Detection of Cervical Lymph Node Metastasis on Histopathology in Stage cN0 after Elective Neck Dissection in Oral Carcinoma

Abstract

Objective: To detect the frequency of lymph node micro-metastasis in clinically negative nodes (cN0) after elective neck dissection in patients of oral cavity carcinoma. Study Design: Cross-sectional descriptive study. This was a multi-center study conducted at four hospitals of Karachi, including Dow University Hospital, PNS Shifa Hospital, Zubaida Medical Center and Hashmani’s Hospital, over a period of two years from June 2013 to June 2015. Materials and Methods: A total of 48 patients were included in this study. Inclusion criterion was all patients of squamous cell carcinoma of the oral cavity with clinically negative nodes (cN0). Surgery was done in all the cases for the primary tumour as well as elective neck dissection. The neck specimen was sent for histopathology after marking the different level. Results: The overall positive neck nodes were found in 17 out of total 48 cases (35.4%). The incidence was found to be highest in level II lymph nodes (64.7%) followed by level Ib lymph nodes (58.8%). Level IV lymph node was not involved in any case. Lower alveolus and palatal carcinoma has the highest incidence for nodal metastasis (50% each) followed by tongue (42.6%), upper alveolus (40%) and lowest in buccal carcinoma (22.7%). Conclusion: The incidence of cervical lymph node metastasis in oral carcinoma is fairly high, so elective neck dissection should be routinely performed in oral carcinoma. Secondly most of the metastasis is in level I, II and III, so classical supra-omohyoid neck dissection is enough in most cases.

Keywords

• oral carcinoma
• neck dissection
• supra-omohyoid neck dissection
• squamous cell carcinoma