title: Frequency of metastases at the area of the supraretrospinal (level IIB) lymph node in laryngeal cancer.
abstract: BACKGROUND
  Neck dissection is the surgical gold standard for the treatment of patients with cervical lymphatic spread. The purpose of this study was to determine the presence of metastases in the supraretrospinal (level IIB) nodal group and the necessity of routine dissection of level IIB during neck dissection, in patients with squamous cell carcinoma of the larynx.
  
  
  METHODS
  Over a 4-year period (between January 2000 and June 2004), the records of patients undergoing laryngectomy and neck dissection were retrospectively evaluated. The numbers of the lymph node and carcinoma metastases at level IIB were recorded. The American Joint Committee on Cancer tumor-node-metastasis classification system was used to classify the primary tumor and neck, and the Memorial Sloan-Kettering Cancer Center classification was used to classify the cervical lymphatic chain.
  
  
  RESULTS
  Sixty-three patients with 98 neck dissections were included in the study. Two patients (3.17%) had subglottic lesions, 19 patients (30.15%) had glottic lesions, and 42 patients (66.66%) had supraglottic lesions. In total, 673 lymph nodes were dissected from level II, and 340 were dissected from level IIB. The 11 supraretrospinal lymph nodes of the 340 dissected nodes demonstrated histologic evidence of metastases (3.23%). Six patients (9.52%; 6/63) had metastases at level IIB, and 2 of them also had synchronous metastases at the contralateral level IIB. The patients without palpable lymph nodes at the neck had no metastases at level IIB.
  
  
  CONCLUSIONS
  Our results showed that, if the level IIA shows positive metastatic changes, perioperative pathologic examination by frozen section that includes level IIb could be an alternative approach. This area may not be routinely dissected during the surgical management of laryngeal carcinoma with no palpable lymph nodes.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ozan Seymen
authors.initials: OS
authors.lastname: Sezen
authors.forename: Utku
authors.initials: U
authors.lastname: Kubilay
authors.forename: Suheyl
authors.initials: S
authors.lastname: Haytoglu
authors.forename: Seref
authors.initials: S
authors.lastname: Unver
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D005931:Glottis / Q000473:pathology; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology* / Q000601:surgery; D007825:Laryngectomy; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D037981:Neck Dissection; D012189:Retrospective Studies