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Michiel W. M. van den Brekel, MD, PhD; Jonas A. Castelijns, MD, PhD; Laurens C. Reitsma, MD; Charles R. Leemans, MD, PhD; Isaäc van der Waal, DD, PhD; Gordon B. Snow, MD, PhD

Arch Otolaryngol Head Neck Surg. 1999;125:153-156.

Objective  To assess the outcome of patients who underwent transoral tumor excision and a wait-and-see policy for the N0 neck, using ultrasonographic-guided fine-needle aspiration cytology (US-FNAC) of the neck for both selecting patients for neck treatment or observation and for follow-up.

Design  Retrospective outcome analysis of a patient cohort without palpable or US-FNAC detectable nodal metastases undergoing transoral tumor excisions. Patients were followed up for 1 to 4 years using palpation and US-FNAC.

Setting  Academic center.

Patients  A consecutive sample of 77 patients mainly with oral carcinomas. Excluded were patients who had neck dissections, radiotherapy, or no US-FNAC during follow-up.

Intervention  Transoral tumor excision. Neck dissection with radiotherapy for regional failure.

Outcome Measure  The recurrence rate in the neck, without failure at the primary site and the salvage rate of these neck recurrences were the most important measures. Treatment delay and histopathologic findings were assessed as well.

Results  Fourteen patients (18%) had occult lymph node metastases and neck failures. Of the 14 neck failures, 9 were detected within 7 months of which 6 were not palpable. Ten (71%) of these 14 patients were successfully salvaged, and 4 died of uncontrolled disease. Three of the 4 patients also had distant metastases.

Conclusions  The low recurrence rate (18%) can be attributed to the initial US-FNAC. The high salvage rate (71%) indicates that strict US-FNAC follow-up enables early detection of recurrence in the neck. A wait-and-see policy thus seems warranted, provided regular US-FNAC examinations during follow-up can be guaranteed.

From the Departments of Otorhinolaryngology–Head and Neck Surgery (Drs van den Brekel, Reitsma, Leemans, and Snow), Radiology (Dr Castelijns), and Oral Surgery and Pathology (Dr van der Waal), Free University Hospital, Amsterdam, the Netherlands.

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