Abstract
Cervical lymph node metastases in oral squamous cell carcinoma (OSCC) are key predictors of disease specific survival. It was therefore the aim of this study to evaluate how much imaging is minimally needed for reliable and efficient identification of cervical lymph node metastases. In this retrospective cross-sectional study, results (metastasis yes/no) of ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) were compared to the final histopathological results of the corresponding neck dissection (ND) specimens (metastasis yes/no). A score was calculated to account for cervical lymph node size, shape, clustering, peripheral enhancement, hilus sign, architecture, blood flow, and central necrosis. Sensitivity and specificity were analyzed for each imaging technique separately. In 164 patients diagnosed with OSCC, 96 underwent uni- or bilateral ND (122 ND in total). One hundred percent sensitivity was achieved by CT+MRI, MRI+PET, US+CT+MRI, US+MRI+PET, CT+MRI+PET, and US+CT+MRI+PET. The highest specificity was realized by US with 79% (95% CI [0.698–0.890]). Specificity for CT+MRI and PET+MRI was 51% (95% CI [0.359–0.665]) and 70% (95% CI [0.416–0.984]), respectively. Regarding 100% sensitivity with acceptable specificity, the combination of CT+MRI or PET+MRI appeared to be suitable for staging cervical lymph nodes in primary OSCC.
Highlights
Oral squamous cell carcinoma (OSCC) is the 15th most frequent tumor worldwide in men and women
From January 2000 to December 2013, a total of 164 patients were diagnosed with OSCC at the University Hospital for Cranio-Maxillofacial and Oral Surgery of the Medical University of Innsbruck, Austria
The number of patients having undergone a combination of two radiological examinations ranged from 15 (MRI+positron emission tomography (PET)) to 76 (US+computed tomography (CT)) respective from 13 (US+magnetic resonance imaging (MRI)+PET) to 56 (US+CT+MRI) for three imaging modalities
Summary
Oral squamous cell carcinoma (OSCC) is the 15th most frequent tumor worldwide in men and women. The incidence is increasing with approximately 300,000 new reported cases annually, or 2.1% of the world total [1]. Especially in combination with heavy alcohol consumption, nonvegetarian diet, poor oral hygiene, poor dentition [2], and in rare cases infections with human papilloma virus (HPV) [3]. The prognosis of OSCC is generally poor with an overall survival rate of less than 60% [4], as well as an estimated recurrence rate of 30% [5]. The persistence of poor survival in this subgroup underscores the need for better prognostic tools, such as the lymph node ratio (LNR) or improved patient stratification
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