The Anatomic Location of Neck Metastasis from Occult Squamous Cell Carcinoma

It has been axiomatic among head and neck surgeons that open biopsy of cervical nodes will jeopardize patients having squamous cell carcinoma. The inappropriate biopsy of a squamous cell carcinoma metastatic to a cervical node will statistically double both the subsequent rates of local recurrence and distant metastasis. There is no reliable method to clearly distinguish a cervical node involved with squamous cell carcinoma from adenopathy of other sources. Because of this, all patients with cervical adenopathy are evaluated with the time honored approach of careful visualization and palpation of the upper aerodigestive tract prior to open biopsy. The extent of this evaluation is often judgmental. A review of patients with cervical adenopathy of unknown origin and who had a tissue diagnosis, shows that node location is the most helpful parameter for predicting eventual histopathology. Nodes in the jugulodigastric, digestive, and anterior cervical regions have a probability of 19% and 12%, respectively, of being a squamous cell carcinoma. Multiple adenopathies in the supraclavicular and posterior cervical areas are frequently malignant (84% and 61% respectively), however, these are usually either lymphoma or infraclavicular metastasis.