Background
Perineural invasion (PNI), nodal positivity and extranodal extension (ENE) are key prognostic indicators in head and neck cancer. The American Joint Committee on Cancer (AJCC) recommends a minimum of 18 lymph nodes are histologically assessed in patients with oral cancer. Insufficient nodal yield may result in underestimation of disease severity.
Methods
A six-year retrospective audit of neck dissections (ND) carried out within the Oral and Maxillofacial surgery department of University Hospital Limerick was undertaken. Completeness of histology reports and lymph node yields were reviewed.
Results
A total of 75 NDs were undertaken, of which nine were bilateral. The majority of patients were male (65%) with a median age of 70 (IQR: 63-76). The most common indication was intra-oral squamous cell carcinoma (76.3%). Histology reports more commonly commented on the presence/absence of lymphovascular invasion compared to perineural invasion at the primary site (83.8% versus 63.5%, p= 0.005). A selective anterolateral ND (level I-IV) was the most commonly performed ND (57.1%). The median lymph node yield was 23.5 (IQR: 17-28). Where nodal positivity was present, 36.8% of reports did not comment on ENE.
Conclusion
The average lymph node yield exceeded AJCC recommendations. However, histopathological reporting was often insufficient, precluding accurate risk stratification and TNM staging.
Saoirse Kilgarriff1, Francesca Lee1, Akinsola Ogunbowale1, Michael Gilbride1
1 Department of Oral & Maxillofacial Surgery, University Hospital Limerick, Limerick