Intraoperative wound irrigation in neck dissections for cytological differential diagnosis and prediction of the presence of lymph node metastases in patients with head and neck squamous cell carcinoma.

Introduction Neck dissection is a standardised procedure in patients with head and neck squamous cell carcinoma (HNSCC) with high relevance of the histopathological findings for adjuvant treatment planning. At the end of the procedure, wound irrigation is performed in routine clinical practice, but in contrast to other specialties, for example gynaecological oncology, it is not used for diagnostic purposes.

Material/Methods: In the present study, intraoperative irrigation of the cervical wound area was performed at the end of surgery in 111 neck dissections of HNSCC patients and the material obtained was processed by liquid-based cytology (LBC). After subsequent PAP and, if necessary, immunocytological staining, the cell suspensions were examined for the presence of tumor cells and the findings were compared with the histological lymph node status.

Results LBC showed high diagnostic validity for the detection of lymph node metastases with extracapsular spread (ECS) with a specificity of 95.4%, sensitivity of 100%, NPV of 100%, PPV of 85.7%. LBC-based tumor cell detection was successful in 1.3% of histologically negative lymph nodes, in 23.1% of histologically positive lymph nodes without ECS and in 100% of histologically positive lymph nodes with ECS.

Discussion Differential cytological analysis of neck dissection wound irrigations, with overall good correlation with histopathological findings, can very quickly provide information on the neck lymph node status of HNSCC patients, pave the way for prompt planning of adjuvant therapy and thus potentially contribute to more efficient therapy management of HNSCC patients.

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Publication History

Article published online:
12 May 2023