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A Modified radical neck dissection specimen. This is a typical example of our previous method of 'en-bloc' resections whereby the tongue/floor of mouth and neck are taken in continuity. The resection has been secured onto a standard neck landmark diagram. Although appearing impressive and attempting to 'help' the pathologist much important data is lost. The bulkiness of the tumour in three dimensions seems to overspill in areas. Also manipulation of the entire specimen during each stage of the excision may easily have shed potential viable tumour cells. Taken objectively and in light of modern molecular biological knowledge many areas of potentially positive resection margins have not been sampled. The specimen in contact with areas of concern e.g. mandible, deep resection margins should have be stained.
This makes for an easier dissection as the surgeon progresses, as a
larger more cumbersome specimen (Figure 3) is avoided and
manipulation of involved nodes is actually reduced with a reduced
risk of tumour spillage.
Furthermore, as illustrated in Figure 3 the actual
three-dimensional bulk of the tumour cannot be encompassed by the
standard two dimensional anatomical template upon which the neck
dissection is secured.
Upile, Tahwinder; Jerjes, Waseem; Nouraei, Seyed Ahmad Reza; Singh, Sandeep; Clarke, Peter; Rhys-Evans, Peter; Hopper, Colin; Howard, David; Wright, Anthony; Sudhoff, Holger; Fisher, Cyril; Sandison, AnnJournal: BMC Surgery
Issue 1DOI: 10.1186/1471-2482-7-21Published: 2007-12-01Institution(s):
The Ear Institute, University College London, Charing Cross Hospital, The Royal National Throat, Nose and Ear Hospital, University College London Hospital, Royal Free & University College Medical School, Medical and Surgical Sciences, UCL Eastman Dental Institute, The Royal Marsden Hospital, University of Bochum
This image is from the article titled "How we do it: a method of neck dissection for histopathological analysis"
(from BMC Surgery) which is copyrighted by Upile et al. For more information on the
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