title: Levels II and III neck dissection for larynx cancer with N0 neck.
abstract: The removal of level II, III, and IV metastases has gained importance in the treatment of squamous cell carcinomas (SCC) of the neck and larynx. This study assessed the possibility of removing level II and level III metastases only, given the low likelihood of occurrence of metastatic lymph nodes on level IV in SCCs of the larynx.
  
  
  OBJECTIVE
  This study aimed to analyze the prevalence rates of metastatic lymph nodes on level IV in laryngeal SCC patients.
  
  
  METHODS
  This prospective study enrolled consecutive patients with laryngeal SCC submitted to neck lymph node dissection. Neck levels were identified and marked for future histopathology testing.
  
  
  RESULTS
  Six percent (3/54) of the necks had level IV metastatic lymph nodes. All cN0 necks (42) were free from level IV metastasis. Histopathology testing done in the cN (+) necks (12) revealed that 25% of the level IV specimens were positive for SCC. The difference between cN0 and cN (+) necks was statistically significant (p = 0.009). Level IV metastases never occurred in isolation, and were always associated with level II or level III involvement (p = 0.002).
  
  
  CONCLUSIONS
  The prevalence rate for lymph node metastasis in cN0 necks was 0%. Level IV metastatic lymph nodes were correlated to cN (+) necks. Level IV metastasis was associated with the presence of metastatic lymph nodes in levels II or III.
authors.affiliation: Department of Otolaryngology Head and Neck, University of Campinas. carloschone@uol.com.br
authors.forename: Carlos Takahiro
authors.initials: CT
authors.lastname: Chone
authors.forename: Hugo Fontana
authors.initials: HF
authors.lastname: Kohler
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Magalhães
authors.forename: Marcos
authors.initials: M
authors.lastname: Navarro
authors.forename: Albina
authors.initials: A
authors.lastname: Altemani
authors.forename: Agricio Nubiato
authors.initials: AN
authors.lastname: Crespo
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D008198:Lymph Nodes / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D009367:Neoplasm Staging; D015995:Prevalence; D011446:Prospective Studies