+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Staging of cervical lymph nodes in oral squamous cell carcinoma: adding ultrasound in clinically lymph node negative patients may improve diagnostic work-up

Staging of cervical lymph nodes in oral squamous cell carcinoma: adding ultrasound in clinically lymph node negative patients may improve diagnostic work-up

Plos one 9(3): E90360

Clinical staging of patients with oral squamous cell carcinoma (OSCC) is crucial for the choice of treatment. Computed tomography (CT) and/or magnetic resonance imaging (MRI) are typically recommended and used for staging of the cervical lymph nodes (LNs). Although ultrasonography (US) is a non-expensive, accessible and non-ionising imaging modality this method is not consistently used. This study aimed to investigate if addition of US of patients classified as clinically LN negative (cN0) by CT and/or MRI, increases the detection of LN metastases. Also, we aimed to identify which of the sonographic characteristics: echogenicity, border, shape, appearance of hilum and nodal blood-flow pattern best detect metastases in this patient group. Fifty-one patients with OSCC classified as cN0 by CT/MRI were consecutively included and prospectively examined with US prior to sentinel node biopsy or selective neck dissection. Localisation, size and sonographic characteristics were registered for each LN and compared with the pathological findings. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for different size measurements and sonographic characteristics. We found that short axial diameter was the best size criterion for detection of metastases. However, the sonographic characteristics were better predictors than size and the presence at least four of the sonographic characteristics: hypo-echoic or heterogeneous appearance; irregular border; spherical shape; absence of nodal hilum; and peripheral nodal blood-flow resulted in a sensitivity of 43.8; specificity 91.4; PPV 70.0; and NPV 78.0. The number of patients with occult metastases decreased from 16 out of 51 (31%) to nine out of 51 (18%). Three patients (6%) were over-staged by US. The addition of US to the clinical work-up of patients with cN0 OSCC increases the detection of metastases, thus US potentially reduces the number of patients requiring a secondary neck surgery after sentinel node biopsy.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 055902969

Download citation: RISBibTeXText

PMID: 24651159

DOI: 10.1371/journal.pone.0090360

Related references

Ultrasound diagnosis of cervical lymph node metastasis and histopathological characteristics of false negative lymph nodes in patients with oral squamous cell carcinoma. Sapporo Medical Journal 72(1-2): 15-21, 2003

Risk Factors Analysis of Pathologically Confirmed Cervical Lymph Nodes Metastasis in Oral Squamous Cell Carcinoma Patients with Clinically Negative Cervical Lymph Node: Results from a Cancer Center of Central China. Journal of Cancer 10(13): 3062-3069, 2019

Association of Number of Dissected Lymph Nodes With Survival in Clinically Node-Negative Oral Cavity Squamous Cell Carcinoma Patients Undergoing Primary Surgery: A Population-Based Analysis. JAMA Otolaryngology-- Head and Neck Surgery 143(10): 1049-1052, 2017

Treatment of patients with clinically lymph node-negative squamous cell carcinoma of the oral cavity. Japanese Journal of Clinical Oncology 38(6): 395-401, 2008

Morphological MRI criteria improve the detection of lymph node metastases in head and neck squamous cell carcinoma: multivariate logistic regression analysis of MRI features of cervical lymph nodes. European Radiology 19(3): 626-633, 2009

Diagnostic analyses of cervical lymph nodes in patients with oral squamous cell carcinoma using CT and US. Oral Radiology 7(2): 1-12, 1991

Number of Metastatic Lymph Nodes and Ratio of Metastatic Lymph Nodes to Total Number of Retrieved Lymph Nodes Are Risk Factors for Recurrence in Patients With Clinically Node Negative Papillary Thyroid Carcinoma. Clinical and Experimental Otorhinolaryngology 11(1): 58-64, 2018

Cervical lymph node metastases in patients with squamous cell carcinoma of the maxillary antrum: the role of elective irradiation of the clinically negative neck. International Journal of Radiation Oncology Biology Physics 5(11-12): 1977-1980, 1979

Management of the clinically negative cervical lymph nodes in patients with non-conventional squamous carcinoma of the larynx. Journal of Laryngology and Otology 113(7): 619-623, 1999

Isolated perifacial lymph node metastasis in oral squamous cell carcinoma with clinically node-negative neck. Laryngoscope 126(10): 2252-2256, 2016

Cervical lymph node metastasis classified as regional nodal staging in thoracic esophageal squamous cell carcinoma after radical esophagectomy and three-field lymph node dissection. Bmc Surgery 14: 110, 2014

The prevalence of lymph node metastases in clinically N0 necks with oral cavity squamous cell carcinoma: is CT good enough for nodal staging?. Acta Radiologica 55(5): 570-578, 2014

Ultrasound and fine needle aspiration cytology in the staging of neck lymph nodes in oral squamous cell carcinoma. British Journal of Oral & Maxillofacial Surgery 38(5): 430-436, 2000

The role of ultrasound in the detection of cervical lymph node metastases in clinically N0 squamous cell carcinoma of the head and neck. Cancer Imaging 7: 167-178, 2007

Tattoo-pigmented cervical lymph node that masqueraded as the sentinel lymph node in oral squamous cell carcinoma. British Journal of Oral and Maxillofacial Surgery 53(9): 886-887, 2015