The frequency of lymph node metastases by neck level in p16 positive oropharyngeal squamous cell carcinoma

Patients with p16+ve OPSCC who are staged cN0 pre-treatment, and who undergo primary surgical treatment of the neck, are required to have a neck dissection to include levels II, III and IV in order to minimise the risk that pathological staging understates the disease burden of clinically occult nodal disease. If patients are staged cN+ve pre-treatment, there is high positive predictive value for the presence of pathological nodal disease at the corresponding neck level. There is poor negative predictive value for the absence of nodal disease clinically at level II. The nodal distribution of HPV-specific disease is not significantly different to that found in previous studies that have not considered HPV (or p16) status. We demonstrate a sensitivity of 93% and a specificity of 83% for overall cN0 staging in p16+ve OPSCC.