Evaluation of Cervical lymphnode Metastasis in Oral Squamous Cell Carcinoma: Comparison between Palpation, USG, CT Scan & Histopathology

Abstract

Background:The presence or absence of nodal metastasis has a great impact on the prognosis and survival of patients with head and neck cancer. The risk of occult metastasis is related to the method by which the lymph nodes are evaluated. It is possible to reduce the risk of undiagnosed metastasis with accurate imaging techniques and thus probably reduce the number of elective neck treatments. Aims and objectives:To assess the accuracy of clinical palpation, CT Scan and Ultrasound in prediction of lymph node metastasis in oral squamous cell carcinoma so that a suitable surgical neck dissection can be carried out. Methods :Twenty patients with oral squamous cell carcinoma who underwent 20 neck dissections (15MRND, 5 SOHND) were included. All the patients underwent examination of neck pre operatively by palpation, Computed Tomography with contrast and Ultrasound for node detection. The findings were correlated with the results of histopathologic examination of the neck specimen. The results were obtained after statistical analysis. Results:Ten neck dissection specimens showed metastatic lymph node involvement in postoperative histopathology. Lymph node involvement was identified preoperatively by palpation in 8 necks, CT in 6necks and US in 17 necks. The palpation showed 80% sensitivity, 30% specificity. CT showed sensitivity of 50%, specificity of 90% and US showed sensitivity of 90%, specificity of 20%. Conclusion:We recommend that the use of preoperative US and CT scanning of the neck by an experienced radiologist is essential and useful for diagnosis , staging and therapy choices which will help to reduce patient