The Correlation between Clinical and Pathological Lymph Node Status in Oral Squamous Cell Carcinoma

Abstract

Introduction: The presence of nodal metastasis from OSCC is the single most important prognostic feature. Extranodal extension further decreases survival by approximately half. Clinical evaluation of the nodal basin has been found to correlate poorly with pathological nodal status. Objectives: Determine the congruency between clinical and pathological nodal status and the incidence of extranodal extension (ENE). Describe the frequency distribution of age, sex, smoking habits, anatomical location, and histology in a South African population. Methods: Ninety-one consecutive cases of oral squamous cell carcinoma were retrospectively studied and the clinical (cN) and pathological (pN) TNM nodal staging compared using the 8th edition of the AJCC/UICC TNM staging system. Extranodal extension was determined in all patients with OSCC, as well as in the subgroup with clinically nodal negative (cN0) disease. The socio-demographical information was described. Results: The cN and pN were congruent in 41.7% (n = 38/91), upstaged in 35.2% (n = 32/91), and down staged in 23.1% (n = 21/91) of cases. Twenty-two patients (24.2%) had pathological evidence of ENE. Males and females constituted 67% and 33% of the study sample, respectively. The median age at the time of diagnosis was 57.3 years (range 5-85 years). A smoking history was present in 73.6%, absent in 14.3%, and unknown in 12.1% of patients. The tongue (38.4%) and floor of mouth (29.7%) were the most common anatomical subsites for primary tumours. Most tumours were conventional squamous cell carcinomas with poorly differentiated grade (62.6%) Conclusion: There is poor correlation between clinical and pathological nodal status when the 8th TNM staging is used. ENE at the time of diagnosis is common among patients with OSCC.