Comparison between clinical examination, ultrasonography, and computed tomography in assessment of cervical lymph node metastasis in oral squamous cell carcinoma

Abstract

Introduction: The most important prognostic factor in oral squamous cell carcinoma (OSCC) is the presence or absence of clinically involved neck nodes. Appropriate diagnosis of the metastatic lymph node is very important for management of OSCC. Aim: The aim of the present study was to evaluate the diagnostic accuracy of metastatic cervical lymph nodes through clinical examination, ultrasonography (USG) and computed tomography (CT), and to compare them with each other. Materials and Methods: Twenty individuals with histologically proven OSCC were selected for the study. The selected individuals were clinically examined by a single trained investigator and further investigations were advised. USG and contrast enhanced CT was performed for each patient with cervical lymphadenopathy to evaluate the findings. The results of each modality were analyzed for sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Pathological analysis of the surgical specimen served as the reference standard. Results: Considering pathological analysis of the surgical resection as the baseline, data obtained from clinical, USG and CT examinations were compared. We found that the cases which showed negative results in clinical evaluation showed positive results in both CT and USG; on comparing the specificity and sensitivity, USG had 93% specificity and 92% sensitivity whereas CT had 84% specificity and 81% sensitivity. Conclusion: This study concludes that one should not rely solely on clinical evaluation; other diagnostic methods should be evaluated. Although CT is better than clinical evaluation, USG was found to be superior to both clinical and CT examinations.