The presence of cervical lymph node metastasis at presentation or at initiation of treatment is the main adverse prognostic factor for patients with squamous cell carcinoma (SCC) of the upper aerodigestive tract. Its presence at either of these times reduces the fiveyear survival rate by approximately 50%, regardless of the primary site of the carcinoma (1). However, clinical and pathologic findings specific to lymph node metastasis provide additional prognostic information related to tumor recurrence and overall survival. Furthermore, accurate pathologic staging of the neck of patients with head and neck cancer is important for providing information and optimizing the treatment plan (2). Pathologic findings in neck dissections are considered definite reference points; therefore, it is essential that both pathologists and clinicians approach the morphologic evidence with rigor, recognizing its limitations as well as its contributions to rational clinical planning (3).