title: Infracentimetric cervical lymph node metastasis in head and neck squamous cell carcinoma: Incidence and prognostic value.
abstract: OBJECTIVE
  Supracentimetric cervical lymph node metastasis is classically a poor prognostic factor for locoregional recurrence and survival in head and neck cancer. Causality, however, is more controversial for infracentimetric cervical lymph node metastases. The objective of this study was to evaluate the incidence and prognostic value of infracentimetric lymph node metastasis.
  
  
  METHODS
  Two hundred and forty-three neck dissections from 150 head and neck cancer patients were analyzed. A single pathologist exhaustively inventoried the number and size of all adenopathies in the surgical specimen.
  
  
  RESULTS
  Cervical lymph node metastases were infracentimetric in 38% of cases, with 72% extracapsular spread (versus 91% for supracentimetric adenopathies; P<0.01). Infracentimetric metastases were more often associated with other cervical lymph node metastases (mean 5.3 versus 3.9; P=0.14). Fifty three percent of specimens showed only supracentimetric metastases (versus 13% infracentimetric metastases; P<0.01). Disease-specific and failure-free survival were lower in case of infracentimetric metastasis, associated with supracentimetric metastasis or not, than in case of macrometastasis only.
  
  
  CONCLUSIONS
  Infracentimetric cervical lymph node metastasis is a factor of poor prognosis, and may represent a different, more aggressive lymphatic process. We suggest complete neck dissection by the surgeon and meticulous analysis by the pathologist, the results of which guide complementary therapy. Close surveillance of recurrence is also recommended.
authors.affiliation: Service d'ORL et de chirurgie cervicofaciale, CHU de Saint-Étienne, 42055 St-Étienne cedex 2, France. Electronic address: aurelie.pauzie@hotmail.fr.
authors.forename: A
authors.initials: A
authors.lastname: Pauzie
authors.affiliation: Service d'ORL et de chirurgie cervicofaciale, CHU de Saint-Étienne, 42055 St-Étienne cedex 2, France.
authors.forename: M
authors.initials: M
authors.lastname: Gavid
authors.affiliation: Service d'anatomie et cytologie pathologiques, CHU de Saint-Étienne, 42055 St-Étienne cedex 2, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Dumollard
authors.affiliation: Service d'ORL et de chirurgie cervicofaciale, CHU de Saint-Étienne, 42055 St-Étienne cedex 2, France.
authors.forename: A
authors.initials: A
authors.lastname: Timoshenko
authors.affiliation: Service d'anatomie et cytologie pathologiques, CHU de Saint-Étienne, 42055 St-Étienne cedex 2, France.
authors.forename: M
authors.initials: M
authors.lastname: Peoc'h
authors.affiliation: Service d'ORL et de chirurgie cervicofaciale, CHU de Saint-Étienne, 42055 St-Étienne cedex 2, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Prades
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology; D005260:Female; D005602:France / Q000453:epidemiology; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology; D006801:Humans; D015994:Incidence; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D011379:Prognosis
keywords: Head and neck squamous cell carcinoma; Infracentimetric cervical lymph node metastasis; Micrometastasis; Recurrence; Survival