title: Prospective study of 583 neck dissections in oral cancers: implications for clinical practice.
abstract: BACKGROUND
  Determining the level of nodal metastases may help decrease the extent of neck dissections and reduce morbidity.
  
  
  METHODS
  A prospective study of neck dissections in patients with oral cancer was conducted. Each nodal level was delineated, sent for histopathology, and reported level-wise. Incidence of overall and isolated metastatic nodes at different levels was calculated. Logistic regression was used to find factors predicting metastases to levels IIB and V.
  
  
  RESULTS
  Five hundred eighty-three neck dissections were prospectively evaluated. A total of 95.7% metastases occurred at levels I to IV. Overall incidence of metastases to levels IIB and V was 3.8% and 3.3%, respectively. Multivariate analysis revealed IIA positivity as an independent predictive factor for metastases to both IIB and V.
  
  
  CONCLUSIONS
  This study of lymph node mapping in patients with oral cancer showed a predictable pattern of lymph node metastasis according to primary site. Selective neck dissection (levels I-IV) in patients with oral cancers may be adequate. Determining status of level IIA is important to guide dissection of levels IIB and V.
authors.affiliation: Head Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India.
authors.forename: Gouri H
authors.initials: GH
authors.lastname: Pantvaidya
authors.forename: Pooja
authors.initials: P
authors.lastname: Pal
authors.forename: Abhishek D
authors.initials: AD
authors.lastname: Vaidya
authors.forename: Prathamesh S
authors.initials: PS
authors.lastname: Pai
authors.forename: Anil K
authors.initials: AK
authors.lastname: D'Cruz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005629:Frozen Sections; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology*; D015999:Multivariate Analysis; D009333:Neck / Q000473:pathology; D011446:Prospective Studies
keywords: neck dissection; neck nodes; nodal metastasis; oral cancer; skip metastases