A Correlative Study on Clinical, Pathological and Computed Tomography Scan Findings of Cervical Nodal Metastases in Head and Neck Malignancies
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 5, Issue 11
Abstract
Background: Presence or absence of metastatic disease in the neck determines the prognosis and survival period of patients with malignant tumors of head and neck. The year survival rate is reduced to half if the palpable nodes are present at the time of diagnosis. Unfortunately, medical opinion is divided into various aspects of metastatic neck disease. Controversies remain in the assessment of neck disease, the prophylactic treatment of metastatic nodes, and place of radical neck dissection as opposed to modified radical neck dissection and the role of radiotherapy. Potential benefits of clinical examination far outweigh other investigative methods in the assessment of regional lymph nodes metastases. Aim of the Study: The aim of the study was to study the pattern of cervical lymph node metastasis in various head and neck malignancies and to compare the accuracy between clinical examination, pathological study, and contrast enhanced computed tomography (CT) scans. Materials and Methods: A total of 181 patients with head and neck malignancies attending the department of ear nose and throat were analyzed by clinical examination, pathological examination, and CT scan findings of the neck for the accuracy of their diagnosis. The sensitivity, specificity and positive and negative predicted values of the methods used in their diagnosis were calculated using crosscheck tables. Observations and Results: A total of 181 patients with squamous cell carcinoma of the head and neck region were included; 33 patients underwent neck dissection. Maximum numbers of cases were carcinoma hypopharynx 26% followed by carcinoma of larynx 24.3%. Clinical examination had sensitivity, specificity, positive predictive value, and negative predictive value as 66.7%, 75%, 82.4%, and 56.3%, respectively (kappa significance 0.389, P = 0.021). The CT examination had sensitivity, specificity, positive predictive value, and negative predictive value as 85.7%, 41.7%, 72%, and 62.5%, respectively, κvalue 0.389; P = 0.021. Conclusions: Higher incidence of head and neck squamous cell carcinoma was observed among the 61–70 years group. Males were more commonly affected. The most common head and neck malignancy with nodal metastasis were observed to be the hypopharyngeal malignancy, followed by carcinoma oropharynx. The occurrence of nodal metastasis was more common in carcinoma oropharynx. Bilateral nodal metastasis was observed to be high from carcinoma of base of tongue, followed by pyriform fossa malignancy and carcinoma supraglottis. Level I lymph node was observed to be the most common lymph node involved in the oral cavity and paranasal sinus malignancy.
Authors and Affiliations
R T Abdul Salam, N Saleena
Keywords
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