Histologic Evaluation of Neck Dissection

The major aim of the histologic evaluation of the status of lymph nodes in cases of carcinoma of the head and neck is to provide information required for staging disease, planning further treatment and predicting patient outcome. The histologic evaluation also documents and confirms the pathologist's own gross evaluation of the dissected specimen. More importantly, increasingly important histologic parameters, such as number, sizes and levels of positive nodes, the presence or absence of extracapsular spread, the presence of desmoplastic reaction, the presence of gross residual tumour and the presence of tumour emboli in intervening lymphatics, among others, can be assessed by a thorough histologic evaluation. These histologic findings by themselves and in combination with other histologic parameters have been increasingly identified as important prognostic factors in disease control and survival, recurrence of neck disease and distant metastasis. The five factors that are currently indicators for adjuvant postoperative therapy can be reliably provided only by histologic evaluation; they are:

1. Extranodal spread of disease,

2. Number of lymph nodes involved,

3. Number of lymph node regions involved,

4. Size of metastases,

5. Presence of desmoplastic reaction in metastatic disease [42].

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