The article is written based on individuals that have had a positive intraoral diagnosis, in which neck involvement appeared not to be present, using conventional scanning technologies. Subsequent surgeries or development of disease yielded the findings over the period that the population was watched. While you would assume that a neck dissection would remove all possible risk, there are possible other issues. In my own case, the nodes were bilaterally involved, even though my primary was just on the right. If I had been found as a stage three, and not a four, those two nodes on the left would have not been developed enough for a scan to pick them up in all likelihood. Second, and this is informed speculation on my part, there is no evidence that nodal involvement is the only place that neck mets go to. We know for sure that the disease can reside in a variety of tissues, muscle, bone, adipose, etc. and while I think it is well understood that nodes are the most likely location for it to go, I am far from certain that this is the ONLY place it goes. A neck dissection in which known mets are not being removed, but for surety sake is being done, only takes out node chains. Could it still exist in that location as a micro met? Your question is a good one and I will pose it to some doctors in next weeks phone conference with the advisory board.