Background: TNM classification of squamous cell carcinomas of the head and neck contains only size and number of the lymph node metastases. The histological criterion of capsular rupture and its prognostic significance was assessed by an exact histological scheme of capsular rupture and extracapsular spread of the metastasis and was compared with N0 or lymph node metastases without capsular rupture respectively.
Methods: Incidences of distant metastases, tumor recurrences, and survival of 194 consecutive patients with squamous cell carcinomas of the head and neck were investigated. Lymph node metastases were examined by the gradual histological scheme and patients were rated according their histological diagnosis.
Results: The classification N0/intranodal tumor growth/extranodal tumor growth resulted in a 5-year survival rate of 74%/62%/25%. According to the classification 67%/72%/37% of the patients were without local recurrent tumor and without distant metastases were 81%/79%/48% after 5 years.
Conclusions: Capsular rupture seems to contain more decisive prognostic value as the criterion of only lymphatic metastatic disease. The histological scheme allows an exact assessment of the capsular rupture or the metastatic pattern of the lymph node. Because of its prognostic significance and individual therapeutic consequences the easily reproducible criterion of capsular rupture is a useful completion to current TNM classification.