Esclamado R M, Carroll W R
Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor.
Arch Otolaryngol Head Neck Surg. 1992 Nov;118(11):1157-8. doi: 10.1001/archotol.1992.01880110025006.
Extracapsular spread of squamous cell carcinoma in cervical lymph nodes is associated with approximately 50% decrease in survival and a twofold increase in regional recurrence. This study examines the hypothesis that increased regional recurrence may be, in part, due to unrecognized microscopic perineural invasion of the nerve rootlets of the cervical plexus. Thirty patients with head and neck squamous cell carcinoma with clinically N+ necks undergoing radical neck dissection were prospectively studied. Neck dissection specimens were evaluated for extracapsular spread, and the cervical plexus rootlets were histologically examined for perineural invasion. The incidence of extracapsular spread was 83% (25 of 30 patients). Only one (4%) of 25 had involvement of the cervical plexus, and this patient had gross as well as microscopic cervical plexus invasion. Microscopic perineural spread of squamous cell carcinoma in the cervical plexus occurs infrequently when extracapsular spread is present. Routine histologic evaluation of cervical rootlets for margins is warranted only when gross tumor is in close proximity to the cervical plexus.
宫颈淋巴结鳞状细胞癌的包膜外扩散与生存率下降约50%以及区域复发率增加两倍相关。本研究检验了以下假设：区域复发增加可能部分归因于未被识别的颈丛神经根微小神经周围浸润。对30例临床颈部N+的头颈部鳞状细胞癌患者进行前瞻性研究，这些患者均接受根治性颈清扫术。对颈清扫标本进行包膜外扩散评估，并对颈丛神经根进行组织学检查以确定是否存在神经周围浸润。包膜外扩散的发生率为83%（30例患者中的25例）。25例中只有1例（4%）累及颈丛，该患者存在颈丛的大体及微小浸润。当存在包膜外扩散时，鳞状细胞癌在颈丛中的微小神经周围扩散很少见。仅当大体肿瘤紧邻颈丛时，才需要对颈神经根切缘进行常规组织学评估。
