Detection of Nodal Micrometastases in Head and Neck Cancer by Serial Sectioning and Immunostaining

ABSTRACT: We investigated the incidence of micrometastases from squamouscell carcinomas of the head and neck in neck dissection specimensoriginally staged as pN0. A total of 76 dissection specimens from60 patients were evaluated using serial microscopic sectioningin 10-mm intervals, H & E staining, and immunostaining withan antibody to pan-cytokeratin. Examination of 1,020 lymph nodesfrom 76 neck dissection specimens revealed 8 micrometastases (7.9%)in 6 specimens from 6 patients with oral and pharyngeal primaries,resulting in upstaging. Six micrometastases were located in lymphnodes 3 to 6 mm in diameter. The surgeon should be aware of therelatively high incidence of micrometastases from oral and pharyngealcarcinomas, which are undetectable preoperatively or by routinehistopathologic examination. Primary tumor site (oral cavity andpharynx) and certain features of the primary can delineate a groupof patients with a higher risk of harboring occult metastaseswho may benefit from elective treatment of the neck. [ONCOLOGY10(8):1221-1226, 1996]

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