Lymph nodes assessment of neck in oral squamous cell carcinoma and its implication in management

Abstract

Background and Aim: This study was conducted to find the correlation between clinically palpable neck nodes and their histopathological examination results which gives some information to the clinician regarding the choice of treatment and for appropriate management of the neck. After the surgical procedure, the whole specimen was submitted for the histopathological examination and a correlation between clinical positive or negative nodes and their histologically confirmed malignancies were drawn. Materials & Methods: A total of 200 patients with the diagnosis of oral malignancy subjected to oral and maxillofacial surgery department and institute of oncology over the period of 2 years were included in the study. Once the confirmation by histopathology was done, routine blood investigation, HIV/HBSAg test, ECG was done and physician’s consent was taken prior to surgery under general anaesthesia. Pre-operatively thorough clinical palpation of the five levels of cervical lymph nodes was performed bilaterally.Results: On clinical examination of lymph nodes by palpation in 200 cases, 50 sides of necks were negative for palpation and 162 sides of necks were positive for palpation. On the histopathological examination of neck dissections, 8 of necks were positive. That is 46 cases were true positive that the histopathology showed no metastasis and 8 cases were false positive which showed metastasis in histopathology. Conclusion: Histopathology examination with its ability to detect 100% metastases in cervical lymph nodes remains the gold standard. Even though, Clinical examination was and is still the routine first line in detecting cervical lymph node metastases in head and neck squamous cell carcinoma, Its use shall be restricted for only an initial evaluation of the patient.