How we do it: a method of neck dissection for histopathological analysis

Abstract

Background: Dissection of the lymphatic structures in the neck is an integral part of the management of many head and neck cancers. We describe a technique of surgical dissection, preparing the tissue for more precise histological analysis while also reducing operative time and complexity.

Methods: When dissected, each level is excised between lymph nodes groups and put into a separate pot of formalin taking care to avoid rupture of any obvious pathological nodes.

Results: This makes for a simpler dissection as the surgeon progresses, as a larger more cumbersome specimen is avoided and manipulation of involved nodes is actually reduced with a reduced risk of tumour spillage.

Conclusion: We feel that our technique provides several advantages for the histopathologist as well as the surgeon. As the dissection of the specimen into the relevant levels has already been performed, time is saved in orientating and then dissecting the specimen. Accuracy of dissection is also improved and each piece of tissue is a more manageable size for processing and analysis.This technique may also have several surgical advantages when compared with the commonly practiced techniques e.g. with reducing in-vivo specimen manipulation, hence reducing the risk of inadvertent injury to important structures and tumour spillage.

Figure 1

Surgical anatomical boundaries of neck node levels.

Figure 2

Showing separated left supra-omohyoid neck dissection specimen per level, (left levels 1, 2A, 2B and 3). The inset shows the separate pathology pots for each neck level and each side in addition to the main specimen.

Figure 3

A Modified radical neck dissection specimen. This is a typical example of our previous method of 'en-bloc' resections whereby the tongue/floor of mouth and neck are taken in continuity. The resection has been secured onto a standard neck landmark diagram. Although appearing impressive and attempting to 'help' the pathologist much important data is lost. The bulkiness of the tumour in three dimensions seems to overspill in areas. Also manipulation of the entire specimen during each stage of the excision may easily have shed potential viable tumour cells. Taken objectively and in light of modern molecular biological knowledge many areas of potentially positive resection margins have not been sampled. The specimen in contact with areas of concern e.g. mandible, deep resection margins should have be stained.