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Utilizing computed tomography as a road map for designing selective and superselective neck dissection after chemoradiotherapy.

Goguen LA, Chapuy CI, Sher DJ, Israel DA, Blinder RA, Norris CM, Tishler RB, Haddad RI, Annino DJ
Otolaryngol Head Neck Surg. 2010 143 (3): 367-74

PMID: 20723773 · DOI:10.1016/j.otohns.2010.04.020

OBJECTIVE - To determine whether computed tomography can distinguish low risk neck levels that can be omitted when neck dissection is undertaken after chemoradiotherapy.

STUDY DESIGN - Case series with chart review.

SETTING - Tertiary care center.

SUBJECTS AND METHODS - Head and neck squamous cell carcinoma patients undergoing neck dissection after chemoradiotherapy between January 1998 and June 2008. We compared computed tomography findings after chemoradiotherapy with neck dissection pathology results; used primary location and computed tomography findings to design selective or superselective neck dissection; and determined whether these surgeries would have contained all metastatic disease.

RESULTS - A total of 104 patients were identified, providing 110 heminecks, 531 neck levels, and 3009 lymph nodes for analysis. Neck dissections were positive in 20 (19%) of 104 patients, corresponding to 20 hemineck dissections, 31 neck levels, and 53 lymph nodes. The negative predictive value for computed tomography was 95 percent. The negative predictive value for computed tomography per neck level was as follows: I, 100 percent; II, 96 percent; III, 96 percent; IV, 97 percent; and V, 96 percent. A selective neck dissection or a superselective neck dissection, guided by level specific computed tomography findings and limited to necks with post treatment partial response in one level, would have captured all disease in 52 (95%) of 55 and 51 (93%) of 55 heminecks.

CONCLUSION - Negative computed tomography accurately predicts pathologic complete response at neck dissection. Neck dissection can be avoided in these patients. Additionally, computed tomography reliably identifies low risk neck levels that do not require dissection, permitting selective neck dissection or superselective neck dissection in partial response patients with limited residual disease.

Copyright 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.

MeSH Terms (17)

Adult Aged Carcinoma, Squamous Cell Chemotherapy, Adjuvant Cohort Studies Female Head and Neck Neoplasms Humans Male Middle Aged Neck Dissection Neoplasm Staging Patient Selection Predictive Value of Tests Radiotherapy, Adjuvant Retrospective Studies Tomography, X-Ray Computed

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