Relation between the depth of tumor and neck node metastasis in early carcinoma of tongue

Abstract

INTRODUCTIONTongue squamous cell carcinoma (TSCC) is one of the commonest cancers within the oral cavity. Incidence of tongue cancer in India is second highest in the world. 1 TSCC is significantly more aggressive than other forms of oral cancer, with a high propensity of local invasion and spread, and a high recurrence rate.1,2 It has been reported that 40% of all TSCC patients have neck metastasis at the time of diagnosis.3 Patients with earlystage TSCC (T1/T2N0) showed occult nodal metastasis in approximately 20-40% cases. 4 The survival in carcinoma of the tongue is poor compared to other sub-sites in oral cavity.5 It has characteristic ABSTRACT Background: Tongue squamous cell carcinoma (TSCC) is one of the aggressive forms of oral cancer with a high recurrence rate. Forty percentages of all TSCC patients have neck metastasis at the time of diagnosis. The status of cervical lymph nodes at presentation is the single most important prognostic factor in TSCC. This study was focused on establishing relation between the tumor depth and neck node metastasis in carcinoma of tongue. Authors accessed the patterns of cervical node metastasis in it. Methods: prospective non-randomised study of 100 patients was carried out. After detail clinical history punch biopsy were taken from the tongue lesion. Biopsy proven cases of early squamous cell carcinoma (T1/T2) with clinically negative neck (cN0) were included in this study. Ultra-sonography of the tongue using 7.5 MHz probe was performed in all cases to know the depth of lesion. Final histopathological findings i.e. pT, pN, differentiation and depth of invasion were compared with pre-operative clinical and radiological findings. Results: Out of 100 patients, 62 were males and 38 were females. Clinically 56 patients were belonged to T2. Ultrasonography of tumor had high sensitivity and specificity. Node positivity increased with the depth of primary tumor. On histopathological examination, positive node observed in total 25 patients. Number of occult neck node positivity raised with increased size of primary tumor. i.e. 15% and 31% with pT1 and pT2, respectively. Level II was the most common site for cervical node involvement followed by level III. Conclusions: Ultra-sonography was a reliable tool to access the depth of tumor pre-operatively in the cases of tongue carcinoma patients with sensitivity and specificity more than 90%. Node positivity increased with the depth of primary tumor. Tumor thickness is a significant predictor of nodal metastasis and elective neck dissection should be decided accordingly.

A study of incidence and propensity of locoregional lymph nodes in clinically N0 cases of carcinoma of tongue

“…In the present study, the number of males (84%) were more than females (16%). This is similar to the studies of Selvamani et al, Kshirsagar et al and Ahmad et al [4][5][6] Higher incidence of carcinoma in males can be attributed to the earlier starting of consumption of alcohol and tobacco in the male population compared to the female population.…”

Elective neck dissection versus watchful waiting in the management of early tongue cancers with node negative neck: our experience of 68 cases

“…28 Our study also shows that male predominance in tongue squamous cell carcinoma with male: female ratio of 3:1 similar to study conducted by Hakeem et al 29 In our study, level IIA lymph node is the most common site for occult nodal metastasis followed by level IB and level IV which is similar to study conducted by Pet al who also concluded that level II is most common neck node in tongue squamous cell carcinoma. 30 Jones et al in their study concluded that there is a strong correlation between thickness of tumor and risk of nodal metastasis. 8 O'Brient et al proposed that depth of tumor invasion is the most important measurable prognostic factor in early stage oral cancer.…”

Pathoradiological association between depth of invasion and neck node metastasis in oral cavity tumours

“…Hence, we found an association between depth of invasion (DOI) and neck node metastasis in cases of carcinoma tongue and carcinoma buccal mucosa. 2,[4][5][6]8,[10][11][12] Eight mm in oral cavity carcinoma seems to be the cut off depth of invasion above which incidence of nodal metastasis increases. 10 Cervical metastatic rates (pN+) are significant at depth more than eight mm in oral tongue and buccal mucosa carcinoma in our study.…”

“…Head and neck cancers are the most common cancers in the developing countries especially in Southeast Asia. 1,2 Oral cancer is the most common cancer in India, as four out of ten of all cancers are oral cavity cancers. 3,4 Cervical lymph node metastasis has remained the most important prognostic factor.…”

“…3,4 Cervical lymph node metastasis has remained the most important prognostic factor. 1,2,[4][5][6][7][8] However, many previous studies have studied different predictive factors for cervical nodal metastasis in oral carcinoma among which depth of tumour invasion (DOI) is the most important. 2,[4][5][6][8][9][10][11][12] Hence, we conducted the study to know whether the increase in the depth of invasion in oral cavity carcinoma assessed histopathologically and radiologically co-relates with neck node metastasis and to accurately co-relate radiological thickness at which neck dissection is required.…”