The Anatomic Location of Neck Metastasis from Occult Squamous Cell Carcinoma

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Abstract
The inappropriate open biopsy of a squamous cell carcinoma metastatic to a cervical node will statistically double the subsequent rates of local recurrence and distant metastasis. There is no reliable method to clearly distinguish a cervical node involved with squamous cell carcinoma from adenopathy of other sources. Patients with cervical adenopathy are evaluated with careful visualization and palpation of the upper aerodigestive tract prior to open biopsy. The extent of this evaluation is often judgmental. A review of patients with cervical adenopathy of unknown origin and who had had a tissue diagnosis, shows that node location is the most helpful parameter for predicting eventual histopathology. Nodes in the jugulodigastric, digestive and anterior cervical regions have a probability of 19 and 12%, respectively, of being squamous cell carcinoma. Multiple adenopathies in the supraclavicular and posterior cervical areas are frequently malignant (84 and 61%, respectively); these are usually either lymphoma or infraclavicular metastasis.

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