title: Defining the risk of involvement for each neck nodal level in patients with early T-stage node-positive oropharyngeal carcinoma.
abstract: OBJECTIVE
  To assess the risk of ipsilateral subclinical neck nodal involvement for early T-stage/node-positive oropharyngeal squamous cell carcinoma.
  
  
  METHODS
  Patients undergoing multilevel upfront neck dissection (ND) at Johns Hopkins Hospital within the last 10 years for early clinical T-stage (cT1-2) node-positive (cN+) oropharyngeal squamous cell carcinoma were identified. Pathologic involvement of Levels IB-V was determined. For each nodal level, the negative predictive value of imaging results was computed by using sensitivity/specificity data for computed tomography (CT). This was used to calculate 1 - negative predictive value, or the risk that a negative level on CT harbors subclinical disease.
  
  
  RESULTS
  One hundred three patients met the criteria. Radical ND was performed in 14.6%; modified radical ND, in 70.9%; and selective ND, in 14.6%. Pathologic positivity rates were 9.5%, 91.3%, 40.8%, 18.0%, and 3.3% for Levels IB-V, respectively. Risks of subclinical disease despite negative CT imaging results were calculated as 3.1%, 76.3%, 17.5%, 6.3%, and 1.0% for Levels IB-V, respectively.
  
  
  CONCLUSIONS
  Levels IB and V are at very low (<5%) risk of involvement, even with ipsilateral to pathologically proven neck disease; this can guide radiation planning. Levels II and III should be included in high-risk volumes regardless of imaging results, and Level IV should be included within the lowest risk volume.
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD 21231-2410, USA. gsangui1@jhmi.edu
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sanguineti
authors.forename: Joseph
authors.initials: J
authors.lastname: Califano
authors.forename: Edward
authors.initials: E
authors.lastname: Stafford
authors.forename: Jana
authors.initials: J
authors.lastname: Fox
authors.forename: Wayne
authors.initials: W
authors.lastname: Koch
authors.forename: Ralph
authors.initials: R
authors.lastname: Tufano
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Sormani
authors.forename: Arlene
authors.initials: A
authors.lastname: Forastiere
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D030361:Papillomavirus Infections / Q000150:complications; D011859:Radiography; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D018570:Risk Assessment