jr, Strorigl T. L., Dew L. L., Toriumi D. M. Rationale for elective neck dissection in 1990. Laryngoscope. 1990 Jan;100(1):54–59. doi: 10.1288/00005537-199001000-00012. [DOI] [PubMed] [Google Scholar]
  8. Grandi C., Alloisio M., Moglia D., Podrecca S., Sala L., Salvatori P., Molinari R. Prognostic significance of lymphatic spread in head and neck carcinomas: therapeutic implications. Head Neck Surg. 1985 Nov-Dec;8(2):67–73. doi: 10.1002/hed.2890080202. [DOI] [PubMed] [Google Scholar]
  9. Hillsamer P. J., Schuller D. E., McGhee R. B., Jr, Chakeres D., Young D. C. Improving diagnostic accuracy of cervical metastases with computed tomography and magnetic resonance imaging. Arch Otolaryngol Head Neck Surg. 1990 Nov;116(11):1297–1301. doi: 10.1001/archotol.1990.01870110069008. [DOI] [PubMed] [Google Scholar]
  10. Mancuso A. A., Harnsberger H. R., Muraki A. S., Stevens M. H. Computed tomography of cervical and retropharyngeal lymph nodes: normal anatomy, variants of normal, and applications in staging head and neck cancer. Part I: normal anatomy. Radiology. 1983 Sep;148(3):709–714. doi: 10.1148/radiology.148.3.6878691. [DOI] [PubMed] [Google Scholar]
  11. Medina J. E., Byers R. M. Supraomohyoid neck dissection: rationale, indications, and surgical technique. Head Neck. 1989 Mar-Apr;11(2):111–122. doi: 10.1002/hed.2880110203. [DOI] [PubMed] [Google Scholar]
  12. Moore C., Flynn M. B., Greenberg R. A. Evaluation of size in prognosis of oral cancer. Cancer. 1986 Jul 1;58(1):158–162. doi: 10.1002/1097-0142(19860701)58:1<158::aid-cncr2820580127>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  13. Noone R. B., Bonner H., Jr, Raymond S., Brown A. S., Graham W. P., 3rd, Lehr H. B. Lymph node metastases in oral carcinoma. A correlation of histopathology with survival. Plast Reconstr Surg. 1974 Feb;53(2):158–166. doi: 10.1097/00006534-197402000-00006. [DOI] [PubMed] [Google Scholar]
  14. Shah J. P., Candela F. C., Poddar A. K. The patterns of cervical lymph node metastases from squamous carcinoma of the oral cavity. Cancer. 1990 Jul 1;66(1):109–113. doi: 10.1002/1097-0142(19900701)66:1<109::aid-cncr2820660120>3.0.co;2-a. [DOI] [PubMed] [Google Scholar]
  15. Som P. M. Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. AJR Am J Roentgenol. 1992 May;158(5):961–969. doi: 10.2214/ajr.158.5.1566697. [DOI] [PubMed] [Google Scholar]
  16. Spiro J. D., Spiro R. H., Shah J. P., Sessions R. B., Strong E. W. Critical assessment of supraomohyoid neck dissection. Am J Surg. 1988 Oct;156(4):286–289. doi: 10.1016/s0002-9610(88)80293-9. [DOI] [PubMed] [Google Scholar]
  17. Spiro R. H., Alfonso A. E., Farr H. W., Strong E. W. Cervical node metastasis from epidermoid carcinoma of the oral cavity and oropharynx. A critical assessment of current staging. Am J Surg. 1974 Oct;128(4):562–567. doi: 10.1016/0002-9610(74)90276-1. [DOI] [PubMed] [Google Scholar]
  18. Stern W. B., Silver C. E., Zeifer B. A., Persky M. S., Heller K. S. Computed tomography of the clinically negative neck. Head Neck. 1990 Mar-Apr;12(2):109–113. doi: 10.1002/hed.2880120203. [DOI] [PubMed] [Google Scholar]
  19. Vandenbrouck C., Sancho-Garnier H., Chassagne D., Saravane D., Cachin Y., Micheau C. Elective versus therapeutic radical neck dissection in epidermoid carcinoma of the oral cavity: results of a randomized clinical trial. Cancer. 1980 Jul 15;46(2):386–390. doi: 10.1002/1097-0142(19800715)46:2<386::aid-cncr2820460229>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England

RESOURCES