The relationship between lymph node size and metastasis and extracapsular spread in squamous cell carcinoma of the larynx, orohypopharynx, and oral cavity

Abstract

OBJECTIVES: We examined the relationship between lymph node size and metastasis and extracapsular spread (ECS) in patients who underwent neck dissection for squamous cell carcinoma of the larynx, orohypopharynx, or oral cavity. PATIENTS AND METHODS: We retrospectively evaluated a total of 200 neck dissections performed in 128 patients (107 males, 21 females; mean age 56+/-11 years; range 26 to 81 years) with squamous cell carcinoma of the larynx, orohypopharynx, or oral cavity, and having complete clinical and pathologic data. Along with 442 metastatic lymph nodes (139 with ECS), the greatest axial diameter of the biggest benign lymph node obtained from each patient was measured. Lymph nodes were classified according to the neck zone and size, and the relationship of lymph node size with metastasis and ECS was examined. RESULTS: Lymph nodes with metastasis and ECS were often 11 to 30 mm in size and the highest rates of metastasis and ECS were seen in lymph nodes measuring 31 to 60 mm. However, approximately 40% and 25% of lymph nodes with metastasis and ECS, respectively, were in the range of 1 to 10 mm, which is not clinically accepted as pathologic. CONCLUSION: In larynx, orohypopharynx, and oral cavity squamous cell carcinomas, the clinical assessment of the size of neck lymph nodes is usually not a predictor for lymph node metastasis or ECS. Thus, until methods like sentinel lymph node biopsy become standard to determine occult metastasis, the importance of elective neck dissections is still valid in clinically N0 necks.