Pretherapeutic evaluation of oropharyngeal and oral cavity squamous cell carcinomas: a clinical, radiological and histological evaluation

Abstract

Idea: Evaluation of pretherapeutic diagnosis and statistical correlation research between physical, radiological and histological examination in oral cavity and oropharyngeal squamous cell carcinomas. Method: Pretherapeutic clinical and computed tomography (CT) scan tomography examinations of 40 patients, surgically treated for an oral cavity or oropharyngeal cancer, were retrospectively studied. Postoperative histological data was estimated according to physical and radiological preoperative conclusions to determine the respective values of both examinations. Results: The diagnosis of local tumor had a CT scan sensitivity of 82%. The predictive value of bone extension was 67% by CT scan, whereas it was only 22% by physical examination. Predictive positive value of lymph node involvement was 54%, and predictive negative value 56% by physical examination. The diagnosis of lymph node involvement was mostly appreciated by CT scan examination (sensibility 80%, specificity 71%, positive predictive value 67% and negative predictive value 83%). Statistical extrapolation showed that 50% of adenopathies had a metastatic involvement up to 2.5-cm diameter by physical examination and up to 1.35-cm diameter by CT scan examination. A total of 30% of adenopathies were histologically involved when clinical examination was negative, but only 9% of them were histologically involved when CT scan examination was negative. Physical examination appeared to have poor capacity to anticipate lymph node involvement (54%) and also its absence of involvement (56%). When lymph nodes were large, physical examination was not superior. CT scan examination provided the best predictive information, when radiological adenopathies were considered up to 15 mm diameter. Tumor size did not appear as a predictive factor to augur the lymph node involvement, which mostly depended on the tumoral histological grade. Conclusion: MR imaging or ultrasound tomographies may provide interesting information, but cannot yet substitute CT scan analysis. CT scan is continuously considered by the authors as the best pretherapeutic radiological examination for patients with oral cavity or orophraryngeal cancers.