DETAILED TOPOGRAPHY OF CERVICAL LYMPH-NODE METASTASES FROM ORAL SQUAMOUS-CELL CARCINOMA

The histologic presence and detailed topography of cervical lymphnode metastatic tumours was investigated in a series of neck dissections fr om 154 previously untreated patients with oral mucosal squamous cell c arcinoma. Metastasis was evident in 73 patients (47%), including 13 (8 %) with bilateral spread and 14 (9%) with only micrometastases. Multip le positive nodes were recovered from 58 (67%) of the 86 positive side s of neck dissection, and fusion of nodes was seen in 22 dissections ( 26%). Both direct extracapsular and embolic spread accounted for advan ced disease. An orderly progressive (''oveflow'') involvement of anato mic levels was seen in 85% of positive dissections. ''Skipping'' of an atomic levels II and/or III was seen in 10%, and ''peppering'' of node s at multiple levels without any macroscopic focus in 5%. Hence, ''fas t-tracks'' may account for the distribution of metastatic carcinoma in 15% of positive necks. Adjuvant radiotherapy was dependent on the pat hologic stage. The range of postoperative follow-up was 1-6 years. Dea th from recurrent regional disease occurred only in patients who had e xhibited macroscopic or microscopic extracapsular spread. Survival was similar (75%) for patients with either macroscopic or microscopic met astases confined to lymph nodes or no evidence of metastasis. Hence, w ith surgery and adjuvant radiotherapy, metastases confined to lymph no des do not appear to affect the short-term prognosis.