What is the nomenclature for a neck dissection involving levels II to VI?

Nomenclature for Neck Dissection Involving Levels II-VI

A neck dissection involving levels II-VI does not fit standard nomenclature categories and would be classified as an "extended selective neck dissection" or potentially a "comprehensive neck dissection" depending on whether level I is clinically involved. 1

Contemporary Classification Framework

The NCCN guidelines establish a two-tiered classification system that has replaced older terminology:

Comprehensive Neck Dissection

• Removes all lymph node groups included in a classic radical neck dissection (levels I-V) 1
• Classification as "comprehensive" is independent of whether the sternocleidomastoid muscle, jugular vein, or spinal accessory nerve is preserved 1
• Recommended for N3 disease 1

Selective Neck Dissection

• Encompasses three or fewer nodal levels based on predictable patterns of lymphatic spread 1
• Standard selective dissections include:
  • Levels I-III (supraomohyoid) for oral cavity tumors 2
  • Levels II-IV for oropharynx and laryngeal tumors 1, 2
  • Levels II-IV plus level VI when appropriate for infraglottic laryngeal cancers 1
• Recommended for N0 disease 1, 2

The Levels II-VI Dissection Problem

Your specific question about levels II-VI presents a nomenclature challenge because:

• This encompasses five nodal levels (II, III, IV, V, VI), which exceeds the three-level threshold for selective neck dissection 3
• It excludes level I, so it does not meet the definition of comprehensive neck dissection 1
• This would be most accurately described as an "extended selective neck dissection" specifying levels II-VI 3, 4

Clinical Context Matters

For laryngeal/hypopharyngeal primaries:

• A dissection of levels II-VI (sparing level I) may be considered a comprehensive neck dissection variant, as level I is rarely at risk from these primary sites 3
• Level VI inclusion is specifically appropriate for infraglottic laryngeal cancers 1

For oral cavity primaries:

• Omitting level I would be inappropriate, as this level is essential for oral cavity tumors with nodal involvement 5

Practical Documentation Approach

When documenting this procedure, specify:

• The exact lymph node levels removed (II, III, IV, V, VI) 3, 4
• Nonlymphatic structures preserved (e.g., sternocleidomastoid muscle, internal jugular vein, spinal accessory nerve) 3, 4
• Any additional nonlymphatic structures excised beyond standard dissection 3

Critical Caveat

A properly performed neck dissection removing levels II-VI should yield at least 10 lymph nodes for pathologic examination if it includes level V (making it comprehensive in scope), or at least 6 lymph nodes if truly selective 2, 5