title: Metastases to level IIb in squamous cell carcinoma of the oral cavity: a systematic review and meta-analysis.
abstract: BACKGROUND
  In this study, a meta-analysis of level IIb metastases in squamous cell carcinoma (SCC) of the oral cavity was conducted.
  
  
  METHODS
  Two independent reviewers screened abstracts and full text papers deemed potentially relevant. Data were pooled using a random intercept model.
  
  
  RESULTS
  In this analysis, 729 abstracts and 177 full text papers were screened (Kappa statistic 0.8 and 1.0, respectively). A total of 332 patients in 9 papers were included in the analysis. Twenty patients had level IIb metastases (mean, 6%; range, 0% to 10.4%). The pooled percentage of level IIb metastases was 6.0% (95% CI: 3.5-8.6). Only 3 patients with level IIb metastases had isolated nodal disease. Eighty-five percent of those with level IIb metastases had additional nodal disease (95% CI: 64.0-94.8), with IIa being a common denominator among all.
  
  
  CONCLUSIONS
  Level IIb nodal metastases are relatively uncommon in previously untreated SCC of the oral cavity (6%). Furthermore, isolated level IIb nodal disease is uncommon. However, given the quality of evidence to date, it is recommended that dissection of level IIb remain the standard of care in oral cavity squamous cell cancer.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Wharton Head and Neck Program, University Health Network, Princess Margaret Hospital, Toronto, Ontario, Canada.
authors.forename: Jane
authors.initials: J
authors.lastname: Lea
authors.forename: Gideon
authors.initials: G
authors.lastname: Bachar
authors.forename: Anna M
authors.initials: AM
authors.lastname: Sawka
authors.forename: Deepak C
authors.initials: DC
authors.lastname: Lakra
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Gilbert
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Irish
authors.forename: Dale H
authors.initials: DH
authors.lastname: Brown
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Gullane
authors.forename: David P
authors.initials: DP
authors.lastname: Goldstein
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D009062:Mouth Neoplasms / Q000473:pathology*; D037981:Neck Dissection