Distribution of metastatic lymph nodes in early oral cancer

Abstract

Objectives: The aim of this study is to demonstrate the prevalence and patterns of regional metastases in Stage I-II squamous cell carcinoma (SCC) of the tongue and floor of the mouth. Methods: From January 1987 through December 1997, 339 previously untreated patients with TI-II N0 M0 SCC of the tongue and floor of the mouth underwent primary surgical treatment in our institution with 245 neck dissections. A retrospective review of the pathology reports and outcome of these patients was made to ascertain the prevalence and distribution of neck metastases (NM) by neck level, according to the primary site and the time of neck dissection (elective versus subsequent therapeutic). Results: Overall incidence of NM was 43.4% (24.8% TIN0M0 and 52.75% TIIN0M0). Occult NM at elective neck dissection ocurred in 22.2% of patients (15.5% TIN0M0 and 25.6% TIIN0M0). Clinically N+ metastases occurred in 21.2% of patients at subsequent neck dissection (9.3% TIN0M0 and 27.1% TIIN0M0). Level II was the most frequent site of NM in all sites in both END and SND groups. Neck level IV nodes were involved in only 1.3% of patients in END group vs 23.7% in SND group. Level V was always always associated withnodal metastases in other neck levels, occurring in only 8.7% in SND group. Of all patients, only 1.8% presented “skip metastases” in the neck. Conclusions: Based on our series of 339 patients with early cancer of the oral cavity, we found levels I, II, and III to be at great risk for the development of nodal metastases.