Evaluation of Selective Lymph Node Sampling in the Node-Negative Neck^†

Objective To determine whether intraoperative selective lymph node sampling before neck dissection in the node-negative (N0) neck accurately reflects the disease content of the neck and can be used to assist in treatment selection.

Study Design A prospective clinical study at a university medical center.

Methods Over a 2-year period, 36 patients with head and neck squamous cell carcinoma scheduled to undergo 41 elective neck dissections were enrolled. At the initiation of the neck dissection, biopsy of the “most suspicious” lymph node within the tumor's primary nodal drainage basin was performed, and the specimen was measured and sent for frozen-section evaluation. The results of lymph node sampling were compared with the final histopathologic interpretation of the resected primary and neck dissection.

Results Of the 41 N0 necks, 29% (12 of 41) were positive for occult metastases. Results of selective lymph node biopsy correlated with the results of neck dissection in 34 of 41 specimens (83%). The specificity and positive predictive value of node sampling were both 100%. The proportion of cases with a positive neck dissection with a positive sampled node (sensitivity) was 42% (5 of 12).

Conclusion The results of selective lymph node biopsy with frozen-section analysis in the N0 neck, as defined in the current study, did not reflect a technique with adequate sensitivity to alter intraoperative treatment strategy.