title: Patterns of cervical lymph node metastases in oral tongue squamous cell carcinoma: implications for elective and therapeutic neck dissection.
abstract: OBJECTIVE
  To determine the patterns of lymph node metastases in oral tongue carcinomas, and examine the implications for elective and therapeutic neck dissection.
  
  
  METHODS
  The study entailed a retrospective analysis of 67 patients with previously untreated oral tongue squamous cell carcinoma who had undergone simultaneous glossectomy and neck dissection.
  
  
  RESULTS
  Of the 40 clinically node-negative patients, 7 patients had metastatic lymph nodes on pathological examination. No occult metastasis was found at level IV. Of the 27 clinically node-positive patients, the incidence rate of level IV metastasis was 11.1 per cent (3 out of 27 patients). No 'skip metastases' were found at level IV. Level IV metastases were significantly related to clinically staged nodes categorised as over 2a (p = 0.03) and metastasis to level III (p = 0.01).
  
  
  CONCLUSIONS
  Routine inclusion of level IV in elective neck dissection is not necessary for clinically node-negative patients with oral tongue squamous cell carcinoma. Furthermore, extended supraomohyoid neck dissection with adjuvant radiotherapy can be sufficient in the treatment of selected patients with clinically node-positive necks.
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Dokuz Eylul University School of Medicine, Izmir, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Dogan
authors.affiliation: Department of Radiation Oncology, Dokuz Eylul University School of Medicine, Izmir, Turkey.
authors.forename: H O
authors.initials: HO
authors.lastname: Cetinayak
authors.affiliation: Department of Pathology, Dokuz Eylul University School of Medicine, Izmir, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Sarioglu
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Dokuz Eylul University School of Medicine, Izmir, Turkey.
authors.forename: T K
authors.initials: TK
authors.lastname: Erdag
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Dokuz Eylul University School of Medicine, Izmir, Turkey.
authors.forename: A O
authors.initials: AO
authors.lastname: Ikiz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009367:Neoplasm Staging; D011859:Radiography; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D014062:Tongue Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome