Neck dissections: emerging role of oral pathologists
Madhusudan Astekar, Amolika Choube, Gaurav Sapra and Rajesh Kumar Chitlangiya
Background: Surgical resection has been the principle treatment approach for early lesions as well as advanced stage carcinomas of upper aero digestive tract. Neck dissection is the primary treatment given to nodal metastasis of oral carcinomas. Choice of irradiation and chemotherapy post surgery relies heavily on the histopathological assessment of surgical margins of resected tumor, dissected lymph nodes and accessory tissues.
Materials and Methods: A total of ten cases of head and neck carcinomas reported in two years period were analyzed. The tissues were assessed histopathologically for tumor grade, margin status, nodal metastasis and vascular invasion.
Results: Out of the total 10 neck dissection specimens, eight cases were of Well Differentiated Squamous Cell Carcinoma, one each of ameloblastic carcinoma and occult cancer with metastasis in cervical lymph nodes. In case of marginal clearance, two cases were negative, one case was of occult primary and seven cases had positive involvement at the margin, of which five cases demonstrated tumor component at 5mm. Concerning the nodal involvement, four cases were positive, five were negative, while in one case no lymph node was available for assessment. Among the accessory tissues received, submandibular gland and perinodal tissue involvement was seen in one case each whereas skin and muscle involvement was negative for tumor cells in all the cases.
Conclusion: The emphasis is on the role of oral pathologists in assessment of such neck dissection specimens. The information provided would maximize treatment outcome and minimize recurrence.
Keywords: Diagnostic Histopathology; Head and Neck Cancer; Lymph Node Excision; Neck Dissection; Operative Surgical Procedures; Sentinel Lymph Node Biopsy