cTNM vs. pTNM: the effect of not applying ultrasonography in the identification of cervical nodal disease

Abstract

Accurate clinical staging of oral squamous cell cancer can be quite difficult to achieve especially if nodal involvement is identified. Radiologically-assisted clinical staging is more accurate and informs the clinician of loco-regional and distant metastasis.In this study, we compared clinical TNM (cTNM) staging (not including ultrasonography) to pathological TNM (pTNM) staging in 245 patients presenting with carcinoma of the oral cavity and the oro-pharyngeal region. Tumour size differences and nodal involvement were highlighted. US reports of the neck were then added to the clinical staging and results compared.Tumour size was clinically underestimated in 4 T1, 2 T2 and 2 T3 oral diseases. Also 20 patients that were reported as nodal disease free had histological proven N1 or N2 nodal involvement; while 3 patients with cTNM showing N1 disease had histologically proven N2 disease.Overall the agreement between the 2 systems per 1 site was 86.6% (Kappa agreement = 0.80), per 2 sites 90.0% (Kappa agreement = 0.68) and per 3 sites 90.5% (Kappa agreement 0.62).An accurate clinical staging is of an utmost importance. It is the corner stone in which the surgical team build the surgical treatment plan and decide whether an adjuvant therapy is required to deal with any possible problem that might arise. The failure to achieve an accurate staging may lead to incomplete surgical planning and hence unforeseen problems that may adversely affect the patient's survival.

Comparative analysis of detecting cervical lymph node metastasis with fine needle aspiration cytology

“…Cancers of the oral cavity and oropharyngeal region are the sixth most common cancers globally. [ 8 ] OSCC continues to affect more males than females with a ratio of 1.5:1[ 9 10 11 ] which is consistent with our observations in this study. High proportion of cases among males may be due to high prevalence of tobacco consumption habits in them, coupled with smoking whereas in our society females less commonly indulge in tobacco smoking.…”

“…In the Asian population, the buccal mucosa is commonly affected due to betel quid/tobacco chewing habits. [ 9 12 ] In our study, chewing tobacco habit was most prevalent in male patients while smoking tobacco was most common in female patients.…”

The impact of HPV infection on survival in a geographically defined cohort of oropharynx squamous cell carcinoma (OPSCC) patients in whom surgical treatment has been one main treatment

“…In particular, N stage is more accurately determined following surgery [8]. Then it is possible to assess more accurately the importance of disease extent on prognosis.…”

Applicability of Preoperative Nuclear Morphometry to Evaluating Risk for Cervical Lymph Node Metastasis in Oral Squamous Cell Carcinoma

“…Many studies have reported the risk factors for cervical lymph node metastasis in oral cancer [8] , [13] – [19] . Most have used a combination of several qualitative methods, including histopathologic parameters [13] – [16] , gene expression [17] – [19] , sentinel lymph node detection [20] – [24] , and imaging techniques [25] – [28] . Quantitative analysis of nuclear variations has been undertaken for other types of lesions such as thyroid and breast cancers [29] , [30] .…”