Résumé
Objectives: The therapeutic strategy for squamous cell carcinomas of the upper aerodigestive tract (SCC-UADT) relies, in part, on the histopathological study of the neck dissection. Currently, several studies aim to limit the use of lymph node neck dissection based on a radioclinical cTNM evaluation. The objective of this study was therefore to assess the accuracy of clinical and radiological examination in nodal analysis of SCC-UADT compared with the histopathological assessment of neck dissection, in order to evaluate the risk of inadequate oncological management in the absence of decision-making based on the histopathological gold standard.Methods: A retrospective single-centre study was carried out between 2010 and 2024, including patients who had undergone excision and neck dissection for a primary SCC-UADT. The primary endpoint was the number of cases in which cN and pN differed during lymph node assessment of SCC-UADT. In addition, the number of lymph node metastases in level IIB in patients classified as cTXN0, as well as the number of metastases bypassing the theoretical first lymphatic drainage level in patients classified as cT1/T2N0, were collected.Results: A total of 1167 patients were identified. 457 patients (164 women and 293 men) with a mean age of 58.3 years were included. 194 patients showed a discrepancy between cN (clinical-radiological CT scan examination) and pN. 41 patients classified as cTxN0 presented a metastasis in level IIB. 16 patients classified as cT1/T2N0 had an occult metastasis bypassing the theoretical first lymph node drainage level.Conclusions: Clinical and radiological examination is not yet sufficiently reliable to serve as the sole basis for an oncological strategy concerning SCC-UADT. It is therefore necessary to pursue further investigations into the safety and reliability of therapeutic de-escalation measures.Contribution to the literature: Although there is currently a desire to place imaging at the centre of oncological strategy, this publication highlights the limitations of such an approach and the importance of histopathological assessment in the management of lymph node metastases in squamous cell carcinomas of the upper aerodigestive tract.