Cervical lymph node metastasis in squamous cell carcinoma of the buccal mucosa: a retrospective study on pattern of involvement and clinical analysis.

N Hoda,R Bc,S Ks,Vd B,S Ghosh,J Nathani

doi:10.4317/medoral.24016

Abstract

Background The study was performed with an aim to map the pattern of metastasis of squamous cell carcinomas of buccal mucosa to various cervical lymph node levels and analyze its correlation with primary tumor size and histo-pathological grading. Material and Methods 254 patients with squamous cell carcinoma of the buccal mucosa treated with surgery first approach were analyzed retrospectively. The tumor size was noted from pre-operative CT Scans and were divided into early and advanced tumors. The resected specimen was studied to note the histo-pathological grading of the squamous cell carcinoma and the metastatic deposits at various lymph node levels. Results Out of 254 patients (149 females, 105 males), 145 patients showed histo-pathologically proven metastatic deposits in one or more lymph nodes out of which there were 56 patients showing occult metastasis. 78/145 patients showed metastatic involvement of level IB and/or IA lymph nodes, 31 showed involvement of level II and/or I lymph nodes, 27 showed involvement of level III with or without involvement of level I and II and 9 showed metastasis to level IV and V lymph nodes with or without level I, II or III lymph nodes. Cervical lymph node metastasis had statistically significant association with tumor size with advanced tumors showing worse pattern of metastatic spread beyond level I and II lymph nodes. As the degree of differentiation of squamous cell carcinoma reduced, they were more prone for cervical metastasis with moderately and poorly differentiated squamous cell carcinoma showing higher involvement of level III, IV and V lymph nodes. Conclusions The majority of buccal mucosa cases showed metastasis to level I, II and III lymph nodes out of which level IB and/or IA was most frequently involved. Metastasis to level IV and V lymph nodes was rare and was seen especially in patients with advanced primary tumor and poor histo-pathologic differentiation. Key words:Oral squamous cell carcinoma (OSCC), cervical lymph node metastasis, histologic differentiation, locally advanced disease.

Highlights

One of the most common sites for cancer in the head and neck region is the oral cavity with squamous cell carcinoma being the most common type of malignancy [1,2]
A total of 254 patients who satisfied the inclusion and exclusion criteria were included in the study. 149 of them were females and 105 were males, and their ages ranged from 26 years to 74 years. 196/254 (77.17%) patients had any habit of chewing or smoking any form of tobacco and/or areca nut. 101/254 cases had clinically positive neck out of which 89 cases showed actual metastasis to cervical lymph nodes
In the remaining 9 cases there were metastasis seen in lymph node levels IV and V with or without involvement of lymph node levels I, II and III (Table 2)

Summary

Introduction

One of the most common sites for cancer in the head and neck region is the oral cavity with squamous cell carcinoma being the most common type of malignancy [1,2]. Oral squamous cell carcinomas (OSCC) carry with them a high tendency for cervical lymph node metastasis which is proven to be the most significant independent prognostic factor, reducing the survival rate of the patient by 50% [4]. The extent of occult metastasis and the involvement of various levels of lymph nodes were analyzed and they were correlated with the size of the primary tumor and the histo-pathological grading. The study was performed with an aim to map the pattern of metastasis of squamous cell carcinomas of buccal mucosa to various cervical lymph node levels and analyze its correlation with primary tumor size and histo-pathological grading. The resected specimen was studied to note the histo-pathological grading of the squamous cell carcinoma and the metastatic deposits at various lymph node levels. Metastasis to level IV and V lymph nodes was rare and was seen especially in patients with advanced primary tumor and poor histo-pathologic differentiation

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