Abstract
Objectives : Primary : To determine the rate of occult cervical
metastasis in primary temporal bone squamous cell carcinomas (TBSSC).
Secondary : to perform a subgroup meta-analysis of the risk of occult
metastasis based on the clinical stage of the tumour and its risk based
on corresponding levels of the neck
Design : A systematic review and meta-analysis of papers
searched through Medline, Cochrane, Embase, Scopus and Web of Science up
to January 2021 to determine the pooled rate of occult lymph
node/parotid metastases. Quality assessment of the included studies was
assessed through the Newcastle-Ottawa scale.
Setting : Centres around the world that perform surgery for
TBSCC
Participants : Patients with TBSCC
Results : Overall, 9 out of 1034 screened studies met the
inclusion criteria, for a total of 907 patients of which 388 had TBSCC.
Out of the 191 patients who underwent a neck dissection, 21 had positive
lymph nodes giving a pooled rate of occult metastases of 11% (95% CI:
7%-17%). When analysed using the Modified Pittsburg staging system, 21
pT2 cases had a pooled occult metastases rate of 3% (95% CI:
0%-21%), 27 pT3 cases had a pooled occult metastases rate of 12%
(95% CI: 1%-60%), and 65 pT4 cases had a pooled occult metastases
rate of 14% (95% CI: 7%-25%). Data available showed that most of the
positive nodes were in Level II.
Conclusion: The rate of occult cervical metastases in TBSCC
increases based on the tumour (T) staging of the disease with majority
of nodal disease found in level 2 of the neck.
Key Words: lymph node metastases, squamous cell carcinoma,
elective neck dissection, meta-analysis, temporal bone carcinoma.