Node Count as a Quality Indicator in Surgically Treated Mucosal Head and Neck Squamous Cell Cancer

Introduction: A yield of ≥18 nodes from neck dissection has been shown to be associated with improved locoregional recurrence rates and survival. We sought to determine factors associated with lymph node yields below this threshold. Materials and Methods: A retrospective review of patients who underwent neck dissection as part of definitive surgical treatment for mucosal head and neck squamous cell carcinoma (SCC) between January 2015 and December 2018 at an academic tertiary referral center was performed. Patients with a history of prior radiation or neck dissection were excluded. Results: There were 412 neck dissections performed in 323 patients. Specimens containing <18 nodes decreased from 16.2% in 2015–2016 to 7.4% of neck dissections in 2017–2018. The proportion of neck dissections removing <3 levels decreased from 9.1% of neck dissections in 2015–2016 to 4.0% in 2017–2018. Multivariable regression analysis demonstrated that dissection of ≥3 levels (OR = 0.2 [0.1–0.4]) and neck dissection in 2017–2018 compared to 2015–2016 (OR = 0.4 [0.2–0.8]) were significantly associated with a lower odds of <18 nodes. Stage, site, race, sex, human papillomavirus status, positive nodes, surgeon volume, and pathologist volume were not associated with neck dissection specimens with <18 nodes, after controlling for all other variables. Conclusions: Increased recognition of the importance of node count as a quality indicator, and the extent of neck dissection is associated with increased nodal yield from neck dissection. These data suggest that node count can be used as a quality measure of neck dissection for mucosal SCC. Level of Evidence: 4 Laryngoscope, 2022.