Level IIB lymph node metastasis in oropharyngeal squamous cell carcinoma


  • Presented at the Triological Society Combined Sections Meeting, Scottsdale, Arizona, U.S.A., January 24–26, 2013.

  • All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: b.c.g., s.m.o., k.d.o., d.l.p.; acquisition of data: b.c.g.; analysis and interpretation of data: b.c.g., s.m.o., k.d.o., d.l.p.; drafting of manuscript: b.c.g., s.m.o., k.d.o., d.l.p.; critical revision of manuscript: b.c.g., s.m.o., j.e.l., j.l.k., e.j.m., k.d.o., d.l.p.; study supervision: k.d.o., d.l.p.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.



To determine the incidence of level IIB lymph node metastasis in patients with oropharyngeal squamous cell carcinoma (OPSCC) and to evaluate the necessity of level IIB dissection for elective and therapeutic neck dissections.

Study Design

Retrospective cohort study.


Patients with OPSCC (N = 348) were surgically managed at our institution from 2004 through 2010. Neck dissection specimens were reviewed by a pathologist, and level IIB metastases were analyzed with respect to clinical and pathologic data.


Level IIB lymph node metastases were present in 2.5% and 25% of elective and therapeutic neck dissections, respectively. Level IIA metastasis, clinical tumor stage, clinical nodal stage, extracapsular spread, and primary tumor location in the tonsil were significantly associated with level IIB metastasis.


This study uniquely demonstrated a statistically significant association between clinical tumor stage and tonsil subsite with level IIB metastasis in OPSCC. Considering the predicted incidence of nodal metastasis, we conclude that level IIB neck dissection can be omitted in early stage (T1 or T2) clinically node negative (cN0) OPSCC. In patients with a cN0 neck and advanced OPSCC (T3 or T4), primary tumor in the tonsil, or ipsilateral clinically node positive (cN+) and contralateral cN0 neck, level IIB dissection should be considered. Level IIB dissection should be performed routinely in patients with cN+ OPSCC.

Level of Evidence

4. Laryngoscope, 123:2700–2705, 2013