Prevalence of occult nodal metastases in squamous cell carcinoma of the
temporal bone: A systematic review and meta-analysis
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.