Ultrasound and fine needle aspiration cytology in the staging of neck lymph nodes in oral squamous cell carcinoma

doi:10.1054/bjom.2000.0332

British Journal of Oral and Maxillofacial Surgery

Volume 38, Issue 5, October 2000, Pages 430-436

https://doi.org/10.1054/bjom.2000.0332 Get rights and content

Abstract

We prospectively studied 49 patients with oral squamous cell carcinoma (SCC) who had their cervical regional lymph nodes examined by ultrasound (US), with or without fine needle aspiration cytology (FNAC), for the detection of metastatic spread. They were screened over a two-year period (1993–1995) by computed tomography (CT) and magnetic resonance imaging (MRI) or both to measure the primary tumour. US, with or without FNAC, was used to stage the neck. All tumours were biopsied preoperatively and the diagnosis of SCC conformed by histological examination. Management of the neck was based on US staging. Thirty-five patients had neck dissections and 14 were managed conservatively. Mean follow-up was 30 months (range 24–48). All patients were alive at one year, but one died at 14 months from recurrence of disease in the neck. There were 3 false negatives (6%). We find that US, with or without FNAC, is an accurate (86%), sensitive (92%) and specific (83%) technique for the preoperative assessment of lymph node metastases in patients with SCC.

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Cited by (42)

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Comprehensive neck dissection is recommended in oral cancers with clinically positive necks. However, the clinical staging of the neck is inaccurate and leads to overtreatment. This study aims to assess the feasibility and validity of ultrasound and ultrasound-guided fine-needle aspiration cytology to identify cervical lymph node metastases.
The prospective study included 50 consecutive operable patients with clinical T3/T4a and N + oral cavity squamous cell carcinomas. Preoperative nodal assessment with palpation, ultrasound and ultrasound-guided FNAC were compared with histopathological findings. The sensitivity, specificity, predictive values and accuracy were calculated.
Amongst 50 clinical N+ necks, 38% were USGFNAC positive and 52% were histopathological positive. A total of 1180 lymph nodes were harvested (median 24) and 58 nodes (4.91%) were pathologically positive. Sensitivity/specificity were 62%/47%, 72%/13% and 47%/93% in palpation, USG and USGFNAC respectively. Positive/negative predictive values were 38%/70%, 31%/48%, and 79%/77% while the accuracy was 52%, 34% and 78% with palpation, USG and USGFNAC respectively.
Around 50% of the palpable nodes in locally advanced oral cancers are metastatic. Ultrasound-guided FNAC of suspicious nodes is highly accurate in correct nodal staging. But USFNAC for every patient with oral cancer is not feasible in high-volume centres and teaching institutes.
Touch Imprint Cytology: Can It Serve as an Alternative to Frozen Section in Intraoperative Assessment of Cervical Metastasis in Oral Squamous Cell Carcinoma?
2019, Journal of Oral and Maxillofacial Surgery
The purpose was to assess the diagnostic accuracy of touch imprint cytology (TIC) compared with frozen section (FS) analysis as an intraoperative diagnostic tool to assess nodal metastasis in oral squamous cell carcinoma.
We intraoperatively assessed 38 patients undergoing neck dissection for oral squamous cell carcinoma, wherein a total of 248 nodes were sectioned and subjected to TIC and, subsequently, FS analysis and were finally submitted to the gold-standard histopathologic examination. The sensitivities, specificities, positive predictive values (PPVs), and negative predictive values (NPVs) of TIC and FS analysis for the detection of metastasis in the cervical nodes were determined with the corresponding 95% confidence intervals.
TIC had a sensitivity of 62.86%, specificity of 96.24%, PPV of 73.33%, NPV of 94.04%, and accuracy of 91.53% compared with histopathologic results. The sensitivity of FS analysis was 60%, specificity was 98.12%, PPV was 84%, NPV was 93.72%, and accuracy was 92.74% compared with histopathologic examination. These results of TIC were comparable to those of FS analysis.
TIC is a straightforward, quick, and reliable technique. It has a definitive role in being used as an adjunct to FS analysis to increase intraoperative diagnostic accuracy. It can serve as a useful technique in centers that do not have FS availability.
Preoperative ultrasonography for evaluation of clinically N0 neck in oral cavity carcinoma
2017, Journal of Cranio-Maxillofacial Surgery
Citation Excerpt :
We selected patients with T1–T3 cN0 OCSCC in order to control biases and to achieve maximal external validity. Most studies include cases with clinically positive LN, which may increase the prevalence of metastasis and sensitivity value (Dangore-Khasbage et al., 2009; de Bondt et al., 2007; Hodder et al., 2000; Stuckensen et al., 2000; Yusa et al., 1999). The histological confirmation of LN after END or the metastasis occurrence during follow-up showed a 2–6% of metastasis or recurrence (Pitman et al., 1997; Nieuwenhuis et al., 2002), which occurred in patients whose END was initially negative (3 patients).
The aim of this study was to evaluate preoperative ultrasound criteria to detect lymph node (LN) cervical metastasis in patients with clinically node-negative neck (cN0) oral cavity squamous cell carcinoma (OCSCC). A prospective, single-center, observational study was conducted in 90 patients undergoing cancer excision with or without elective neck dissection (END) between 2005 and 2012. A surgeon and an experienced radiologist performed preoperative cervical ultrasonography in all cases. The primary objective was to obtain an a priori sensitivity of 90% and specificity >50% in cN0 OCSCC staging. The sonographic criteria for LN assessment were as follows: number; neck levels; clusters; aspect; heterogeneity; longitudinal diameter (L); transverse diameter (T); L/T ratio; and combination in series or in parallel of T and L/T ratio. The gold standard for comparison was the LN histological identification of metastasis after END or the occurrence in the follow-up at least 36 months. Statistically significant sonographic criteria in univariate analysis (P < 0.05) were as follows: multilevel lymph nodes, T diameter >6.5 mm, and the combination T > 6.5 mm or L/T < 1.3 ratio; and in multivariate logistic regression analysis were (P < 0.05): combination T > 6.5 mm and L/T < 1.3 ratio, LN in level II, and moderately-poorly differentiated OCSCC. By using selected sonographic criteria, ultrasound can be a valid preoperative diagnostic method to optimize staging cervical metastasis and to help decide about neck dissection.
Neck Dissection
2017, Maxillofacial Surgery, 3rd Edition: Volume 1-2
Ultrasound characteristics of malignant sub-clinical cervical lymph nodes in patients with oral epidermoid carcinoma
2010, Revista Espanola de Cirugia Oral y Maxilofacial
El carcinoma epidermoide de cavidad oral produce metástasis cervicales subclínicas en el 30-40% de los casos, lo que justifica la disección cervical electiva profiláctica dentro del tratamiento. La disponibilidad de pruebas diagnósticas que nos permitiesen detectar dichas metástasis evitaría el sobretratamiento del 60-70% de los pacientes, así como el coste y la morbilidad asociados. La ecografía cervical detecta las metástasis subclínicas con una sensibilidad y especificidad variables.
Usar la ecografía para la valoración de adenopatías cervicales metastásicas antes de plantear el tratamiento quirúrgico.
Hemos realizado un estudio de seguimiento prospectivo de pacientes diagnosticados de carcinoma epidermoide de cavidad oral en estadio precoz (I-II) a los que se les ha efectuado un estudio ecográfico cervical (con longitud de onda larga) antes del tratamiento quirúrgico. Hemos revisado y aplicado diferentes criterios de malignidad obtenidos de los estudios publicados. Hemos comparado los datos de la ecografía con los resultados del estudio anatomopatológico de la disección cervical que hemos usado como patrón oro de metástasis.
Tras haber estudiado a 48 pacientes diagnosticados de carcinoma oral estadio I-II (34 hombres y 14 mujeres, con edad media de 50 años), a los que se ha realizado la disección cervical, se han detectado adenopatías metastásicas en el 30%. Con nuestros criterios utilizados para la detección de metástasis por ecografía, hemos obtenido una sensibilidad de hasta el 0,93 y un especificidad de hasta el 0,91, en función de los criterios utilizados.
Oral carcinoma of oral cavity spread subclinical neck metastasis in 30-40%, this situation justify elective neck dissection in treatment. The availability of diagnostic test that allow detect neck metastasis would avoid overtreatment in 60-70% of patients with cost and morbidity associated. Neck ultrasound detect subclinical metastasis with different sensitivity and specificity.
Use ultrasound for detect metastatic lymph nodes before surgical treatment.
We make a prospective follow up of patients with diagnosis squamous carcinoma of oral cavity in stage I-II in our services. We make an ultrasound study (with long wave) before surgery treatment. We check and apply different malignant criteria that we get from literature. We compare ultrasound information with pathological results of cervical dissection, this is our gold standard for metastasis.
We studied 48 patients with diagnostic of oral carcinoma in stage I-II, 34 men and 14 women with medium age of 50 years old. We make neck dissection, and we find metastatic lymph nodes in 30%, with our criteria for detection of metastatic lymph node with ultrasound we obtain a sensitivity until 0.93 and a specificity until 0.91 depend on used criteria.
Tracking the risk factors associated with high-risk cSCC: A 10-year, Two-Institution, Greek study
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Regular ArticleUltrasound and fine needle aspiration cytology in the staging of neck lymph nodes in oral squamous cell carcinoma

Abstract

Int J Maxillofac Surg

J Cranio Maxillofac Surg

Am J Surg

Clin Radiol

Am J Surg

Am J Surg

Cervical lymph node metastasis: diagnostic, therapeutic and prognostic implications

Oncology

Management of neck nodes in the head and neck cancer: a surgeon’s view

Bull NY Acad Med

Supraomohyoid neck dissection rationale, indications and surgical technique

Head Neck

A surgeon looks at cervical lymph nodes

Radiology

Patterns of cervical node metastasis from squamous carcinoma of the oropharynx and hypopharynx

Head Neck

The management of cervical lymph nodes in squamous carcinomas of the head and neck

Semin Surg Oncol

Correlation between prognosis and degree of lymph node involvement in carcinoma of the oral cavity

Am J Surg

Histologically controlled comparison of palpation and sonography in the diagnosis of cervical lymph node metastases

Laryngo Rhinolo otologie

Regular Article
Ultrasound and fine needle aspiration cytology in the staging of neck lymph nodes in oral squamous cell carcinoma