Nodular Cervical Metastases of Spinocellular Carcinoma of Oropharynx and Pharynx (Part 2)

Overview

Summary:
The aim of the work was to contribute to the evaluation of the mode of regional metastases of spinocellular carcinoma (SCC) of oropharynx and pharynx. The authors define which sectors of lymphatic cervical nodes represent the risk of origin of nodular metastases. Special attention was devoted to occult nodular metastases, i.e. metastases demonstrated by histopathology, but not during the preoperative examination. The other aim was to determine the representation of nodular metastases smaller than 10 mm and metastases smaller than 5 mm. The study included 26 patients with SCC of oropharynx and 23 patients with SCC of the pharynx. In these patients the authors performed 49 cervical dissections (91 side of the neck operated on) and obtained 1,012 lymphatic nodes. Nodal staging was evaluated on the basis of palpation, USG, CT and MRI examinations. One hundred per cent of patients with SCC of the tongue root and 86% of those with SCC of tonsils proved to have histological finding of N+ in comparison with N+ finding in patients with SCC of glottis and 50% in patients with SCC of supraglottis. In the total number of histopathologically established 72 nodular metastases, 25% were smaller than 10 mm and 10% of metastases were smaller than 5 mm. Regardless of the locality of primary tumor the authors observed maximum nodular metastases in the sector IIa (47%). Maximum of nodular metastases of SCC of oropharynx were in the sector IIa, the risk sectors included also II and V ones. In the case of SCC of the larynx the nodular affection of the sector IIa, II and VI was predominant. Among all histologically demonstrated metastases, palpation correctly identified only 49% in comparison with USG, CT and MRI, which diagnosed incorrectly only 11%, 25% and 22%, respectively. In then same way an insufficient palpation diagnostics of metastases smaller than 10 mm and metastases smaller than 5 mm was established as compared with the morphological techniques of examination.

Key words:
cervical nodular metastases, cervical dissection, occult metastases, oropharynx, pharynx.