Cervical Lymph Node Evaluation in Oral Squamous Cell Carcinoma Patients Using Ultrasound-Guided Fine-Needle Aspiration Cytology - A Descriptive Diagnostic Evaluation Study in a Tertiary Care Center.

Abstract

Background:Oral cancer is the most frequent type of cancer of the head and neck area, with squamous cell carcinoma (SCC) being the most common single entity. Worldwide, oral cancer accounts for 2%–4% of all cancer cases, the prevalence being highest in India. Lymph node metastases occur in about 40% of patients with oral cancer. Clinically, their manifestations are hidden in rates of 15% to 34%. More accurate imaging techniques can reduce the risk of undiagnosed metastasis. Ultrasonography has gained wide acceptance as a diagnostic aid in the evaluation of reactive and metastatic lymph nodes. The present study is an attempt to assess the earliest evaluation of the cervical lymph nodes by ultrasound-guided fine-needle aspiration cytology (FNAC).Methodology:A descriptive diagnostic evaluation study was carried out to find out the sensitivity and specificity of ultrasound-guided FNAC in detecting metastasis to cervical lymph nodes from oral SCC in the Department of Oral Medicine and Radiology, Government Dental College, Thiruvananthapuram, in collaboration with the Department of Imageology, Regional Cancer Centre, Thiruvananthapuram during the time period from July 2015 to September 2016.Results:A total of 112 patients with histologically proven oral SCC having palpable lymph nodes were evaluated clinically and ultrasonographically. In this study, sensitivity and specificity of >90% were obtained for ultrasonographic criteria such as the long axis to short axis ratio <2, the absence of hilum, heterogeneous architecture, and altered vascularity in the evaluation of metastatic lymph nodes. The diagnostic yield in the detection of metastatic lymph nodes was much higher in the ultrasonographic examination.Conclusion:Ultrasound-guided FNAC offers an opportunity to enhance patient prognosis through early detection and a specific diagnosis (92.5%) when compared to clinical examination (78.6%) in the current study.