Norling Rikke, Therkildsen Marianne H, Bradley Patrick J, Nielsen Michael B, von Buchwald Christian
Department of Radiology, Copenhagen University Hospital, Denmark.
Acta Otolaryngol. 2013 Sep;133(9):965-71. doi: 10.3109/00016489.2013.799290.
The total lymph node yield in neck dissection is highly variable and depends on anatomical, surgical and pathological parameters. A minimum yield of six lymph nodes for a selective neck dissection (SND) as recommended in guidelines lies in the lower range of the reported clinical nodal yields. A future application of a lymph node ratio may improve the risk stratification of head and neck cancer patients. However, this will require a higher number of retrieved lymph nodes.
To compare the clinical guideline recommendations for nodal yield in SND with the number of lymph nodes obtained from cadavers and the clinical nodal yield reported in the literature.
Lymph nodes retrieved from SND specimens from nine fresh cadavers were quantified histopathologically. The literature on nodal yields reportedly obtained by clinicians performing neck dissections was reviewed. Finally, the discussion makes reference to the six lymph nodes currently recommended in international clinical guidelines.
For clinical SNDs (I-III) the lowest mean nodal yield was 19.4, for SNDs (II-IV) it was 26.4. The cadaver SNDs (I-III and II-IV) yielded 8.8 (range 1-15) and 10.4 nodes (range 1-19), respectively.
颈部清扫术中获取的淋巴结总数差异很大，取决于解剖学、手术和病理学参数。指南中推荐的选择性颈部清扫术（SND）的淋巴结最小获取数为6枚，这处于已报道的临床淋巴结获取数的较低范围。未来应用淋巴结比率可能会改善头颈癌患者的风险分层。然而，这将需要获取更多数量的淋巴结。
比较SND中淋巴结获取数的临床指南推荐值与从尸体获取的淋巴结数量以及文献报道的临床淋巴结获取数。
对9具新鲜尸体的SND标本中获取的淋巴结进行组织病理学定量分析。回顾了关于临床医生进行颈部清扫术所获取淋巴结数量的文献。最后，讨论参考了国际临床指南中目前推荐的6枚淋巴结。
对于临床SND（I - III），最低平均淋巴结获取数为19.4枚，对于SND（II - IV），为26.4枚。尸体SND（I - III和II - IV）分别获取了8.8枚（范围1 - 15枚）和10.4枚淋巴结（范围1 - 19枚）。
