Abstract

Aim: Carcinoma oral cavity ranks third in the incidence of freshly detected cancers among both the genders. The most impactful prognostic factor in carcinoma oral cavity is the presence of cervical lymph node metastasis. Clinically node negative neck harbors occult metastasis in 06 to 46% of cases. The gold standard currently of managing cN0 neck is Supra Omohyoid neck dissection (SOHND). However, various imaging modalities are challenging the gold standard. The present NCCN guidelines incorporate clinical palpation, USG Neck and contrast-enhanced computed tomography (CECT) in evaluating the nodal status of such patients. This study has critically evaluated, whether USG/CECT is sufficient in the clinically node-negative neck (cN0), in patients with an early stage carcinoma oral cavity or do we need to add other investigations in evaluating the nodal status. Materials and methods: A single-center prospective study of 51 patients of early stage carcinoma oral cavity with cNo neck underwent evaluation of the neck by ultrasonography (USG) and CECT in a tertiary care center. All patients subsequently underwent SOHND and the results were compared. Results: Fifty-eight neck sides were dissected (44 unilateral, 7 bilateral), involving a total of 885 lymph nodes (mean, 15.26 lymph nodes per neck side). Histopathologic analysis revealed occult lymph node metastases in 10 of 51 patients (19.6%) which equated to 10 of 58 neck sides (17.24%). The sensitivity and specificity of USG was 40% and 97.8% respectively with a diagnostic accuracy of 87.9%. CECT neck was found to be a better diagnostic modality with a sensitivity of 90% and specificity of 87.5%. Conclusions: Contrast-enhanced computed tomography (CECT) is a better modality than USG and clinical palpation. However, we recommend further studies with other modalities like PET–CT, and lymphangoscinitigraphy.

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