Proper management of the clinically involved neck in OSCC patients continues to be a matter of debate. Our aim was to analyze the accuracy of computerized tomography (CT) and ultrasound (US) in anticipating the exact location of lymph node (LN) metastases of OSCC patients across the AAO-HNS (American Academy of Otolaryngology—Head and Neck Surgery) levels ipsi- and contralaterally. Furthermore, we wanted to assess the suitability of therapeutic selective neck dissection (SND) in patients with one or two ipsilateral positive nodes upon clinical staging (cN1/cN2a and cN2b(2/x) patients).
We prospectively analyzed the LN status of patients with primary OSCC using CT and US from 2007 to 2013. LNs were individually assigned to a map containing the AAO-HNS levels; patients bearing a single or just two ipsilateral positive nodes (designated cN1/cN2a or cN2b(2/x) patients either by CT (CT group) or US alone (US group) or in a group combining findings of CT and US (CTUS group)) received an ipsi-ND (I–V) and a contra-ND (I–IV). 78% of the LNs were sent individually for routine histopathological examination; the remaining were dissected and analyzed per neck level.
Upon the analysis of 1.670 LNs of 57 patients, the exact location of pathology proven LN metastases in cN1 patients was more precisely predicted by US compared to CT with confirmed findings only in levels IA, IB und IIA. Clearly decreasing the number of missed lesions, the findings in the CTUS group nearly kept the spatial reliability of the US group. The same analysis for patients with exactly two supposed ipsilateral lesions (cN2b(2/x)) yielded confirmed metastases from levels I to V for both methods individually and in combination and, therefore, render SND insufficient for these cases.
Our findings stress the importance of conducting both, CT and US, in patients with primary OSCC. Only the combination of their findings warrants the application of therapeutic SND in patients with a single ipsilateral LN metastasis (cN1/cN2a patients) but not in patients with more than one lesion upon clinical staging (≥ cN2b).
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The 2 indicates the 2 positive LNs and the x stands for the total number of LN seen per examination and varies from patient to patient and between the modalities, but was not further analyzed here.
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Flowchart of patients included. All patients were examined with both procedures, CT and US. Depending on the number of suspected metastases (0, 1, 2 or more than 2 ipsilateral or contralateral), they were divided into the groups shown. Patients can be assigned to several groups; hence, the higher total number of patients than were included at all (PPTX 39 KB)
Comparison of the number of suspected metastases and histopathologically confirmed metastases per procedure and patient. x-axis: number of histopathologically confirmed metastases. y-axis: number of individual patients. Patients in whom the imaging shows exactly one ipsilateral metastasis in CT = blue bars (CT cN1 group) or in ultrasound = green bars (US cN1 group) or in a combination of both methods = yellow bars (CTUS cN1 group). b Patients in whom the imaging shows exactly two ipsilateral metastases on CT = blue bars (CT cN2b(2/x) group) or on ultrasound = green bars (US cN2b(2/x) group) or in a combination of both procedures = yellow bars (CTUS cN2b(2/x) group) a maximum of two ipsilateral metastases was seen. The black boxes frame those patients for whom the imaging findings and the histopathological assessment are matching (PPTX 62 KB)
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Sproll, K.C., Leydag, S., Holtmann, H. et al. Is the prediction of one or two ipsilateral positive lymph nodes by computerized tomography and ultrasound reliable enough to restrict therapeutic neck dissection in oral squamous cell carcinoma (OSCC) patients?. J Cancer Res Clin Oncol (2021). https://doi.org/10.1007/s00432-021-03523-8
- Ipsilateral lymph node metastasis
- cN1-Oral squamous cell carcinoma (OSCC)
- Selective neck dissection (SND)
- Neck dissection (ND)
- Head and neck ultrasound
- Computerized tomography (CT)