Outcome of observing the N0 neck using ultrasound-guided cytology for follow-up

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 histopathology 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 no 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.