The extracapsular spread of tumors in cervical node metastasis.

Extracapsular spread (ECS) of lymph node metastases is believed to be an indicator of poor prognosis. In general, it has been thought that ECS was limited to large "fixed" nodes. To test the validity of the assumption that nodes less than 3 cm in diameter do not have ECS, the specimens from 177 radical neck dissections were reviewed retrospectively with regard to ECS. Sixty-five percent of the nodes that were 2.9 cm or less in diameter were found to demonstrate ECS. We found no substantial difference in the number of patients who had no histologic disease in their necks when compared with a second group of patients who had metastasis confined to the lymph node. The patients whose lesions had ECS had statistically significantly reduced numbers of survivors. Other factors, eg, tumor differentiation and the number of malignant nodes, had no prognostic importance. The impact of ECS on staging, the reporting of retrospective reviews, and therapy are discussed.