Figure 3 - uploaded by Kevin Thomas Robbins
Content may be subject to copyright.
Source publication
Since the first description of the radical neck dissection by George Crile almost a century ago, many variations and modifications of the procedure have been added. These include the functional neck dissection, the modified radical neck dissection, and various selective neck dissections. In response to the need for an organized approach in describi...
Similar publications
Cervical lymphadenopathy is a common reason for refer-ral to the Otolaryngology-Head & Neck Surgery clinic. The differential diagnosis is broad, and can include infectious, traumatic, anatomical, and neoplastic etiologies. Cervical lymph nodes are the primary site of metastasis for head and neck cancers, but have also been implicated in other forms...
Citations
... При лечении опухолей головы и шеи применяются различные варианты шейных лимфодиссекций такие как радикальная лимфодиссекция, модифицированная радикальная лимфодиссекция шеи, расширенная лимфодиссекция и метод селективной лимфодиссекции [8]. До сих пор нет принятого единого варианта боковой лимфодиссекции шеи, выполняемой при РЩЖ. ...
Introduction. Despite the fact that highly differentiated thyroid cancer is included in the group of malignant neoplasms with a favorable prognosis, data on the high frequency and recurrence of relapses are reported. The presence of metastatic lymph nodes in HDTC increases the risk of regional relapse by up to 27%. According to the literature, the factors that increase the risk of recurrence are: histological type, stage, depth of extrathyroid invasion, the presence of metastatic lymph nodes, age, and the volume of primary surgical intervention. Lateral neck dissection should be performed in patients with morphologically verified metastatic thyroid cancer, but there is still no clear consensus on the volume of dissection.
Aim. Assessment of factors affecting the risk of regional recurrence in the lateral neck tissue and the localization of recurrence.
Materials and methods. The study included 56 patients with HDTC, in whom metastatic lateral neck nodes were identified and verified. All patients previously underwent unilateral or bilateral neck lymph node dissection in various institutions. During the period of dynamic follow-up, these patients revealed regional recurrences in the lateral tissue of the neck. The patients were observed and treated for recurrence at the N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia.
Results. Age over 55 years is a prognostically significant factor affecting the frequency of regional relapse in the lateral neck tissue (p=0.002). The presence of metastatic nodes in the lateral tissue of the neck at the initial treatment is a prognostically significant factor that increases the risk of regional recurrence in the lateral tissue of the neck (p=0.017). According to the results of a single-factor analysis, a statistically significant effect of the stage on the risk of regional relapses in the lateral neck tissue was noted (p=0.014). In 35.7% of cases, recurrent nodes were localized in the level V.
Conclusion. Main risk factors for relapse are clinico-morphological, such as age, aggressive type of HDTC, stage of the disease, N1b status after primary surgery, as well as technical defects during primary surgical treatment.
... The following parameters were recorded: lymph node location, lymph node size, lymph node shape, and presence or absence of calcification. The size of lymph node was evaluated based on maximal diameter, the location was classified according to Robbins et al. [18], and the shape was described based on the long/short axis ratio (L/S), where L/S < 2 indicated a round shape, and L/S ≥ 2 indicated an elliptical shape. ...
... The mean maximum diameter of the sampled lymph nodes was 14.6 ± 6.2 mm ( Table 1). The sampled lymph nodes were located at different levels, as classified according to Robbins et al. [18]: 16 at Level I, 63 at Level II, 88 at Level III, 281 at Level IV, 49 at Level V, and 8 at Level VI. Notably, no complications such as bleeding, infection, nerve damage, or tumor cell seeding were observed during the ultrasound-guided FNA procedure. ...
Purpose
The overall diagnostic value of fine-needle aspiration (FNA) is not as excellent as that of core needle biopsy (CNB). Limited research has investigated small cervical lymph nodes inaccessible to ultrasound-guided CNB due to technical challenges associated with their small size. Therefore, this study aimed to evaluate the accuracy of ultrasound-guided FNA in determining the etiology of small cervical lymph nodes.
Methods
A retrospective analysis was conducted on patients who underwent FNA between May 2018 and May 2021 at our hospital. Cytological, histopathological, and clinical follow-up data were analyzed. The diagnostic yield of FNA was assessed based on sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy calculations.
Results
This study included 505 patients, each with a small cervical lymph node under evaluation (total number of lymph nodes: 505). The average maximal diameter of the lymph nodes was 14.6 ± 6.2 mm. According to the Sydney system, the cytology results were as follows: Category I in 26 lymph nodes (5.1 %); Category II in 269 (53.3 %); Category III in 35 (6.9 %); Category IV in 17 (3.4 %); and Category V in 158 (31.3 %). We identified 212 malignant cases (203 metastases and 9 lymphomas) and 293 benign lymph nodes. FNA achieved high sensitivity (88.8 %), specificity (99.6 %), PPV (99.4 %), NPV (91.8 %), and overall accuracy (94.8 %) in determining the etiology of small cervical lymph nodes.
Conclusion
FNA cytology is suitable for small lesions inaccessible by CNB and provides a diagnostic basis for implementing clinically appropriate treatment measures.
... С тех пор она подвергалась различным модификациям. В 1991 г. Американская академия отоларингологии (American Academy of Otolaryngology -Head and Neck Surgery, AAO-HNS) опубликовала стандартизированную версию этой классификации, чтобы обеспечить единый подход к шейной лимфодиссекции, которая была обновлена в 2002 г. (например, были добавлены подуровни ЛУ IIA и IIB) [15]. ...
Introduction. Head and neck cancer is the 7th most common malignancy worldwide; squamous cell carcinoma of the oral mucosa are almost a third of tumors of that localization. metastatic lesions of the neck lymph nodes are an unfavorable prognostic factor for malignant tumors of that location since it is associated with a 50 % decrease in overall survival. In this regard, the detection of metastases to the neck lymph nodes is an important component of high-quality oncological care for patients with that pathology.
Aim. To evaluate the efficiency of sentinel lymph node biopsy in squamous cell carcinoma of cavity of mouth mucosa cT1–2N0м0.
Materials and methods. 72 patients were included in trial at the age from 21 to 74 (mean 57.3) with confirmed squamous cell carcinoma of cavity of mouth mucosa cT1–2N0м0. No evidence of regional metastasis, by preoperative examination, including ultrasound, computed tomography with intravenous contrast was observed. All patients received radioisotope research to determine localization of sentinel lymph nodes, and then biopsy of that nodes was performed. Before obtaining information about the status of the sentinel lymph node, radical neck dissection was not performed. Pathology report with immunohistochemical investigation was performed by pathologist of A. f. Tsyb medical Radiological Research Center – branch of the National medical Research Radiological Center, ministry of Health of Russia.
Results. When assessing efficiency of sentinel lymph node method, true positives results (detection of metastasis in sentinel lymph node) were achieved in 3 (4.17 %) out of 72 cases. follow up time was from 1 to 69 months. Among those cases, where metastasis in sentinel lymph nodes were not detected, relapse in regional lymph nodes was developed in 3 (4.35 %) out of 69 cases. Radical neck dissection was performed in cases with metastasis in sentinel lymph nodes. The specificity of method was 95 %, the predictive value of a negative result was 0.04.
Conclusion. Sentinel lymph neck node biopsy is an effective method of subclinical locoregional metastases detection in cancer of oral mucosa cT1–2N0m0. In our study of sentinel lymph neck node biopsy, oncological outcomes were comparable to radical neck dissection, with fewer postoperative complications.
... An additional topographical classification that has gained widespread acceptance, introduced by K. Thomas Robbins in 1991 and updated by him in 2001, has had a significant impact on conventional oncological practice [42,43]. This classification system aims to establish consistency in naming different types of cervical lymph node dissections by categorizing the involved topographical regions and any anatomical structures sacrificed during the procedure. ...
... In 2002, the committee for neck dissection classification reviewed the system proposed in 1991. They decided to continue the use of the level system to classify the location of lymph node disease and introduced a new sublevel system [43]. For the neck dissection, they continued using the terminology of radical, extended radical, and modified radical neck dissection but redefined and classified selective neck dissection according to the malignancy type [43] (Table 1). ...
... They decided to continue the use of the level system to classify the location of lymph node disease and introduced a new sublevel system [43]. For the neck dissection, they continued using the terminology of radical, extended radical, and modified radical neck dissection but redefined and classified selective neck dissection according to the malignancy type [43] (Table 1). Furthermore, selective lymph node dissection for thyroid cancer encompasses both central and lateral neck dissection. ...
Thyroidectomy is a commonly performed surgery for thyroid cancer, Graves’ disease, and thyroid nodules. With the increasing incidence of thyroid cancer, understanding the anatomy and surgical techniques is crucial to ensure successful outcomes and minimize complications. This review discusses the anatomical considerations of the thyroid and neck, including lymphatic drainage and the structures at risk during thyroidectomy. Emphasis is placed on the significance of cautious dissection to preserve critical structures, such as the parathyroid glands and recurrent laryngeal nerve. Neck dissection is also explored, particularly in cases of lymph node metastasis, in which its proper execution is essential for better survival rates. Additionally, this review evaluates various thyroidectomy techniques, including minimally invasive approaches, highlighting their potential benefits and limitations. Continuous surgical knowledge and expertise updates are necessary to ensure the best results for patients undergoing thyroidectomy.
... Depending on the level of lymph nodes involved, 1 of the following 2 techniques was used: (1) central lymph node dissection (CLND), including prelaryngeal, pretracheal, and paratracheal dissection for patients with evidence of central compartment involvements and (2) CLND plus LLND including levels II, III, and IV with preservation of the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve for patients with evidence of lateral lymph node involvement. 14 ...
Background
The reported complication rates of neck dissection are not specific patients with papillary thyroid cancer` with metastatic lymph nodes. This study aimed to describe the complication profile of neck dissection and the effect of concurrent lateral neck dissection on complication rates.
Methods
This single-center prospective cohort study analyzed the data of 52 patients who underwent a total thyroidectomy and therapeutic lymph node dissection between March 2021 and March 2023. The clinicopathologic characteristics of patients and surgical complications were analyzed.
Results
The transient recurrent laryngeal nerve palsy (RLNP) and hypoparathyroidism rates were 55.8% and 51.9%, respectively. The chyle leakage rate was 5.8%. Tracheostomy was performed on 1 patient (1.9%). Patients with transient RLNP had more retrieved lymph nodes than patients without RLNP (5.5 ± 2.7 vs 3.9 ± 1.5, P = .013). The rates of transient RLNP and hypoparathyroidism were higher in the total thyroidectomy with central and lateral neck dissection group than the total thyroidectomy with central neck dissection group (62.2% vs 14.3%, P = .035 and 57.8% vs 14.3%, P = .046). Multivariate analysis showed that the increased number of retrieved lymph nodes in the central compartment and the addition of lateral neck dissection were independent risk factors for transient RLNP, with odds ratio (OR) (95% confidence interval) of 0.72 (0.53-0.98) and 9.42 (1.02-87.34).
Conclusion
The rates of transient RLNP and hypoparathyroidism after lymph node dissection in patients with papillary thyroid cancer with metastatic lymph nodes were high, and a greater number of retrieved lymph nodes in the central neck and the addition of lateral neck dissection were predictors for transient RLNP. These data may be used to discuss preoperatively with patients and make surgeons more cautious and meticulous during surgery to minimize complications.
... is squamous cell carcinoma in 65-76% of cases, followed by undifferentiated carcinoma (14%), adenocarcinoma (13%), and nasopharyngeal-type undifferentiated carcinoma (8%) [4][5][6]. The lymph node metastases are usually localized in the upper two-thirds of the neck (levels I-III), mainly deriving from squamous cell carcinoma of the head and neck [7,8]. Metastases localized in the lower third of the neck (levels IV-V) suggest a primary tumor located under the clavicle, usually an adenocarcinoma [9,8]. ...
Objective:
This study aimed to evaluate the characteristics and oncological outcomes of head and neck carcinoma of unknown primary (HNCUP) patients in an endemic nasopharyngeal cancer (NPC) area.
Methods:
One hundred and forty-four HNCUP patients curatively treated between January 1995 and December 2022 from 5 centers were retrospectively recruited onto the study to analyze the clinicopathological characteristics and oncological outcomes and compare them with historical data. A multivariate Cox proportional hazards model analysis was performed to evaluate factors affecting survival outcomes. A propensity-matched pair analysis of the patients with positive and negative EBV-encoded small RNA (EBER) staining was applied to compare the characteristics and outcomes between the two groups.
Results:
The median follow-up time was 45 months. Most patients (88.2%) received total mucosal irradiation (TMI). Primary tumor emergence (PTE) was detected in 6 patients (4.2%) who did not have TMI. The 5-year overall survival (OS), disease-free survival, and locoregional recurrence-free survival were 51.3%, 64.9%, and 72.7%, respectively. Extranodal extension and N3 compared with the N1 stage were the significant independent predictors for OS (HR 2.90, 95% CI 1.12-7.51, p = 0.028 and HR 3.66, 95%CI 1.23-11.89, p = 0.031, respectively). The matched-pair analysis demonstrated comparable all survival outcomes between the EBER-positive and -negative groups. All patients in the matched pair analysis received TMI, and no PTE was detected.
Conclusion:
Our survival outcomes were comparable to previous studies with a low rate of PTE. The matched pair analysis of EBER-positive and -negative groups revealed similar oncological outcomes and no primary tumor emergence when total mucosal irradiation was administered.
... In accordance with the treatment principles for clinical LN metastasis from head and neck cancer, all patients in this study underwent type II or type III modified radical ND. The ND classification proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery was used to classify the location of LNs [8]. ...
Background: Despite its rarity and limited documentation, therapeutic neck dissection (ND) for cervical lymph node (LN) metastases from distant primary sites is increasingly practiced, potentially enhancing survival rates. However, the optimal ND extent remains unclear. This study aimed to determine the safety of excluding upper neck levels from ND. Methods: We retrospectively analyzed 25 patients who underwent ND for cervical LN metastases from remote primary tumors between 2015 and 2021 (12 with primary lung tumors, four with ovary, three with mammary gland, three with esophagus, two with thymus, and one with colon). Results: Assessing clinical characteristics and occult metastasis rates, we observed LN metastases predominantly at levels III and IV. Occult metastases occurred in 14 out of 25 patients, primarily at neck levels III and IV (55.0% and 50.0%, respectively). The five-year disease-specific survival rate for all patients was 44.3%. While no statistically significant impact of occult metastasis on prognosis was confirmed, an association between the postoperative LN ratio and poor prognosis was revealed. Conclusions: Our findings suggest that prophylactic NDs at levels I, II, and Va may not be essential for managing cervical LN metastases from remote primary malignancies. This could lead to a more tailored and less invasive therapeutic strategy.
... The locations of the suspected LNs were determined based on the guidelines from the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery [17]. LN size was measured as the long-axis and short-axis diameter on the maximal longitudinal section. ...
Objective
The primary objective was to establish a radiomics model utilizing longitudinal +cross-sectional ultrasound (US) images of lymph nodes (LNs) to predict cervical lymph node metastasis (CLNM) following differentiated thyroid carcinoma (DTC) surgery.
Methods
A retrospective collection of 211 LNs from 211 postoperative DTC patients who underwent neck US with suspicious LN fine needle aspiration cytopathology findings at our institution was conducted between June 2021 and April 2023. Conventional US and clinicopathological information of patients were gathered. Based on the pathological results, patients were categorized into CLNM and non-CLNM groups. The database was randomly divided into a training cohort (n = 147) and a test cohort (n = 64) at a 7:3 ratio. The least absolute shrinkage and selection operator algorithm was applied to screen the most relevant radiomic features from the longitudinal + cross-sectional US images, and a radiomics model was constructed. Univariate and multivariate analyses were used to assess US and clinicopathological significance features. Subsequently, a combined model for predicting CLNM was constructed by integrating radiomics, conventional US, and clinicopathological features and presented as a nomogram.
Results
The area under the curves (AUCs) of the longitudinal + cross-sectional radiomics models were 0.846 and 0.801 in the training and test sets, respectively, outperforming the single longitudinal and cross-sectional models (p < 0.05). In the testing cohort, the AUC of the combined model in predicting CLNM was 0.901, surpassing that of the single US model (AUC, 0.731) and radiomics model (AUC, 0.801).
Conclusions
The US-based radiomics model exhibits the potential to accurately predict CLNM following DTC surgery, thereby enhancing diagnostic accuracy.
... In case of suspected extra-nodal extension, a modified-radical or radical neck dissection was performed. Every ND was performed according the anatomical and surgical boundaries suggested by Robbins et al. [16]. Frozen sections were not routinely taken during surgery. ...
Salvage surgery is mandatory when regional persistence/recurrence after chemoradiation. The aim of this study is to describe the outcomes of salvage surgery.
A retrospective study was conducted in patients with locally advanced head and neck squamous cell carcinoma that were primarily treated with chemorradiation and underwent salvage neck dissection (ND) with suspected recurrent/persistent nodal disease. All patients had a response evaluation at 12 weeks through clinical examination and computed tomography-positron emission tomography. Decision for ND was taken in case of suspected persistence or if there was suspicion of recurrence, histologically confirmed.
There were 40 patients included. 32/40 (80%) ND were done because of confirmed/suspected persistence and 8/40 (20%) were done because of recurrences. Persistence was confirmed histologically in 14/32 (43.8%) cases and recurrence in 6/8 (75%) cases. Median survival from diagnosis was 39 months (95% CI 28.162–49.838). Significant differences were observed between patients who had viable tumour cells in the sample and those who did not, but the differences were only significant when only deaths due to tumour progression were considered (p = 0.014). 14/32 (43.8%) patients with suspected or confirmed persistence developed a recurrence after the ND and 3/8 (37.5%) patients with suspected or confirmed recurrence developed a new recurrence. New recurrences were more frequent in cases that had viable tumor in the specimen.
Patients with nodal persistence/recurrence have a poor prognosis, even after salvage surgery. However, in a substantial number of patients the disease is controlled after ND, so it should be offer to these patients.
... The neck's topographical areas are categorized into levels based on anatomical landmarks, as outlined by Robbins et al. (2002Robbins et al. ( , 1991 or in modification by Kesting (2015) and Koerdt et al. (2016). Kesting introduced a classification system and a sequential algorithm for neck dissection that emphasizes surgical technical aspects over anatomical topography, diverging from the approach advocated by Robbins (Kesting 2015). ...
Accurate preoperative prediction of lymph node (LN) status plays a pivotal role in determining the extension of neck dissection (ND) required for patients with oral squamous cell carcinoma (OSCC). This study aims to evaluate the diagnostic accuracy of contrast-enhanced computed tomography (CT) in detecting LN metastases (LNMs) and to explore clinicopathological factors associated with its reliability.
Data from 239 patients with primary OSCC who underwent preoperative CT and subsequent radical surgery involving ND were retrospectively reviewed. Suspicious LNs were categorized into three groups: accentuated (< 10 mm), enlarged (≥ 10 mm), and melted. Statistical analysis encompassing correlation and comparative analysis, and determination of sensitivity, specificity, PPV, and NPV were performed.
Overall, sensitivity was significantly higher in the accentuated LNs group (83.54%) compared to the melted LNs group (39.24%, p < 0.05, t test). Conversely, specificity was significantly higher in the melted LNs group (98.19%) compared to the accentuated LNs group (55.15%, p < 0.05, t test). Accentuated LNs exhibited a false negative rate of 13.00%. False positive rates were 51.80%, 30.26% and 8.82%, respectively. Diagnostic accuracy for detecting LNMs in level IIa and IIb exceeded that of level III. Patients with solely accentuated LNs were more likely to have a small, well-differentiated tumor. However, no distinctions emerged in terms of the occurrence of T4 tumors among the three groups.
CT proves sufficient to predict LNMs in patients with OSCC. Looking ahead, the potential integration of artificial intelligence and deep learning holds promise to further enhance the reliability of CT in LNMs detection. However, this prospect necessitates further investigation.
