KISEP Head and Neck Korean J Otolaryngol 2001;44:190-5 두경부암종에서병리학적으로확인한 Level IIb 림프절전이 - 예비결과 - 고윤우 1 김동영 2 최재진 1 김인섭 1 김상엽 1 최은창 1 Pathologically Proven Level IIb Lymph Node Metastasis in Head and Neck Cancer Preliminary Report Yoon Woo Koh, MD 1, Dong Young Kim, MD 2, Jae Jin Choi, MD 1, In-Sup Kim, MD 1, Sang Yub Kim, MD 1 and Eun Chang Choi, MD 1 1 Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul; and 2 Department of Otolaryngology-Head and Neck Surgery, Gil Medical Center, Gachon Medical School, Incheon, Korea ABSTRACT Background and ObjectivesThe spinal accessory nerve dysfunction is a serious sequela following selective neck dissections despite preservation of the spinal accessory nerve. The incidence of this complication is known to be 2030% and the primary cause of nerve dysfunction is known as significant traction during resection of level IIb lymph node group. To try to answer whether level IIb could be preserved, we evaluated the incidence of metastasis to level IIb lymph node from various types of the head and neck cancer. Materials and MethodsSixty patients who underwent surgery for their head and neck cancer as an initial treatment from February 1999 to July 2000 were prospectively evaluated. Histopathological evaluations for 106 neck dissection specimens were performed in 60 patients with the head and neck cancer. ResultsA total of 7 patients 11.7% had metastasis to level IIb lymph node. All but one case had ipsilateral level IIb metastasis. All seven cases had multiple lymph node metastases to other levels, including level I, IIa, III, IV, or V. Occult metastasis to level IIb was noted in one case of 25 clinically proven N0 head and neck cancer patients 4%. Primary sites and pathologies with level IIb metastasis were varied, including such sites as upper eyelid, parotid gland, or thyroid gland. ConclusionsThis preliminary report reveals low incidence of level IIb metastasis in some of pathologically proven N0 head and neck cancer. Contralateral level IIb lymph node could be preserved in clinical N0 heasd and neck cases. Multiple lymph node metastases increase the probability of metastasis to level IIb. Level IIb resection is necessary in clinical N cases with multiple nodes or multiple levels of metastases. Also, Level IIb metastasis may tend to increase in some of the primary sites, which drain into the jugular chain via level IIb lymph node. Korean J Otolaryngol 2001;44:190-5 KEY WORDSNeck dissection Head and neck cancer Lymph node metastasis. 190
Table 1. Primary sites and level IIb metastasis Primary sites Number of cases Pathologic LN of level IIb % Glottis 4 1 25 Supraglottis 9 1 11 Hypopharynx 6 Oral cavity 13 Oropharynx 14 1 7 Cervical esophagus 1 Primary unknown 1 Maxillary sinus 1 Upper eyelid 1 1 100 Thyroid gland 3 2 67 Parotid gland 2 1 50 Submandibular gland 4 Conjunctiva 1 Total 60 7 11.7 191
Level llb 림프절의 전이 빈도 7%)이었다. Level IIb 림프절전이가 있었던 7예의 원발암 morphic adenoma 이었다. 편평세포암종 4예의 원발부위는 은 4예가 편평세포암종이었으며 나머지 3예는 갑상선의 선 성문암, 성문상부암, 구인두암 그리고 상안검암이 각각 1예 암종과 유두상암종, 이하선에 발생한 carcinoma ex pleo- 로서 다양하였다(Table 1 and 2). 원발병기는 T4가 3예, T3 Fig. 1. The surgical field following lateral neck dissection is shown. Note that the border of level IIb dissection consists of the upper part of spinal accessory nerve, posterior belly of digastric muscle and posterior border of sternocleidomastoid muscle (arrow). The floor of level IIb consists of splenius capitus muscle (asterisk). Fig. 2. The surgical specimen following lateral neck dissection is shown. Arrows indicate the portion of level IIb lymph nodes. Fig. 3. Neck treatment algorhythm. BND bilateral neck dissection, UND unilateral neck dissection, pn0 pathologically negative neck, pn pathologically positive neck. 192 Korean J Otolaryngol 2001 ;44 :190-5
Table 2. Profiles of level IIb metastasis patients Case No. Sexage Primary site Pathology TN stage Neck Tx. Ipsi. IIb plntln Contra. IIb plntln Total levels plntln 1 M71 Glottis SCC T4N2b LND 17 448 2 M54 Supraglottis SCC T4N3 RNDLND 14 06 749 3 M49 Upper eyelid SCC T1N2b RND 14 424 4 M45 Oropharynx SCC T4N2c RNDSOND 01 29 859 5 F51 Thyroid gland AC T2N1b FNDMRND 210 05 69100 6 M66 Thyroid gland Papillary T2N1a FND 14 1038 7 M55 Parotid gland Ca. ex Pleom. T3N2b RND 66 4455 SCCsquamous cell carcinoma, ACadenocarcinoma, Papillarypapillary cancer, Ca. ex Pleom.carcinoma ex pleomorphic adenoma, Tx.treatment, ipsiipsilateral, contracontralateral, LNDlateral neck dissection, RNDradical neck dissection, SONDsupraomohyoid neck dissection, FNDfunctional neck dissection, MRNDmodified radical neck dissection, plnpathologic lymph nodes, tlntotal lympn nodes 193
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