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PRINCIPLE OF THE TEST.
A radical neck dissection is performed for known or suspected cancer,
or other clinical indication, and received in surgical pathology
for evaluation. The specimen should be oriented, evaluated grossly,
surgical margins inked, and any gross abnormalities described thoroughly.
The final report should reflect an adequate sampling of tissue,
and should include the size and TNM stage of any tumor.
SPECIMEN REQUIRED.
Tissue Specimen and filled-out
Tissue Examination Form (USSF515).
REAGENTS, INSTRUMENTATION.
1. Dissection Instruments.
STEP-BY-STEP DESCRIPTION.
1. Orient the specimen. The salivary gland occupies
the most anterosuperior aspect of the resection. The internal jugular vein
lies over the medial surface of the sternocleidomastoid muscle.
2. Open the vein. Sample any lesions.
3. Separate off each level. Identify all of the lymph nodes.
Sample each node for histology.
4. Examine the salivary gland.
Submit a section for histology.
5. Section the muscle. Submit a section of it,
if any lesions are encountered.
6. Levels in the neck dissection specimens are assigned
as accepted by the AJCC.
7. The surgeon orients the specimen, and places
marking sutures in designated areas of the specimens.
8. The surgeon sends neck specimens to pathology fresh,
so that they can be cut while it is still easy to identify
known structures and lymph nodes.
9. An up-to-date CAP approved checklist
(scientifically validated data elements, SVDEs), based on the
AJCC/UICC staging system, is included in the report
for all complex specimens (i.e., everything that is
not a biopsy or simple skin excision).
These checklists have been compiled by pathologists, surgeons,
and oncologists, and include all the relevant information including
perineural invasion, lymphatic invasion, maximum tumor size,
size of largest lymph node metastasis, presence of extracapsular spread, etc.
10. All neck dissections are reviewed with the resident
by the attending pathologist prior to grossing, to ensure accurate
orientation and thorough sampling.
11. All neck dissections have two designating sutures
placed by the surgeon performing the neck dissection, one indicating
the lowest level present in the dissection and the second designating
the highest level in the neck dissection.
12. All neck dissections are submitted
to the pathology department, fresh on ice.
FIGURE 1.
REFERENCES.
1. Rosai J.
Rosai and Ackerman's Surgical Pathology. Ninth Edition.
St Louis: C.V. Mosby. 2004;:.
ISBN: 0323013422, 3080 pages.
2. Mills SE, Carter D, Greenson JK, Oberman HA,
Reuter VE, Stoler MH, eds.
Sternberg's Diagnostic Surgical Pathology. Fourth Edition.
New York: Lippincott Williams & Wilkins. 2004;:.
ISBN: 0781740517, 3089 pages.
3. Westra WH, Hruban RH, Phelps TH, Isacson C.
Surgical Pathology Dissection. An Illustrated Guide.
Second Edition. With a Forward by Askin FB.
New York: Springer. 2002.
ISBN 0-387-95559-3, 258 pages.
4. Lester SC.
Manual of Surgical Pathology.
New York: Churchill Livingstone.
A Harcourt Health Sciences Company. 2001;:.
ISBN 0-443-07918-8, 336 pages.