Reliability of the pre-operative imaging to assess neck nodal involvement in oral cancer patients, a single-center study.
Journal
Medicina oral, patologia oral y cirugia bucal
ISSN: 1698-6946
Titre abrégé: Med Oral Patol Oral Cir Bucal
Pays: Spain
ID NLM: 101231694
Informations de publication
Date de publication:
01 Mar 2022
01 Mar 2022
Historique:
received:
29
11
2021
accepted:
07
02
2022
entrez:
26
2
2022
pubmed:
27
2
2022
medline:
3
3
2022
Statut:
epublish
Résumé
Primary sites for the metastasis of oral cancer are the cervical lymph nodes. Although there has been considerable technical advancement in the radiological imaging, capability to recognize all metastatic lymph nodes pre-operatively has remained as a challenge. Thus elective neck dissection (END) has remained as reliable practice to treat cervical lymph nodes. This study evaluated the accuracy of pre-operative imaging in pre-operative diagnostics of cervical lymph node status using computed tomography or magnetic resonance imaging in patients with oral squamous cell carcinoma (OSCC). We have also considered the reasons for the difficulties to recognise metastatic nodes in cervical area. Patient charts of patients who had had elective neck dissection as a treatment for primary OSCC in the Department of Oral and Maxillofacial Surgery, Helsinki University Hospital between 2016 and 2017 were assessed retrospectively. The outcome variable was post-operatively histologically confirmed lymph node metastasis in the neck area. The primary predictor variable was radiologically confirmed metastasis in the neck area. The explanatory variables were age, sex, pT-class, imaging modality, delay and location of the tumour. Descriptive statistics, sensitivity, specificity and Youden-J index were computed. Eighty-three patients were included in the study. The sensitivity to detect pathological lymph nodes was 44.8%, and the specificity for the examination was 87.0%. 19.3% of cN0 patients had metastasis in the cervical nodes, whereas of the cN+ patients 8.4% were actually pN0. Patients having cN0, the largest neck metastasis was over 10 mm in 12.5%, whereas cN1-3 patients the corresponding rate was 45.5%. The computational threshold to diagnose a metastatic node was 7 mm. Especially small metastases are difficult to diagnose. Limitations of radiological diagnostics must be considered when treating OSCC.
Sections du résumé
BACKGROUND
BACKGROUND
Primary sites for the metastasis of oral cancer are the cervical lymph nodes. Although there has been considerable technical advancement in the radiological imaging, capability to recognize all metastatic lymph nodes pre-operatively has remained as a challenge. Thus elective neck dissection (END) has remained as reliable practice to treat cervical lymph nodes. This study evaluated the accuracy of pre-operative imaging in pre-operative diagnostics of cervical lymph node status using computed tomography or magnetic resonance imaging in patients with oral squamous cell carcinoma (OSCC). We have also considered the reasons for the difficulties to recognise metastatic nodes in cervical area.
MATERIAL AND METHODS
METHODS
Patient charts of patients who had had elective neck dissection as a treatment for primary OSCC in the Department of Oral and Maxillofacial Surgery, Helsinki University Hospital between 2016 and 2017 were assessed retrospectively. The outcome variable was post-operatively histologically confirmed lymph node metastasis in the neck area. The primary predictor variable was radiologically confirmed metastasis in the neck area. The explanatory variables were age, sex, pT-class, imaging modality, delay and location of the tumour. Descriptive statistics, sensitivity, specificity and Youden-J index were computed.
RESULTS
RESULTS
Eighty-three patients were included in the study. The sensitivity to detect pathological lymph nodes was 44.8%, and the specificity for the examination was 87.0%. 19.3% of cN0 patients had metastasis in the cervical nodes, whereas of the cN+ patients 8.4% were actually pN0. Patients having cN0, the largest neck metastasis was over 10 mm in 12.5%, whereas cN1-3 patients the corresponding rate was 45.5%. The computational threshold to diagnose a metastatic node was 7 mm.
CONCLUSIONS
CONCLUSIONS
Especially small metastases are difficult to diagnose. Limitations of radiological diagnostics must be considered when treating OSCC.
Identifiants
pubmed: 35218648
pii: 25228
doi: 10.4317/medoral.25228
pmc: PMC8898583
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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