The value of elective neck dissection in treatment of cancer of the tongue

Purpose: The "adequate" therapy of tongue cancer has not yet been determine d. The authors report their experience with 58 N-0 patients to elucidate th e role of elective neck dissection in surgical treatment of cancer of the t ongue. Materials and Methods: The files of 58 N-0 patients with tongue cancer were evaluated retrospectively. In every patient, partial glossectomy continuou s with neck dissection was the mainstay of the treatment. TNM staging, intr aoperative N staging, pathologically confirmed cervical lymph node metastas es and their levels, and clinical outcomes (local and regional recurrences) were recorded. The sensitivity and specificity of intraoperative staging w as determined. Results: Fifty-four percent (31/58) of the patients presented as T-1, and 2 6% (15/58) as T-2. The overall occult metastasis rate was 29.3% (17/58). Th e occult metastasis rate for T-1 and T-2 lesions was 19.4% (6/31) and 26.7% (4/15), respectively. The sensitivity of intraoperative staging was 76.5%, and the specificity was 51.2%. Conclusions: The rate of occult metastasis to the neck is too high in all t ongue cancer cases to take the risk of regional recurrence, and the surgeon can not solely depend on neck palpation for determination of neck metastas is. Radiologic investigations and fine-needle aspiration decrease, but neve r reduce to zero the rate of false-negative examination. There is an obviou s indication for neck dissection, even in early cases.