Neck dissection in node negative oral malignancies: is it justified

Abstract

INTRODUCTIONOral cancer is one of the ten most common cancers in world, prevalence being highest in India.1 Incidence rates are quiet high in India with crude rate for males being 9.7 and 6.1 for females.2 More than 90% of tumors in head and neck region are squamous cell carcinoma.The therapy regime of the oral squamous cell carcinoma should be based on careful clinical examination and composite analysis on primary lesion related to size, location and cervical lymph nodes. 3 The most important prognostic factor in oral cavity cancer is the status of regional lymph node metastasis. Cure rate drops to 50% when regional nodes are involved. 4As early as the mid-19th century Chelius noted, "once growth in the mouth has spread to submandibular gland complete removal is impossible". 5 This pessimism of Chelius was challenged by newer approaches in management of regional lymph node metastasis.At the end of 19th century Henry Butlin reported cure rate of 28% in a series of 102 oral cancer patients. He also proposed and practiced anterior triangle dissection. ABSTRACTBackground: Oral cancer is one of the ten most common cancers in world, prevalence being highest in India. The objective of the study was to decide whether it is justifiable to do neck dissection in every case of oral malignancy in true negative necks diagnosed by investigative modalities and to decide whether we can avoid unnecessary block dissection in patient of oral malignancy with negative necks diagnosed by investigation. Methods: It was proposed randomized controlled study conducted over period of 2 years including all patients diagnosed of having oral squamous cell carcinoma. Lymph nodes were assessed by clinical examination and ultrasonography (USG). FNAC was done with the help of USG guidance. After thorough evaluation, the patient was subjected for treatment either surgery or radiotherapy and sometimes chemotherapy. After neck dissection, whole block was sent for histopathological examination. Data collected was analysed on various statistical parameters. Results: For clinical examination consistency and fixity is having high reliability than size and shape. On USG central necrosis, ECS, shape and RI were having specificity and accuracy. Sensitivity, specificity and accuracy of USG FNAC is more. Conclusions: USG and USG FNAC are helpful methods in directing further work up in more efficient and costeffective manner and these help in reaching diagnosis more accurately than the clinical examination alone and thus it is considered second step in evaluation of neck only after clinical examination.